Challenges in Diabetic Macular Edema Management: An Expert Consensus Report

Figures & data

Figure 1 Spectral domain optical coherence tomography image of an eye with cystoid macular edema (CME) and serous retinal detachment (SRD).

Figure 2 Spectral domain optical coherence tomography images. (A) Disorganization of the retinal inner layers (DRIL). It is not easy to identify the boundaries of the inner layers (white dotted line). Additionally, it is possible to see cysts (Cy) and hyperreflective dots (HD) in the outer layers, as well as the posterior hyaloid (PHL). (B) Spongiform edema with damage in the outer (ORL) and inner (INL) retinal layers. Besides the presence of cysts (Cy), it is possible to identify the external limiting membrane (ELM), and ellipsoid zone (EZ) disruptions. (C) Cystoid macular edema with external limiting membrane disruptions (ELMD). Additionally, it is possible to see some damage in the ellipsoid zone (EZ) and some cysts (Cy).

Abbreviation: ORL, outer retinal layers.

Table 1 Overview of the Role of the Different Biomarkers Comments are based on the expert panel members experience as well as currently available scientific evidence [see references^60–106]

	Inflammatory Marker	Prognosis*	Chronicity Marker	Predictor of Response to DEX	Candidate for First-Line Treatment with DEX
SRD	Yes	Good/bad prognosis (depends on time course and other biomarkers)	No	Yes	Yes
CYSTS	No (cysts with Hyperreflective material inside, have a greater inflammatory component)	Good/bad prognosis (depends on number, size, location and chronicity. Dense content is a sign of better prognosis)	Yes (if big cysts are present)	Yes (intraretinal inflammatory cysts)	Yes
HRD	Yes	Bad prognosis	Yes (in general terms)	Yes	Yes
DRIL	No	Bad prognosis	Yes	No	No
ORL	No	Bad prognosis	Yes	No	No
ONL	No	Bad prognosis	Yes	No	No (DEX and anti-VEFG indistinctively)
CMT^+	No	Bad prognosis	No	No (an exception in patients with SRD)	Yes (in cases with high TMV)

Notes: *Its presence is a sign of … + big volume.

Abbreviations: DEX, dexamethasone intravitreal implant; SRD, serous retinal detachment; HRD, hyperreflective dots; DRIL, disorganization of the retinal inner layers; ORL, outer retinal layer; ONL, outer nuclear layer; CMT, central macular thickness; anti-VEGF, vascular endothelial growth factor inhibitors; TMV, total macular volume.

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