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Enhancing Diabetic Macular Edema Treatment Outcomes: Exploring the ESASO Classification and Structural OCT Biomarkers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2024年3月26日

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  • Giacomo Panozzo,
  • Maria V. Cicinelli,
  • Giulia Dalla Mura,
  • Diana Giannarelli,
  • Maria Vadalà,
  • Vincenza Bonfiglio,
  • Giovanni Bellisario,
  • Francesco Bandello,
  • Edoardo Angelini,
  • Pietro Airaghi,
  • Teresio Avitabile,
  • Andrea Beccastrini,
  • Giorgia Benedetti,
  • Federico Bertuzzi,
  • Vincenza Maria Elena Bonfiglio,
  • Francesco Boscia,
  • Adriano Carnevali,
  • Marianna Carosielli,
  • Matteo Giuseppe Cereda,
  • Cecilia Contardi,
  • Michele Coppola,
  • Ciro Costagliola,
  • Riccardo Cristofolini,
  • Pasquale Cucciniello,
  • Rossella D’Aloisio,
  • Maddalena Bernardo,
  • Alessandro Filippis,
  • Roberto Dell’Omo,
  • Ilenia Paola,
  • Matteo Dell’Acqua,
  • Alessio Franco,
  • Maria Oliva Grassi,
  • Giulia Gregori,
  • Elena Gusson,
  • Rosangela Lattanzio,
  • Paolo Lanzetta,
  • Antonio Longo,
  • Giorgio Marchini,
  • Paola Marolo,
  • Rodolfo Mastropasqua,
  • Giuliana Mele Bertoldo,
  • Giuseppina Monteleone,
  • Elina Ortisi,
  • Guglielmo Parisi,
  • Salvatore Parrulli,
  • Porzia Pucci,
  • Marco Rocco Pastore,
  • Michele Reibaldi,
  • Stanislao Rizzo,
  • Francesco Romano,
  • Nicola Rosa,
  • Valentina Sarao,
  • Giuseppe Scarpa,
  • Vincenzo Scorcia,
  • Andrea Scupola,
  • Giovanni Staurenghi,
  • Valentina Sunseri Trapani,
  • Daniele Tognetto,
  • Giuseppe Trabucchi,
  • Sabrina Vaccaro,
  • Daniele Veritti,
  • Alex Lucia Vinciguerra,
  • Emma Clara Zanzottera

摘要

Introduction

This study assessed the European School of Advanced Studies in Ophthalmology (ESASO) classification’s prognostic value for diabetic macular edema (DME) in predicting intravitreal therapy outcomes.

Methods

In this retrospective, multicenter study, patients aged > 50 years with type 1 or 2 diabetes and DME received intravitreal antivascular endothelial growth factor (anti-VEGF) agents (ranibizumab, bevacizumab, and aflibercept) or steroids (dexamethasone). The primary outcome was visual acuity (VA) change post-treatment, termed as functional response, measured 4–6 weeks post-third anti-VEGF or 12–16 weeks post-steroid injection, stratified by initial DME stage.

Results

Of the 560 eyes studied (62% male, mean age 66.7 years), 31% were classified as stage 1 (early), 50% stage 2 (advanced), 17% stage 3 (severe), and 2% stage 4 (atrophic). Visual acuity (VA; decimal) improved by 0.12–0.15 decimals in stages 1–2 but only 0.03 decimal in stage 3 (all p < 0.0001) and 0.01 in stage 4 (p = 0.38). Even in eyes with low baseline VA ≤ 0.3, improvements were significant only in stages 1 and 2 (0.12 and 0.17 decimals, respectively). Central subfield thickness (CST) improvement was greatest in stage 3 (−229 µm, 37.6%, p < 0.0001), but uncorrelated with VA gains, unlike stages 1 and 2 (respectively: −142 µm, 27.4%; − 5 µm, 12%; both p < 0.0001). Stage 4 showed no significant CST change. Baseline disorganization of retinal inner layers and focal damage of the ellipsoid zone/external limiting membrane did not influence VA improvement in stages 1 and 2. Treatment patterns varied, with 61% receiving anti-VEGF and 39% dexamethasone, influenced by DME stage, with no significant differences between therapeutic agents.

Conclusion

The ESASO classification, which views the retina as a neurovascular unit and integrates multiple biomarkers, surpasses single biomarkers in predicting visual outcomes. Significant functional improvement occurred only in stages 1 and 2, suggesting reversible damage, whereas stages 3 and 4 likely reflect irreversible damage.