Jorge Ruiz-Medrano, Patricia Udaondo Mirete, Marina Fernández-Jiménez, Monica Asencio-Duran, José Ignacio Fernández-Vigo, Marta Medina-Baena, Ignacio Flores-Moreno, Jesus Pareja-Esteban, Sara Touhami, Audrey Giocanti-Aurégan, Maria Vittoria Cicinelli, Anat Loewenstein, José M Ruiz-Moreno
{"title":"切换到地塞米松植入治疗糖尿病黄斑水肿的风险生物标志物在真实临床实践:一项多中心研究","authors":"Jorge Ruiz-Medrano, Patricia Udaondo Mirete, Marina Fernández-Jiménez, Monica Asencio-Duran, José Ignacio Fernández-Vigo, Marta Medina-Baena, Ignacio Flores-Moreno, Jesus Pareja-Esteban, Sara Touhami, Audrey Giocanti-Aurégan, Maria Vittoria Cicinelli, Anat Loewenstein, José M Ruiz-Moreno","doi":"10.1136/bjo-2024-325665","DOIUrl":null,"url":null,"abstract":"Objective To establish the influence of different optical coherence tomography (OCT) biomarkers at baseline treatment on the potential response to anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular oedema (DME). Methods Multicentric, retrospective, case-series study in patients with DME switched to dexamethasone implant injections (DEX-i) after anti-VEGF in real clinical practice. Biomarkers analysed on OCT images at baseline included intraretinal fluid (IRF), subretinal fluid (SRF), disorganisation of retinal inner layers (DRIL), disorganisation of retinal outer layers (DROL), hyperreflective foci (HRF), hyperreflective cystoid walls (HCW), dense intraretinal cyst (DIR) and vitreomacular interface (VMI) abnormalities. DME was classified according to the European School for Advanced Studies in Ophthalmology classification. Patients who were treated with anti-VEGF injections with an adequate response were selected as the control group. Results 275 eyes were analysed in this study; 209 eyes (76.0%) switched from anti-VEGF to DEX-i were compared with 66 control eyes (24.0%). Patients who required switching were statistically older, showed worse initial BCVA and higher CRT. Logistic regression analyses showed that female gender, age, central retinal thickness, type of diabetes, SRF, HCW, DIR and VMI increase the likelihood of switching. The OR regarding the need to switch generated by the presence of two of these three factors (SRF, HCW, VMI) was 48.95. Having all three multiplies it by 4.56×1016. Conclusion If baseline OCT shows two of SRF, HCW and VMI biomarkers at baseline, the risk of failure of anti-VEGF therapy is close to 50%. In the presence at baseline of all three biomarkers, failure of anti-VEGF therapy is almost certain. Data are available upon reasonable request.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"9 1","pages":""},"PeriodicalIF":3.7000,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Biomarkers of risk of switching to dexamethasone implant for the treatment of diabetic macular oedema in real clinical practice: a multicentric study\",\"authors\":\"Jorge Ruiz-Medrano, Patricia Udaondo Mirete, Marina Fernández-Jiménez, Monica Asencio-Duran, José Ignacio Fernández-Vigo, Marta Medina-Baena, Ignacio Flores-Moreno, Jesus Pareja-Esteban, Sara Touhami, Audrey Giocanti-Aurégan, Maria Vittoria Cicinelli, Anat Loewenstein, José M Ruiz-Moreno\",\"doi\":\"10.1136/bjo-2024-325665\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective To establish the influence of different optical coherence tomography (OCT) biomarkers at baseline treatment on the potential response to anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular oedema (DME). Methods Multicentric, retrospective, case-series study in patients with DME switched to dexamethasone implant injections (DEX-i) after anti-VEGF in real clinical practice. Biomarkers analysed on OCT images at baseline included intraretinal fluid (IRF), subretinal fluid (SRF), disorganisation of retinal inner layers (DRIL), disorganisation of retinal outer layers (DROL), hyperreflective foci (HRF), hyperreflective cystoid walls (HCW), dense intraretinal cyst (DIR) and vitreomacular interface (VMI) abnormalities. DME was classified according to the European School for Advanced Studies in Ophthalmology classification. Patients who were treated with anti-VEGF injections with an adequate response were selected as the control group. Results 275 eyes were analysed in this study; 209 eyes (76.0%) switched from anti-VEGF to DEX-i were compared with 66 control eyes (24.0%). Patients who required switching were statistically older, showed worse initial BCVA and higher CRT. Logistic regression analyses showed that female gender, age, central retinal thickness, type of diabetes, SRF, HCW, DIR and VMI increase the likelihood of switching. The OR regarding the need to switch generated by the presence of two of these three factors (SRF, HCW, VMI) was 48.95. Having all three multiplies it by 4.56×1016. Conclusion If baseline OCT shows two of SRF, HCW and VMI biomarkers at baseline, the risk of failure of anti-VEGF therapy is close to 50%. In the presence at baseline of all three biomarkers, failure of anti-VEGF therapy is almost certain. Data are available upon reasonable request.\",\"PeriodicalId\":9313,\"journal\":{\"name\":\"British Journal of Ophthalmology\",\"volume\":\"9 1\",\"pages\":\"\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-05-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British Journal of Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/bjo-2024-325665\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/bjo-2024-325665","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
Biomarkers of risk of switching to dexamethasone implant for the treatment of diabetic macular oedema in real clinical practice: a multicentric study
Objective To establish the influence of different optical coherence tomography (OCT) biomarkers at baseline treatment on the potential response to anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular oedema (DME). Methods Multicentric, retrospective, case-series study in patients with DME switched to dexamethasone implant injections (DEX-i) after anti-VEGF in real clinical practice. Biomarkers analysed on OCT images at baseline included intraretinal fluid (IRF), subretinal fluid (SRF), disorganisation of retinal inner layers (DRIL), disorganisation of retinal outer layers (DROL), hyperreflective foci (HRF), hyperreflective cystoid walls (HCW), dense intraretinal cyst (DIR) and vitreomacular interface (VMI) abnormalities. DME was classified according to the European School for Advanced Studies in Ophthalmology classification. Patients who were treated with anti-VEGF injections with an adequate response were selected as the control group. Results 275 eyes were analysed in this study; 209 eyes (76.0%) switched from anti-VEGF to DEX-i were compared with 66 control eyes (24.0%). Patients who required switching were statistically older, showed worse initial BCVA and higher CRT. Logistic regression analyses showed that female gender, age, central retinal thickness, type of diabetes, SRF, HCW, DIR and VMI increase the likelihood of switching. The OR regarding the need to switch generated by the presence of two of these three factors (SRF, HCW, VMI) was 48.95. Having all three multiplies it by 4.56×1016. Conclusion If baseline OCT shows two of SRF, HCW and VMI biomarkers at baseline, the risk of failure of anti-VEGF therapy is close to 50%. In the presence at baseline of all three biomarkers, failure of anti-VEGF therapy is almost certain. Data are available upon reasonable request.
期刊介绍:
The British Journal of Ophthalmology (BJO) is an international peer-reviewed journal for ophthalmologists and visual science specialists. BJO publishes clinical investigations, clinical observations, and clinically relevant laboratory investigations related to ophthalmology. It also provides major reviews and also publishes manuscripts covering regional issues in a global context.