1
|
Panozzo G, Cicinelli MV, Dalla Mura G, Giannarelli D, Vadalà M, Bonfiglio V, Bellisario G, Bandello F. Enhancing Diabetic Macular Edema Treatment Outcomes: Exploring the ESASO Classification and Structural OCT Biomarkers. Ophthalmol Ther 2024; 13:1383-1398. [PMID: 38530567 DOI: 10.1007/s40123-024-00925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Giacomo Panozzo
- Ophthalmology Unit, Clinica San Francesco, Verona, Italy.
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland.
| | - Maria V Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Diana Giannarelli
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Maria Vadalà
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Giovanni Bellisario
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesco Bandello
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| |
Collapse
|
2
|
Pastore MR, Vinciguerra AL, Mura GD, Jabali AE, Tognetto D, Panozzo G. Worsening of early DME after cataract surgery. The DICAT II Study report #2. Eur J Ophthalmol 2024:11206721241245743. [PMID: 38576315 DOI: 10.1177/11206721241245743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
PURPOSE To analyse the long anatomical and functional outcome of a subgroup of the DICAT II study cohort, consisting of 26 patients undergoing cataract surgery and withdrawn from the study for a clinically significant worsening of early diabetic macular edema (DME). MATERIALS Patients who underwent cataract surgery and withdrawn from the DICAT II study for a clinically significant worsening of early DME with at least 12 months follow-up after the dropout. The study population was divided into two groups according to the clinical evaluation at one-year follow-up: ongoing treatment patients for DME (Treatment group, TG) and patients no longer treated (Non Treatment group, NTG). RESULTS Central foveal thickness (CFT) at baseline and dropout time were higher in TG than in the NTG, with a statistically significant difference (p < 0.05). In addition, TG patients reported a higher levels of glycated hemoglobin at time baseline compared to NTG patients (7.81 ± 1.15 vs 7.02 ± 0.56; p = 0.048). The linear regression analysis demonstrated a statistically significant relationship between the visual acuity and the ongoing treatment group at one-year follow-up (p = 0.042). CONCLUSION The study provides parameters to be considered when assessing the risk of developing persistent DME after cataract surgery in diabetic patients. In particular, CFT at baseline and dropout time have been reported to be an effective and predictable OCT biomarkers when evaluating DME progression. During the evaluation of the systemic disease, similar results were found for the glycated hemoglobin at baseline.
Collapse
Affiliation(s)
- Marco R Pastore
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Alex Lucia Vinciguerra
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Abdallah El Jabali
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Giacomo Panozzo
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Panozzo G, Franzolin E, Giannarelli D, Dalla Mura G, Longo R, Cicinelli MV. Validation of Esaso Classification of Diabetic Maculopathy. Eur J Ophthalmol 2024; 34:497-501. [PMID: 37455446 DOI: 10.1177/11206721231186649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
PURPOSE To test reliability and reproducibility of ESASO morphologic OCT-based classification of diabetic maculopathy (DM). METHODS This is a multi-center cross-sectional study including a coordination center (CC) and 18 participating centers (PCs). After instruction on the correct use of ESASO Classification, the validation process was carried out in two consecutive stages. In the first retrospective phase, we evaluated the concordance between PCs and CC in the staging of OCT images collected during PCs' daily activity (608 images). In a second prospective phase, we analyzed the inter-observer agreement of staging assigned by each PCs to OCT images selected by the CC (22 images). RESULTS The overall concordance achieved in the retrospective phase was 89.8% (Kappa = 0.83 (95% CI: 0.78-0.87); p<0.0001). In 99.5% of cases, concordance did not differ by more than one stage. In the prospective phase, PCs reached an inter-operator agreement of 93.0% (Krippendorff's Alpha = 0.953, 95% CI: 0.929-0.977, p<0.0001). Any discrepancy among the 22 images was within one stage. CONCLUSION The results achieved in this study confirm that ESASO OCT-based Classification can be considered as an easy and reproducible method to stage DM during clinical practice. A diffused use of a common and validated method to describe the progression of retinal damage in DM may offer several clinical and scientific advantages.
