358
Views
9
CrossRef citations to date
0
Altmetric
Expert Opinion

Challenges in Diabetic Macular Edema Management: An Expert Consensus Report

ORCID Icon, ORCID Icon, ORCID Icon, , ORCID Icon, , , , ORCID Icon, & show all
Pages 3183-3195 | Published online: 27 Jul 2021

References

  • Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271–281. doi:10.1016/j.diabres.2018.02.023
  • Bourne RRA, Jonas JB, Bron AM, et al.; Vision Loss Expert Group of the Global Burden of Disease Study. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe in 2015: magnitude, temporal trends and projections. Br J Ophthalmol. 2018;102(5):575–585. doi:10.1136/bjophthalmol-2017-311258.
  • Li JQ, Welchowski T, Schmid M, et al. Prevalence, incidence and future projection of diabetic eye disease in Europe: a systematic review and meta-analysis. Eur J Epidemiol. 2020;35(1):11–23. doi:10.1007/s10654-019-00560-z
  • Kocur I, Resnikoff S. Visual impairment and blindness in Europe and their prevention. Br J Ophthalmol. 2002;86(7):716–722. doi:10.1136/bjo.86.7.716
  • Cunha-Vaz J, Coscas G. Diagnosis of macular edema. Ophthalmologica. 2010;224(Suppl 1):2–7. doi:10.1159/000315156
  • Barham R, El Rami H, Sun JK, Silva PS. Evidence-based treatment of diabetic macular edema. Semin Ophthalmol. 2017;32(1):56–66. doi:10.1080/08820538.2016.1228388
  • Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, et al. Guidelines for the management of diabetic macular edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017;237(4):185–222. doi:10.1159/000458539
  • García-Layana A, Figueroa MS, Arias L, et al. Clinical decision-making when treating diabetic macular edema patients with dexamethasone intravitreal implants. Ophthalmologica. 2018;240(2):61–72. doi:10.1159/000486800
  • Kim EJ, Lin WV, Rodriguez SM, Chen A, Loya A, Weng CY. Treatment of diabetic macular edema. Curr Diab Rep. 2019;19(9):68. doi:10.1007/s11892-019-1188-4
  • Kodjikian L, Bellocq D, Bandello F, et al. First-line treatment algorithm and guidelines in center-involving diabetic macular edema. Eur J Ophthalmol. 2019;29(6):573–584. doi:10.1177/1120672119857511
  • Singh RP, Elman MJ, Singh SK, Fung AE, Stoilov I. Advances in the treatment of diabetic retinopathy. J Diabetes Complications. 2019;33(12):107417. doi:10.1016/j.jdiacomp.2019.107417
  • Acón D, Wu L. Multimodal Imaging in Diabetic Macular Edema. Asia Pac J Ophthalmol. 2018;7(1):22–27. doi:10.22608/APO.2017504
  • Liu G, Xu D, Wang F. New insights into diabetic retinopathy by OCT angiography. Diabetes Res Clin Pract. 2018;142:243–253. doi:10.1016/j.diabres.2018.05.043
  • Wong TY, Sun J, Kawasaki R, et al. Guidelines on Diabetic Eye Care: the International Council of Ophthalmology Recommendations for Screening, Follow-up, Referral, and Treatment Based on Resource Settings. Ophthalmology. 2018;125(10):1608–1622. doi:10.1016/j.ophtha.2018.04.007
  • Kwan CC, Fawzi AA. Imaging and biomarkers in diabetic macular edema and diabetic retinopathy. Curr Diab Rep. 2019;19(10):95. doi:10.1007/s11892-019-1226-2
  • Early Treatment Diabetic Retinopathy Study Research Group: Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 2. Ophthalmology. 1987;94:761–774. doi:10.1016/s0161-6420(87)33527-4
  • Early Treatment Diabetic Retinopathy Study Research Group: Focal photocoagulation treatment of diabetic macular edema. Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report No. 19. Arch Ophthalmol. 1995;113:1144–1155. doi:10.1001/archopht.1995.01100090070025
  • Cunningham ET, Adamis AP, Altaweel M, et al.; Macugen Diabetic Retinopathy Study Group. A Phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology. 2005;112(10):1747–1757.
