OCT biomarkers in treatment-naïve patients with DME

Background Anti-vascular endothelial growth factor (anti-VEGF) inhibitors and intravitreal steroid implants play a key role among DME treatments. However, some patients do not respond effectively to anti-VEGF therapy [1]. In addition, the strict regimen of these drugs often results in patients not achieving an optimal response in real-life clinical practice. In addition to cases of poor response to anti-VEGF therapy or refractory DME, dexamethasone implants may be an effective and safe first-line treatment for previously untreated patients. For example, patients with subfoveal neuroretinal detachment have higher levels of inflammatory cytokines in both the vitreous and aqueous humor, suggesting the presence of an important inflammatory component. Another important biomarker of inflammation in optical coherence tomography is the presence of hyperreflective foci, which are considered a clinical sign of activated microglial cell aggregates in the retina. Furthermore, there appears to be a significant correlation between the number of hyperreflective lesions and the presence of subfoveal neuroretinal detachment, supporting the hypothesis of a stronger inflammatory component in this pattern of DME. Another group of treatment-naive DME patients in whom dexamethasone implant should be first-line therapy are patients requiring cataract surgery [2]. Conclusion Therefore, when choosing first-line therapy in patients with DME, special attention should be paid to both the patient's ophthalmologic and systemic comorbidities, including glaucoma, lens status, aphakia, inflammatory phenotype, previous vitrectomy [3], traction type of DME, stage of diabetic retinopathy, accessibility, and cardiovascular events. Keywords: optical coherence tomography; diabetic macular edema; biomarkers