Author: Margarida Brizido (Portugal)
Co-authors: Beatriz Lopes, Ana C. Almeida, Florence Aerts, Pedro Simões, Margarida Miranda
Foveal eversion (FE), as diagnosed and defined by structural OCT, has recently been considered a potential marker of severity in diabetic macular edema (DME). Previous studies hypothesized that DME with this foveal phenotype might have a different pathogenic mechanism, with similarities to Irvine Gass syndrome or uveitic macular edema. Considering this hypothesis, the aim of this study is to assess the impact of the FE phenotype on the outcomes of 0.19 mg fluocinolone acetonide intravitreal implant (FAc; ILUVIEN®) in the treatment of diabetic macular edema.
Non-interventional, retrospective, and single center analysis performed at the Ophthalmology Department, Hospital Beatriz Ângelo, Loures, Portugal.
The authors performed a retrospective study in a clinical setting, including 22 eyes (16 patients) treated with a single FAc intravitreal implant for recurrent or persistent DME. Patient demographics and ocular baseline characteristics were collected. Outcome measures included best-corrected visual acuity (BCVA; ETDRS letters score), central macular thickness (CMT; µm), and intraocular pressure (IOP; mmHg). Prior treatments were noted. Patients were separated in two groups, based on the presence or absence of FE before treatment, and assessed at baseline, months 1 and 3, and then quarterly thereafter. Outcomes were analyzed at baseline and 1-year post-FAc injection for all parameters. Statistical analysis was performed using T-test, non-parametric test and Kruskal Wallis test of SPSS (version 25.0); statistical significance was taken as p-value lower than 0,05.
Nine patients (56%) were male and, at baseline, the mean(±SD) age was 71±5,98 years. Distribution by lens status was 55%/45% phakic/pseudophakic, respectively. All eyes showed chronic DME, with median duration of 3.00±1.44 years, and sixteen of them (73%) presented foveal eversion. Comparing the two groups (FE versus absence of FE), the median(±SD) BCVA, CMT and IOP at 1-year indicated greater functional and anatomic improvement in eyes with foveal eversion (+7 ETDRS letters [p= 0.6], -165µm [p= 0.002]) and a slight IOP increase of +3mmHg (p=0.4) in this group. Our data also showed that eyes with FE required more intravitreal adjuvant therapy with anti-VEGF agents (69% vs 33% of eyes [p=0.2]).
This retrospective real-world analysis showed a higher prevalence of foveal eversion than described in the literature. Our study also revealed that the presence of foveal eversion is associated with higher retreatment percentages (p=0.2), which is supported by previous studies [Arrigo et al 2021]. However, eyes with foveal eversion showed greater functional and anatomic improvements, with the latter showing statistical significance. Considering the limitations of this study, higher patient numbers are needed to confirm the current findings.
The authors acknowledge the support from Alimera Sciences in performing the statistical analysis of the data.