  • Sultan MB, Zhou D, Loftus J, Dombi T, Ice KS; Macugen 1013 Study Group. A Phase 2/3, multicenter, randomized, double-masked, 2-year trial of pegaptanib sodium for the treatment of diabetic macular edema. Ophthalmology. 2011;118(6):1107–1118. doi:10.1016/j.ophtha.2011.02.045
  • Wells JA, Glassman AR, Ayala AR, et al.; Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema. N Engl J Med. 2015;372(13):1193–1203.
  • Wells JA, Glassman AR, Ayala AR, et al.; Diabetic Retinopathy Clinical Research Network. Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology. 2016;123(6):1351–1359. doi:10.1016/j.ophtha.2016.02.022.
  • Nguyen QD, Brown DM, Marcus DM, et al.; RISE and RIDE Research Group. Ranibizumab for diabetic macular edema: results from 2 Phase III randomized trials: RISE and RIDE. Ophthalmology. 2012;119(4):789–801. doi:10.1016/j.ophtha.2011.12.039.
  • Brown DM, Nguyen QD, Marcus DM, et al.; RIDE and RISE Research Group. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology. 2013;120(10):2013–2022. doi:10.1016/j.ophtha.2013.02.034.
  • Boyer DS, Nguyen QD, Brown DM, Basu K, Ehrlich JS; RIDE and RISE Research Group. Outcomes with as-needed ranibizumab after initial monthly therapy: long-term outcomes of the phase III RIDE and RISE Trials. Ophthalmology. 2015;122(12):2504–2513.e1. doi:10.1016/j.ophtha.2015.08.006
  • Korobelnik JF, Do DV, Schmidt-Erfurth U, et al. Intravitreal aflibercept for diabetic macular edema. Ophthalmology. 2014;121(11):2247–2254. doi:10.1016/j.ophtha.2014.05.006
  • Brown DM, Schmidt-Erfurth U, Do DV, et al. Intravitreal aflibercept for diabetic macular edema: 100- week results from the VISTA and VIVID studies. Ophthalmology. 2015;122:2044–2052. doi:10.1016/j.ophtha.2015.06.017
  • Do DV, Nguyen QD, Vitti R, et al. Intravitreal aflibercept injection in diabetic macular edema patients with and without prior anti-vascular endothelial growth factor treatment: outcomes from the phase 3 program. Ophthalmology. 2016;123(4):850–857. doi:10.1016/j.ophtha.2015.11.008
  • Boyer DS, Faber D, Gupta S, et al.; Ozurdex CHAMPLAIN Study Group. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina. 2011;31(5):915–923. doi:10.1097/IAE.0b013e318206d18c.
  • Callanan DG, Gupta S, Boyer DS, et al.; Ozurdex PLACID Study Group. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120(9):1843–1851. doi:10.1016/j.ophtha.2013.02.018.
  • Gillies MC, Lim LL, Campain A, et al. A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology. 2014;121(12):2473–2481. doi:10.1016/j.ophtha.2014.07.002
  • Fraser-Bell S, Lim LL, Campain A, et al. Bevacizumab or Dexamethasone Implants for DME: 2-year Results (The BEVORDEX Study). Ophthalmology. 2016;123(6):1399–1401. doi:10.1016/j.ophtha.2015.12.012
  • Aroney C, Fraser-Bell S, Lamoureux EL, Gillies MC, Lim LL, Fenwick EK. Vision-Related quality of life outcomes in the bevordex study: a clinical trial comparing ozurdex sustained release dexamethasone intravitreal implant and bevacizumab treatment for diabetic macular edema. Invest Ophthalmol Vis Sci. 2016;57(13):5541–5546. doi:10.1167/iovs.16-19729
  • Campochiaro PA, Brown DM, Pearson A, et al.; FAME Study Group. Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology. 2011;118(4):626–635.e2. doi:10.1016/j.ophtha.2010.12.028.
  • Cunha-Vaz J, Ashton P, Iezzi R, et al.; FAME Study Group. Sustained delivery fluocinolone acetonide vitreous implants: long-term benefit in patients with chronic diabetic macular edema. Ophthalmology. 2014;121(10):1892–1903. doi:10.1016/j.ophtha.2014.04.019.
