ESASO classification relevance in the diagnosis and evolution in diabetic macular edema patients after dexamethasone implant treatment

Graefes Arch Clin Exp Ophthalmol. 2024 Sep;262(9):2813-2821. doi: 10.1007/s00417-024-06473-2. Epub 2024 Apr 4.

Abstract

Purpose: To assess the clinical relevance of The European School for Advanced Studies in Ophthalmology (ESASO) classification in patients with diabetic macular edema (DME) after their first dexamethasone implant (DEXI) treatment.

Methods: Retrospective real-world study conducted on consecutive DME patients who underwent DEXI treatment and were controlled at month-2. Subjects were initially classified according to the ESASO classification stages. The outcomes were anatomical biomarkers with spectral-domain optical coherence tomography (SD-OCT) and best-corrected visual acuity (BCVA).

Results: A total of 128 patients were classified according to ESASO classification stages as early (7; 5.5%), advanced (100; 78.1%), and severe (21; 16.4%). At baseline, there were significant differences between stages in BCVA, central macular thickness (CMT), and tomography anatomical biomarkers (p < 0.05). Initial BCVA (logMAR) was 0.33 ± 0.10, 0.58 ± 0.34, and 0.71 ± 0.35 in the early, advanced, and severe stages, respectively (p < 0.05). At month-2, BCVA was 0.17 ± 0.15, 0.46 ± 0.29, and 0.69 ± 0.27 in those classified as early, advanced, and severe stages, respectively. At month-2, DME was resolved or improved in 6 (85.7%), 60 (60%), and 12 (60%) patients classified as early, advanced, and severe stages, respectively.

Conclusions: There was a good correlation between BCVA and ESASO classification stages. Patients in the severe stage did not achieve visual acuity improvement over the study period.

Keywords: Biomarker; Diabetic macular edema; ESASO classification; Intravitreal dexamethasone implant; Outcomes.

MeSH terms

  • Aged
  • Dexamethasone* / administration & dosage
  • Diabetic Retinopathy* / classification
  • Diabetic Retinopathy* / diagnosis
  • Diabetic Retinopathy* / drug therapy
  • Diabetic Retinopathy* / physiopathology
  • Drug Implants*
  • Female
  • Follow-Up Studies
  • Glucocorticoids* / administration & dosage
  • Humans
  • Intravitreal Injections*
  • Macula Lutea / diagnostic imaging
  • Macula Lutea / pathology
  • Macular Edema* / classification
  • Macular Edema* / diagnosis
  • Macular Edema* / drug therapy
  • Macular Edema* / etiology
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tomography, Optical Coherence* / methods
  • Visual Acuity*

Substances

  • Dexamethasone
  • Glucocorticoids
  • Drug Implants