Ophthalmology Science
Contrasting OCT Biomarkers, Visual Acuity, and Response to Corticosteroids in Diabetic and Uveitic Macular Edema
By Maria Vittoria Cicinelli, Costanza Barresi, Makan Ziafati and 8 others.
Abstract
Purpose
To compare AI-derived OCT biomarkers, visual acuity (VA), and corticosteroid response of diabetic macular edema (DME) versus uveitic macular edema.
Design
Retrospective observational cohort study.Subjects: A total of 173 treatment-naive eyes, including 114 eyes with DME and 59 eyes with uveitic macular edema.Methods: Clinical records and OCT imaging were reviewed.AI-based analysis automatically segmented and quantified volumetric biomarkers, including intraretinal fluid (IRF) stratified by ETDRS subfields, subretinal fluid (SRF), hyperreflective foci (HRF), and ellipsoid zone disruption.Uveitic eyes were compared to the overall DME cohort and previously defined latent DME phenotypic clusters.Coupling between structure and VA was assessed via biomarker correlation networks.Time to complete OCT dryness following corticosteroid therapy was evaluated using survival analysis.Main Outcome Measures: AI-derived OCT biomarker characteristics and spatial distribution, associations with VA, and time to OCT dryness after intravitreal corticosteroid therapy.Results: Uveitic eyes showed significantly lower total IRF volume than DME eyes (0.62±0.85 vs 2.01±1.80mm³; p<0.001), with preferential central (1-mm) localization (+10.4%;p=0.001).Uveitic eyes also exhibited a higher baseline HRF burden (109 ± 38.8 vs 95.4 ± 46.4 lesions; p=0.04) and less extensive EZ disruption (13.7±28.4% vs 26.5±34.6%;p=0.03).In DME, VA correlated significantly with total IRF volume (ρ=0.44),peripheral IRF redistribution (ρ=0.35), and EZ disruption (ρ=0.49),indicating tighter structure-vision coupling; these associations were weak or absent in uveitic macular edema.Among previously identified DME, cluster 1 closely resembled the uveitic phenotype, whereas cluster 2 showed marked differences in biomarkers and delayed anatomical resolution.Consistently, cluster 2 exhibited a significantly lower probability of achieving OCT dryness after intravitreal corticosteroids compared with uveitis (HR 0.35, 95% CI 0.16-0.76;p=0.008), while clusters 1 and 3 did not differ significantly.Conclusion: Diabetic and uveitic macular edema display distinct anatomical architectures and differing correlations with visual acuity.Notably, specific DME phenotypes share structural features with uveitic macular edema and appear to show a more favorable response to intravitreal corticosteroid therapy.