  • Baker CW, Glassman AR, Beaulieu WT, et al.; DRCRRetina Network. Effect of initial management with aflibercept vs laser photocoagulation vs observation on vision loss among patients with diabetic macular edema involving the center of the macula and good visual acuity: a randomized clinical trial. JAMA. 2019;321(19):1880–1894. doi:10.1001/jama.2019.5790.
  • Reznicek L, Cserhati S, Seidensticker F, et al. Functional and morphological changes in diabetic macular edema over the course of anti-vascular endothelial growth factor treatment. Acta Ophthalmol. 2013;91(7):e529–536. doi:10.1111/aos.12153
  • Matsuda S, Tam T, Singh RP, et al. The impact of metabolic parameters on clinical response to VEGF inhibitors for diabetic macular edema. J Diabetes Complications. 2014;28(2):166–170. doi:10.1016/j.jdiacomp.2013.11.009
  • Zur D, Iglicki M, Busch C, Invernizzi A, Mariussi M, Loewenstein A; International Retina Group. OCT biomarkers as functional outcome predictors in diabetic macular edema treated with dexamethasone implant. Ophthalmology. 2018;125(2):267–275. doi:10.1016/j.ophtha.2017.08.031
  • Gerendas BS, Prager S, Deak G, et al. Predictive imaging biomarkers relevant for functional and anatomical outcomes during ranibizumab therapy of diabetic macular oedema. Br J Ophthalmol. 2018;102(2):195–203. doi:10.1136/bjophthalmol-2017-310483
  • Lee H, Kang KE, Chung H, Kim HC. Prognostic factors for functional and anatomic outcomes in patients with diabetic macular edema treated with dexamethasone implant. Korean J Ophthalmol. 2018;32(2):116–125. doi:10.3341/kjo.2017.0041
  • Lee H, Kang KE, Chung H, Kim HC. Three-dimensional analysis of morphologic changes and visual outcomes in diabetic macular edema. Jpn J Ophthalmol. 2019;63(3):234–242. doi:10.1007/s10384-019-00657-8
  • Do DV, Cho M, Nguyen QD, et al. Impact of optical coherence tomography on surgical decision making for epiretinal membranes and vitreomacular traction. Retina. 2007;27(5):552–556. doi:10.1097/IAE.0b013e31802c518b
  • Sakamoto A, Nishijima K, Kita M, Oh H, Tsujikawa A, Yoshimura N. Association between foveal photoreceptor status and visual acuity after resolution of diabetic macular edema by pars plana vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2009;247(10):1325–1330. doi:10.1007/s00417-009-1107-5
  • Alasil T, Keane PA, Updike JF, et al. Relationship between optical coherence tomography retinal parameters and visual acuity in diabetic macular edema. Ophthalmology. 2010;117(12):2379–2386. doi:10.1016/j.ophtha.2010.03.051
  • Maheshwary AS, Oster SF, Yuson RM, Cheng L, Mojana F, Freeman WR. The association between percent disruption of the photoreceptor inner segment-outer segment junction and visual acuity in diabetic macular edema. Am J Ophthalmol. 2010;150(1):63–67.e1. doi:10.1016/j.ajo.2010.01.039
  • Dugel PU, Campbell JH, Kiss S, et al. Association between early anatomic response to anti-vascular endothelial growth factor therapy and long-term outcome in diabetic macular edema: an independent analysis of protocol I study data. Retina. 2019;39(1):88–97. doi:10.1097/IAE.0000000000002110
  • Busch C, Fraser-Bell S, Zur D, et al.; International Retina Group. Real-world outcomes of observation and treatment in diabetic macular edema with very good visual acuity: the OBTAIN study. Acta Diabetol. 2019;56(7):777–784. doi:10.1007/s00592-019-01310-z.
  • Wykoff CC. Thresholds for initiating treatment of eyes with diabetic macular edema and good vision: consideration of DRCR.Net Protocol V Results. Ophthalmol Retina. 2019;3(11):917–919. doi:10.1016/j.oret.2019.07.007
  • Wells JA, Glassman AR, Jampol LM, et al.; Diabetic Retinopathy Clinical Research Network. Association of baseline visual acuity and retinal thickness with 1-year efficacy of aflibercept, bevacizumab, and ranibizumab for diabetic macular edema. JAMA Ophthalmol. 2016;134(2):127–134. doi:10.1001/jamaophthalmol.2015.4599.