Collapse
Affiliation(s)
- Giacomo Panozzo
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Elia Franzolin
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Giulia Dalla Mura
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Rosa Longo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | |
Collapse
|
4
|
Longo R, Avesani A, Dalla Mura G, Dell’Orco D, Manfredini S, Panozzo G. Clinical improvement of ocular surface parameters in dry eye patients following treatment with urea/crosslinked-hyaluronate eyedrops correlates with the secretion of MUC-4. Expert Review of Ophthalmology 2021. [DOI: 10.1080/17469899.2021.1999808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rosa Longo
- Department of Neurosciences, Biomedicine and Movement Sciences, Ophthalmology Unit, University of Verona, Verona, Italy
| | - Anna Avesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Biological Chemistry, University of Verona, Verona, Italy
| | - Giulia Dalla Mura
- European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Daniele Dell’Orco
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Biological Chemistry, University of Verona, Verona, Italy
| | - Stefano Manfredini
- Department of Life Sciences and Biotechnology, Master Course in Cosmetic Science and Technology (COSMAST), University of Ferrara, Ferrara, Italy
| | - Giacomo Panozzo
- European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| |
Collapse
|
5
|
Panozzo G, Mura GD, Franzolin E, Giannarelli D, Albano V, Alessio G, Arrigo A, Casati S, Cassottana P, Contardi C, D'Aloisio R, Fasce F, Gusson E, Marchini G, Mastropasqua L, Niccolò M, Palmisano C, Pastore MR, Saviano S, Tognetto D, Bandello F. Early DMO: a predictor of poor outcomes following cataract surgery in diabetic patients. The DICAT-II study. Eye (Lond) 2021; 36:1687-1693. [PMID: 34345028 PMCID: PMC8330474 DOI: 10.1038/s41433-021-01718-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/28/2021] [Accepted: 07/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prospective DIabetes and CATaract Study II (DICAT II) was performed to characterise the risks of cataract surgery to the retinae of patients with early diabetic macular oedema (E-DMO). METHODS DICAT II was a prospective, comparative, multicentre, observational study involving six Italian clinics. Patients were aged ≥55 years, had type 1 or 2 diabetes with spectral-domain optical coherence tomography evidence of ESASO classification Early DMO. Group 1 eyes (78 eyes, 78 patients) underwent phacoemulsification-based cataract surgery. Group 2 eyes (65 eyes, 65 patients) had E-DMO and either clear media or had undergone uncomplicated cataract surgery ≥1 year previously. Central subfield thickness (CST) and best-corrected visual acuity (BCVA) were assessed in both groups. RESULTS The negative impact of surgery on CST was evident after the first postoperative week; CST peaked during the first month, then rapidly decreased. CST worsening ≥10 µm was observed in 63/78 eyes (80.7%) and 29/65 eyes (44.6%) in Groups 1 and 2, respectively (p < 0.0001). CST worsening of ≥50 µm was observed in 51 eyes (65.4%) and 10 eyes (15.4%) in Groups 1 and 2, respectively (p < 0.0001). Mean CST worsening was lower in Group 2 than in Group 1 (38.6 ± 30.4 µm vs 85.5 ± 55.3 µm, p < 0.0001) with a lower BCVA loss (-2.6 ± 3.5 letters vs -8.2 ± 6.2 letters, p < 0.0001). Higher glycaemic levels and HBA1c levels were significantly associated with the risk of >50 μm CST worsening in eyes from both groups. CONCLUSION Early DMO is associated with poorer outcomes after cataract surgery and requires close pre- and postoperative monitoring.
Collapse
Affiliation(s)
- Giacomo Panozzo
- Ophthalmology Unit, Clinica San Francesco, Verona, Italy. .,ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland.
