Enhancing Diabetic Macular Edema Treatment Outcomes : Exploring the ESASO Classification and Structural OCT Biomarkers
© 2024. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
Ophthalmology and therapy - 13(2024), 5 vom: 23. Apr., Seite 1383-1398 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Panozzo, Giacomo [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-VEGF |
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| Anmerkungen: |
Date Revised 26.04.2024 published: Print-Electronic Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1007/s40123-024-00925-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM370201302 |
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| 100 | 1 | |a Panozzo, Giacomo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Enhancing Diabetic Macular Edema Treatment Outcomes |b Exploring the ESASO Classification and Structural OCT Biomarkers |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 26.04.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024. The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Anti-VEGF | |
| 650 | 4 | |a Diabetic macular edema | |
| 650 | 4 | |a ESASO classification | |
| 650 | 4 | |a OCT Biomarkers | |
| 650 | 4 | |a Optical coherence tomography | |
| 650 | 4 | |a Retinal Neurovascular Unit | |
| 650 | 4 | |a Steroid | |
| 650 | 4 | |a Treatment outcomes in DME | |
| 700 | 1 | |a Cicinelli, Maria V |e verfasserin |4 aut | |
| 700 | 1 | |a Dalla Mura, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Giannarelli, Diana |e verfasserin |4 aut | |
| 700 | 1 | |a Vadalà, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Bonfiglio, Vincenza |e verfasserin |4 aut | |
| 700 | 1 | |a Bellisario, Giovanni |e verfasserin |4 aut | |
| 700 | 1 | |a Bandello, Francesco |e verfasserin |4 aut | |
| 700 | 0 | |a ESASO Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Angelini, Edoardo |e investigator |4 oth | |
| 700 | 1 | |a Airaghi, Pietro |e investigator |4 oth | |
| 700 | 1 | |a Avitabile, Teresio |e investigator |4 oth | |
| 700 | 1 | |a Beccastrini, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Benedetti, Giorgia |e investigator |4 oth | |
| 700 | 1 | |a Bertuzzi, Federico |e investigator |4 oth | |
| 700 | 1 | |a Bonfiglio, Vincenza Maria Elena |e investigator |4 oth | |
| 700 | 1 | |a Boscia, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Carnevali, Adriano |e investigator |4 oth | |
| 700 | 1 | |a Carosielli, Marianna |e investigator |4 oth | |
| 700 | 1 | |a Cereda, Matteo Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Contardi, Cecilia |e investigator |4 oth | |
| 700 | 1 | |a Coppola, Michele |e investigator |4 oth | |
| 700 | 1 | |a Costagliola, Ciro |e investigator |4 oth | |
| 700 | 1 | |a Cristofolini, Riccardo |e investigator |4 oth | |
| 700 | 1 | |a Cucciniello, Pasquale |e investigator |4 oth | |
| 700 | 1 | |a D'Aloisio, Rossella |e investigator |4 oth | |
| 700 | 1 | |a Bernardo, Maddalena |e investigator |4 oth | |
| 700 | 1 | |a Filippis, Alessandro |e investigator |4 oth | |
| 700 | 1 | |a Dell'Omo, Roberto |e investigator |4 oth | |
| 700 | 1 | |a Paola, Ilenia |e investigator |4 oth | |
| 700 | 1 | |a Dell'Acqua, Matteo |e investigator |4 oth | |
| 700 | 1 | |a Franco, Alessio |e investigator |4 oth | |
| 700 | 1 | |a Grassi, Maria Oliva |e investigator |4 oth | |
| 700 | 1 | |a Gregori, Giulia |e investigator |4 oth | |
| 700 | 1 | |a Gusson, Elena |e investigator |4 oth | |
| 700 | 1 | |a Lattanzio, Rosangela |e investigator |4 oth | |
| 700 | 1 | |a Lanzetta, Paolo |e investigator |4 oth | |
| 700 | 1 | |a Longo, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Marchini, Giorgio |e investigator |4 oth | |
| 700 | 1 | |a Marolo, Paola |e investigator |4 oth | |
| 700 | 1 | |a Mastropasqua, Rodolfo |e investigator |4 oth | |
| 700 | 1 | |a Bertoldo, Giuliana Mele |e investigator |4 oth | |
| 700 | 1 | |a Monteleone, Giuseppina |e investigator |4 oth | |
| 700 | 1 | |a Ortisi, Elina |e investigator |4 oth | |
| 700 | 1 | |a Parisi, Guglielmo |e investigator |4 oth | |
| 700 | 1 | |a Parrulli, Salvatore |e investigator |4 oth | |
| 700 | 1 | |a Pucci, Porzia |e investigator |4 oth | |
| 700 | 1 | |a Pastore, Marco Rocco |e investigator |4 oth | |
| 700 | 1 | |a Reibaldi, Michele |e investigator |4 oth | |
| 700 | 1 | |a Rizzo, Stanislao |e investigator |4 oth | |
| 700 | 1 | |a Romano, Francesco |e investigator |4 oth | |
| 700 | 1 | |a Rosa, Nicola |e investigator |4 oth | |
| 700 | 1 | |a Sarao, Valentina |e investigator |4 oth | |
| 700 | 1 | |a Scarpa, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Scorcia, Vincenzo |e investigator |4 oth | |
| 700 | 1 | |a Scupola, Andrea |e investigator |4 oth | |
| 700 | 1 | |a Staurenghi, Giovanni |e investigator |4 oth | |
| 700 | 1 | |a Trapani, Valentina Sunseri |e investigator |4 oth | |
| 700 | 1 | |a Tognetto, Daniele |e investigator |4 oth | |
| 700 | 1 | |a Trabucchi, Giuseppe |e investigator |4 oth | |
| 700 | 1 | |a Vaccaro, Sabrina |e investigator |4 oth | |
| 700 | 1 | |a Veritti, Daniele |e investigator |4 oth | |
| 700 | 1 | |a Vinciguerra, Alex Lucia |e investigator |4 oth | |
| 700 | 1 | |a Zanzottera, Emma Clara |e investigator |4 oth | |
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