  • Cantrell RA, Lum F, Chia Y, et al. Treatment patterns for diabetic macular edema: an intelligent research in sight (IRIS®) registry analysis. Ophthalmology. 2020;127(3):427–429. doi:10.1016/j.ophtha.2019.10.019
  • Sadda SR, Campbell J, Dugel PU, et al. Relationship between duration and extent of oedema and visual acuity outcome with ranibizumab in diabetic macular oedema: a post hoc analysis of Protocol I data. Eye. 2020;34(3):480–490. doi:10.1038/s41433-019-0522-z
  • Browning DJ, Stewart MW, Lee C. Diabetic macular edema: evidence-based management. Indian J Ophthalmol. 2018;66(12):1736–1750. doi:10.4103/ijo.IJO_1240_18
  • Rosenblatt BJ, Shah GK, Sharma S, Bakal J. Pars plana vitrectomy with internal limiting membranectomy for refractory diabetic macular edema without a taut posterior hyaloid. Graefes Arch Clin Exp Ophthalmol. 2005;243(1):20–25. doi:10.1007/s00417-004-0958-z
  • Patel JI, Hykin PG, Schadt M, Luong V, Fitzke F, Gregor ZJ. Pars plana vitrectomy for diabetic macular oedema: OCT and functional correlations. Eye. 2006;20(6):674–680. doi:10.1038/sj.eye.6701945
  • Maturi RK, Glassman AR, Liu D, et al.; Diabetic Retinopathy Clinical Research Network. Effect of Adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema: a drcr network phase 2 randomized clinical trial. JAMA Ophthalmol. 2018;136(1):29–38. doi:10.1001/jamaophthalmol.2017.4914.
  • Bressler NM, Beaulieu WT, Glassman AR, et al.; Diabetic Retinopathy Clinical Research Network. Persistent macular thickening following intravitreous aflibercept, bevacizumab, or ranibizumab for central-involved diabetic macular edema with vision impairment: a secondary analysis of a randomized clinical trial. JAMA Ophthalmol. 2018;136(3):257–269. doi:10.1001/jamaophthalmol.2017.6565.
  • Chen YP, Wu AL, Chuang CC, Chen SN. Factors influencing clinical outcomes in patients with diabetic macular edema treated with intravitreal ranibizumab: comparison between responder and non-responder cases. Sci Rep. 2019;9(1):10952. doi:10.1038/s41598-019-47241-1
  • National cancer institute dictionary of cancer terms. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/prognostic-factor. Accessed May 13, 2021.
  • Haritoglou C, Maier M, Neubauer AS, Augustin AJ. Current concepts of pharmacotherapy of diabetic macular edema. Expert Opin Pharmacother. 2020;21(4):467–475. doi:10.1080/14656566.2020.1713093
  • Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999;127(6):688–693. doi:10.1016/S0002-9394(99)00033-1
  • Kim BY, Smith SD, Kaiser PK. Optical coherence tomographic patterns of diabetic macular edema. Am J Ophthalmol. 2006;142(3):405–412. doi:10.1016/j.ajo.2006.04.023
  • Sonoda S, Sakamoto T, Yamashita T, Shirasawa M, Otsuka H, Sonoda Y. Retinal morphologic changes and concentrations of cytokines in eyes with diabetic macular edema. Retina. 2014;34(4):741–748. doi:10.1097/IAE.0b013e3182a48917
  • Bandyopadhyay S, Bandyopadhyay SK, Saha M, Sinha A. Study of aqueous cytokines in patients with different patterns of diabetic macular edema based on optical coherence tomography. Int Ophthalmol. 2018;38(1):241–249. doi:10.1007/s10792-017-0453-2
  • Yenihayat F, Özkan B, Kasap M, et al. Vitreous IL-8 and VEGF levels in diabetic macular edema with or without subretinal fluid. Int Ophthalmol. 2019;39(4):821–828. doi:10.1007/s10792-018-0874-6
  • Tsai MJ, Hsieh YT, Shen EP, Peng YJ. Systemic associations with residual subretinal fluid after ranibizumab in diabetic macular edema. J Ophthalmol. 2017;2017:4834201. doi:10.1155/2017/4834201
  • Turgut B, Gul FC, Ilhan N, Demir T, Celiker U. Comparison of serum glycosylated hemoglobin levels in patients with diabetic cystoid macular edema with and without serous macular detachment. Indian J Ophthalmol. 2010;58(5):381–384.