| | - Giulia Dalla Mura
- ESASO, European School of Advanced Studies in Ophthalmology, Lugano, Switzerland
| | - Elia Franzolin
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Diana Giannarelli
- UOSD Clinical Trial Center, Biostatistics and Bioinformatics, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Valeria Albano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Gianni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Casati
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Paola Cassottana
- Department of Ophthalmology, San Martino University Hospital, IRCCS, Genova, Italy
| | - Cecilia Contardi
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rossella D'Aloisio
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Francesco Fasce
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elena Gusson
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Giorgio Marchini
- Ophthalmology Unit, Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Leonardo Mastropasqua
- Department of Ophthalmology, G. d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Massimo Niccolò
- Department of Ophthalmology, University of Genova, Genova, Italy
| | - Carmela Palmisano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Marco Rocco Pastore
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Sandro Saviano
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medical Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
6
|
Panozzo G, Staurenghi G, Dalla Mura G, Giannarelli D, Alessio G, Alongi S, Appolloni R, Baldascino A, Boscia F, Caporossi A, Cereda M, D'Ugo E, Fallico M, Avitabile T, Galan A, La Spina C, Lo Giudice G, Mastropasqua L, Palmisano C, Panico C, Parravano MC, Penna R, Pintore P, Vaiano A, Reibaldi M, Rizzo S, Rossi T, Varano M, Virgili G. Prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy: The DIabetes and CATaract study. Eur J Ophthalmol 2019; 30:315-320. [PMID: 30854895 PMCID: PMC7079292 DOI: 10.1177/1120672119830578] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The purpose of this study is to determine the prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy. METHODS It is a prospective, multicenter, cross-sectional study. Thirteen ophthalmic units equally distributed across the Italian territory have been involved in the study. For a period of 3 months, all subjects undergoing phacoemulsification received an Optical Coherence Tompgraphy (OCT) scan and were screened for the anamnestic presence of diabetes. In addition, five selected units collected blood samples from all their patients to measure glycated hemoglobin (HbA1c) levels and detect the presence of occult diabetes (HbA1c > 6.5%). In diabetic patients, levels of retinopathy were measured and diabetic macular edema was considered significant (clinically significant macular edema) when foveal thickness was above 30% of normal levels. RESULTS A total number of 3657 subjects have been screened. Among them, 20.4% were diabetics. Prevalence of diabetes was significantly higher in males (24.7%) than in females (17%). Levels of HbA1c were tested in a representative sample of 1216 consecutive subjects, and occult diabetes was diagnosed in 4.8% of cases. No significant differences were observed between age groups or different geographic areas. Among diabetic patients, diabetic macular edema of any kind was present in 27.5% (clinically significant macular edema (6.6%)). No significant differences were seen in the prevalence of diabetic macular edema between males and females or between age groups. Among the 745 diabetic patients, no signs of retinopathy were seen in 537 subjects (76.3%), while 101 patients (14.3%) had nonproliferative retinopathy, 13 (1.7%) had nontreated proliferative diabetic retinopathy, and 53 (7.5%) had laser-treated retinopathy. In the entire sample of 3657 subjects, a normal macula was present in 90.9% of cases, diabetic macular edema of any kind in 5.4%, and other maculopathies in 3.4%. CONCLUSION In this large cohort study on patients undergoing cataract surgery, more than one-fourth were diabetics and more than one-fourth of these had diabetic macular edema. These high prevalences suggest the opportunity to plan an adequate preoperative assessment in all patients in order to reduce the risk of postoperative development or worsening of a sight-threatening complication such as chronic diabetic macular edema.
Collapse
Affiliation(s)
- Giacomo Panozzo
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Giovanni Staurenghi
- Department of Biomedical and Clinical Science Sacco Hospital, University of Milan, Italy
| | - Giulia Dalla Mura
- ESASO European School of Advances Studies in Ophthalmology, Lugano, Switzerland
| | - Diana Giannarelli
- Department of biostatistics, Regina Elena National Cancer Institute-IRCCS, Rome, Italy
| | | | | | | | | | | | - Aldo Caporossi
- Department of Ophthalmology, Policlinico Gemelli, Roma, Italy
| | - Matteo Cereda
- Department of Biomedical and Clinical Science Sacco Hospital, University of Milan, Italy
| | - Erminia D'Ugo
- Department of Ophthalmology, University of Chieti, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Italy
| | | | - Alessandro Galan
- Ophthalmology Unit, Sant'Antonio General Hospital, Padova, Italy
| | | | | | | | | | | | | | | | | | | | | | - Stanislao Rizzo
- Department of Ophthalmology, University of Firenze, Florence, Italy
| | - Tommaso Rossi
- Ophthalmology Unit, Policlinico San Martino, Genova, Italy
| | | | - Gianni Virgili
- Department of Ophthalmology, University of Firenze, Florence, Italy
| |
Collapse
|