  • Sophie R, Lu N, Campochiaro PA. Predictors of functional and anatomic outcomes in patients with diabetic macular edema treated with ranibizumab. Ophthalmology. 2015;122(7):1395–1401. doi:10.1016/j.ophtha.2015.02.036
  • Fickweiler W, Schauwvlieghe AME, Schlingemann RO; BRDME Research Group. Predictive value of optical coherence tomographic features in the Bevacizumab and Ranibizumab in patients with Diabetic Macular Edema (BRDME) sTUDY. Retina. 2018;38(4):812–819. doi:10.1097/IAE.0000000000001626
  • Shimura M, Yasuda K, Yasuda M, Nakazawa T. Visual outcome after intravitreal bevacizumab depends on the optical coherence tomographic patterns of patients with diffuse diabetic macular edema. Retina. 2013;33(4):740–747. doi:10.1097/IAE.0b013e31826b6763
  • Kaya M, Karahan E, Ozturk T, Kocak N, Kaynak S. Effectiveness of intravitreal ranibizumab for diabetic macular edema with serous retinal detachment. Korean J Ophthalmol. 2018;32(4):296–302. doi:10.3341/kjo.2017.0117
  • Hwang HB, Jee D, Kwon JW. Characteristics of diabetic macular edema patients with serous retinal detachment. Medicine. 2019;98(51):e18333. doi:10.1097/MD.0000000000018333
  • Castro-Navarro V, Cervera-Taulet E, Navarro-Palop C, Monferrer-Adsuara C, Hernández-Bel L, Montero-Hernández J. Intravitreal dexamethasone implant Ozurdex® in naïve and refractory patients with different subtypes of diabetic macular edema. BMC Ophthalmol. 2019;19(1):15.
  • Spaide RF. Retinal vascular cystoid macular edema: review and new theory. Retina. 2016;36(10):1823–1842. doi:10.1097/IAE.0000000000001158
  • Sacconi R, Lutty GA, Mullins RF, Borrelli E, Bandello F, Querques G. Subretinal pseudocysts: a novel OCT finding in diabetic macular edema. Am J Ophthalmol Case Rep. 2019;16:100567. doi:10.1016/j.ajoc.2019.100567
  • Yamamoto S, Yamamoto T, Hayashi M, Takeuchi S. Morphological and functional analyses of diabetic macular edema by optical coherence tomography and multifocal electroretinograms. Graefes Arch Clin Exp Ophthalmol. 2001;239(2):96–101. doi:10.1007/s004170000238
  • Bezzina AD, Carbonaro F. Factors Predicting treatment response in anti-vascular endothelial growth factor naïve diabetic macular edema patients treated with intravitreal bevacizumab. J Ocul Pharmacol Ther. 2019;35(10):551–557. doi:10.1089/jop.2018.0112
  • De Benedetto U, Sacconi R, Pierro L, Lattanzio R, Bandello F. Optical coherence tomographic hyperreflective foci in early stages of diabetic retinopathy. Retina. 2015;35(3):449–453. doi:10.1097/IAE.0000000000000336
  • Chatziralli IP, Sergentanis TN, Sivaprasad S. Hyperreflective foci as an independent visual outcome predictor in macular edema due to retinal vascular diseases treated with intravitreal dexamethasone or ranibizumab. Retina. 2016;36(12):2319–2328. doi:10.1097/IAE.0000000000001070
  • Hwang HS, Chae JB, Kim JY, Kim DY. Association between hyperreflective dots on spectral-domain optical coherence tomography in macular edema and response to treatment. Invest Ophthalmol Vis Sci. 2017;58(13):5958–5967. doi:10.1167/iovs.17-22725
  • Schreur V, Altay L, van Asten F, et al. Hyperreflective foci on optical coherence tomography associate with treatment outcome for anti-VEGF in patients with diabetic macular edema. PLoS One. 2018;13(10):e0206482. doi:10.1371/journal.pone.0206482
  • Vujosevic S, Torresin T, Bini S, et al. Imaging retinal inflammatory biomarkers after intravitreal steroid and anti-VEGF treatment in diabetic macular oedema. Acta Ophthalmol. 2017;95(5):464–471. doi:10.1111/aos.13294
  • Sun JK, Lin MM, Lammer J, et al. Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with center-involved diabetic macular edema. JAMA Ophthalmol. 2014;132(11):1309–1316. doi:10.1001/jamaophthalmol.2014.2350
  • Das R, Spence G, Hogg RE, Stevenson M, Chakravarthy U. Disorganization of inner retina and outer retinal morphology in diabetic macular edema. JAMA Ophthalmol. 2018;136(2):202–208. doi:10.1001/jamaophthalmol.2017.6256
  • Radwan SH, Soliman AZ, Tokarev J, Zhang L, van Kuijk FJ, Koozekanani DD. Association of disorganization of retinal inner layers with vision after resolution of center-involved diabetic macular edema. JAMA Ophthalmol. 2015;133(7):820–825. doi:10.1001/jamaophthalmol.2015.0972
  • Zur D, Iglicki M, Sala-Puigdollers A, et al.; International Retina Group (IRG). Disorganization of retinal inner layers as a biomarker in patients with diabetic macular oedema treated with dexamethasone implant. Acta Ophthalmol. 2020;98(2):e217–e223. doi:10.1111/aos.14230.
  • Yanyali A, Bozkurt KT, Macin A, Horozoglu F, Nohutcu AF. Quantitative assessment of photoreceptor layer in eyes with resolved edema after pars plana vitrectomy with internal limiting membrane removal for diabetic macular edema. Ophthalmologica. 2011;226(2):57–63. doi:10.1159/000327597
  • Shin HJ, Lee SH, Chung H, Kim HC. Association between photoreceptor integrity and visual outcome in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol. 2012;250(1):61–70. doi:10.1007/s00417-011-1774-x
  • Muftuoglu IK, Mendoza N, Gaber R, Alam M, You Q, Freeman WR. Integrity of outer retinal layers after resolution of central involved diabetic macular edema. Retina. 2017;37(11):2015–2024. doi:10.1097/IAE.0000000000001459
  • Rangaraju L, Jiang X, McAnany JJ, et al. Association between visual acuity and retinal layer metrics in diabetics with and without macular edema. J Ophthalmol. 2018;2018:1089043.
  • Wong RL, Lee JW, Yau GS, Wong IY. Relationship between outer retinal layers thickness and visual acuity in diabetic macular edema. Biomed Res Int. 2015;2015:981471. doi:10.1155/2015/981471
  • Eliwa TF, Hussein MA, Zaki MA, Raslan OA. Outer retinal layer thickness as good visual predictor in patients with diabetic macular edema. Retina. 2018;38(4):805–811. doi:10.1097/IAE.0000000000001599
  • Abd Elhamid AH. Quantitative assessment of outer retinal layer and photoreceptor outer segment layer and their relation to visual acuity in diabetic macular edema. J Ophthalmol. 2019;2019:8216150. doi:10.1155/2019/8216150
  • Hatz K, Ebneter A, Tuerksever C, Pruente C, Zinkernagel M. Repeated dexamethasone intravitreal implant for the treatment of diabetic macular oedema unresponsive to anti-VEGF therapy: outcome and predictive SD-OCT features. Ophthalmologica. 2018;239(4):205–214. doi:10.1159/000485852
  • Castro-Navarro V, Monferrer-Adsuara C, Navarro-Palop C, Montero-Hernández J, Cervera-Taulet E. Effect of dexamethasone intravitreal implant on visual acuity and foveal photoreceptor integrity in macular edema secondary to retinal vascular disease. Ophthalmologica. 2021;244(1):83–92. doi:10.1159/000512195
  • Jain A, Saxena S, Khanna VK, Shukla RK, Meyer CH. Status of serum VEGF and ICAM-1 and its association with external limiting membrane and inner segment-outer segment junction disruption in type 2 diabetes mellitus. Mol Vis. 2013;19:1760–1768.
  • De S, Saxena S, Kaur A, et al. Sequential restoration of external limiting membrane and ellipsoid zone after intravitreal anti-VEGF therapy in diabetic macular oedema. Eye. 2021;35(5):1490–1495. doi:10.1038/s41433-020-1100-0
  • Bansal P, Agarwal A, Gupta V, Singh R, Gupta A. Spectral domain optical coherence tomography changes following intravitreal dexamethasone implant, Ozurdex® in patients with uveitic cystoid macular edema. Indian J Ophthalmol. 2015;63(5):416–422. doi:10.4103/0301-4738.159870
  • Altunel O, Duru N, Goktas A, Ozkose A, Goktas E, Atas M. Evaluation of foveal photoreceptor layer in eyes with macular edema associated with branch retinal vein occlusion after ozurdex treatment. Int Ophthalmol. 2019;2019(2):333–339. doi:10.1007/s10792-016-0261-0
  • Iacono P, Parodi MB, Scaramuzzi M, Bandello F. Morphological and functional changes in recalcitrant diabetic macular oedema after intravitreal dexamethasone implant. Br J Ophthalmol. 2017;101(6):791–795. doi:10.1136/bjophthalmol-2016-308726
  • Bonfiglio V, Reibaldi M, Pizzo A, et al. Dexamethasone for unresponsive diabetic macular oedema: optical coherence tomography biomarkers. Acta Ophthalmol. 2019;97(4):e540–e544. doi:10.1111/aos.13935
  • Chen Y, Li J, Yan Y, Shen X. Diabetic macular morphology changes may occur in the early stage of diabetes. BMC Ophthalmol. 2016;16:12. doi:10.1186/s12886-016-0186-4
  • Wanek J, Blair NP, Chau FY, Lim JI, Leiderman YI, Shahidi M. Alterations in retinal layer thickness and reflectance at different stages of diabetic retinopathy by en face optical coherence tomography. Invest Ophthalmol Vis Sci. 2016;57(9):OCT341–347. doi:10.1167/iovs.15-18715
  • Huang XL, Song YP, Ding Q, Chen X, Hong L. Evaluation of outer retinal tubulations in diabetic macular edema underwent anti-VEGF treatment. Int J Ophthalmol. 2019;12(3):442–450. doi:10.18240/ijo.2019.03.15
  • Fonollosa A, Zarranz-Ventura J, Valverde A, et al. Predictive capacity of baseline hyperreflective dots on the intravitreal dexamethasone implant (Ozurdex®) outcomes in diabetic macular edema: a multicenter study. Graefes Arch Clin Exp Ophthalmol. 2019;257(11):2381–2390. doi:10.1007/s00417-019-04446-4
  • Lee H, Jang H, Choi YA, Kim HC, Chung H. Association between soluble CD14 in the aqueous humor and hyperreflective foci on optical coherence tomography in patients with diabetic macular edema. Invest Ophthalmol Vis Sci. 2018;59(2):715–721. doi:10.1167/iovs.17-23042
  • Jonas JB, Jonas RA, Neumaier M, Findeisen P. Cytokine concentration in aqueous humor of eyes with diabetic macular edema. Retina. 2012;32(10):2150–2157. doi:10.1097/IAE.0b013e3182576d07
  • Lafuma A, Brézin A, Lopatriello S, et al. Evaluation of non-medical costs associated with visual impairment in four European countries: France, Italy, Germany and the UK. Pharmacoeconomics. 2006;24(2):193–205. doi:10.2165/00019053-200624020-00007
  • Abraldes MJ, Pareja A, Roura M; En representación del grupo del estudio OBSERVAR. Analysis of costs associated with the management and morbidity of diabetic macular oedema and macular oedema secondary to retinal vein occlusion. Arch Soc Esp Oftalmol. 2016;91(6):273–280. doi:10.1016/j.oftal.2015.11.019
  • Romero-Aroca P, de la Riva-fernandez S, Valls-Mateu A, et al. Cost of diabetic retinopathy and macular oedema in a population, an eight year follow up. BMC Ophthalmol. 2016;16:136. doi:10.1186/s12886-016-0318-x