Lentes intraoculares multifocales refractivas de nuevo diseño segmentado

La presbicia y las cataratas son dos condiciones oculares relacionadas con el envejecimiento del cristalino, que presentan una elevada incidencia conjunta por encima de los 60 años. Dada la tendencia, claramente visible en los estudios de pirámides poblacionales, al envejecimiento en la población mundial por la mayor esperanza de vida, ambas condiciones van a tener una enorme incidencia en el futuro. Ambas comparten una opción terapéutica común: la sustitución del cristalino por una lente intraocular multifocal (LIOMTF), que permite a los pacientes restaurar su visión y además obtener un amplio rango de distancias con visión funcional sin necesidad de ayudas ópticas. En la actualidad existen numerosos diseños de LIOMTF, cada uno de ellos con sus virtudes y sus limitaciones. Las LIOMTF difractivas (LIOMTFDF) bifocales desplazaron a las primeras LIOMTF refractivas (LIOMTFRF) de diseño anular por ofrecer mejores resultados en VP, pero sus resultados en VI resultaban insuficientes. Por ese motivo se desarrollaron las LIOMTFRF de diseño segmentado rotacionalmente asimétricas, con las que el problema de la VI se solventó casi por completo. Sin embargo, los resultados de éstas en VP eran más discretos que con los modelos bifocales difractivos. Por esa razón, se realizaron posteriormente implantes combinados, con LIOMTFRF segmentada en un ojo y LIOMTFDF en el ojo contralateral de un mismo paciente, consiguiendo con ello ampliar el rango de visión sumando las ventajas de cada uno de los modelos. Recientemente se ha dado un paso más en los diseños de LIOMTF y se dispone actualmente de LIOMTFDF trifocales, que son una evolución de los modelos bifocales, a los que se les ha añadido un foco para la VI. En esta Tesis Doctoral se va a realizar un estudio del rendimiento de las LIOMTFRF de diseño segmentado, y se va a comparar su rendimiento con el de otros sistemas multifocales. El hilo conductor de los estudios planteados en esta Tesis Doctoral es la aplicación clínica directa a pacientes con los que trabajo en mi desempeño diario de la optometría en una clínica oftalmológica. Cronológicamente, los pacientes a los que atendemos buscando independencia de ayudas ópticas, han pasado consecutivamente por las soluciones planteadas en cada uno de los capítulos, hasta llegar a la solución con la que trabajamos actualmente, presentada en el Capítulo 8 de esta Tesis Doctoral. En el Capítulo 1 se realiza una introducción general, exponiendo diversos aspectos relacionados con la presbicia y las cataratas, y se exponen las opciones terapéuticas para ambas condiciones, tanto ópticas como quirúrgicas. Una vez presentadas todas las opciones de tratamiento, se fija como objetivo el estudio de la única opción que puede tratar ambas condiciones simultáneamente: la sustitución del cristalino por una LIOMTF, por lo que en este capítulo se hace un repaso de las distintas tecnologías de LIOMTF con las que contamos actualmente en la práctica clínica. De entre todas las opciones de LIOMTF disponibles, la Tesis Doctoral se centra, como objetivo principal, en el estudio de una LIO: la LIOMTFRF Lentis Mplus (Oculentis, Alemania). La razón para ello es que esta LIOMTF en concreto es una solución equilibrada, con visión funcional a varias distancias de trabajo, y con poca incidencia de fenómenos disfotópsicos, que puede proporcionar a los pacientes independencia de ayudas ópticas para sus tareas cotidianas. En el Capítulo 2 se justifica la importancia del estudio de una solución combinada para las cataratas y la presbicia y se plantean la hipótesis y los objetivos de la Tesis Doctoral. En el Capítulo 3 se describe la metodología general que se va a seguir en los estudios clínicos que componen esta Tesis Doctoral. Se exponen las características de las muestras de sujetos estudiadas y los criterios de inclusión y exclusión. Se detallan las características de las LIOs implantadas y se describen los instrumentos de medida utilizados en posteriores capítulos para obtener los resultados, así como los procedimientos estadísticos para evaluar dichos resultados y sacar de ellos conclusiones. El Capítulo 4 se centra en describir el rendimiento visual de una muestra de 32 pacientes implantados bilateralmente con la LIOMTFRF Lentis Mplus. Para ello se presentan resultados refractivos y de visión 6 meses tras la intervención. Se describe la curva de desenfoque monocular, que permite conocer el rendimiento de la LIO a distintas distancias, y se presentan las curvas de SC medidas en los sujetos implantados con esta LIO. Se les suministra también a los sujetos un cuestionario de calidad visual para conocer su apreciación subjetiva sobre la visión tras la intervención. Los resultados demuestran un excelente comportamiento de la LIO en VL y VI, y un resultado algo más discreto en VP, con muy poca incidencia de fenómenos disfotópsicos, y SC similar a la de las LIO monofocales (LIOMNF) en VL, con peor resultado en frecuencias espaciales altas en VP. En el Capítulo 5 se presenta un método para intentar mejorar los resultados obtenidos con la LIOMTFRF Lentis Mplus: implantar monocularmente esta LIO en un ojo y combinarla con implante en el ojo contralateral del mismo sujeto de una LIOMTFDF bifocal Acri.LISA. Los resultados en una muestra de 40 pacientes señalan que este implante combinado, conocido como “Mix&Match”, consigue mantener las ventajas que tiene cada una de las LIOMTFs por separado, y superar sus limitaciones al combinarse, obteniéndose un mayor rango de distancias a las que los pacientes consiguen visión funcional sin ayudas ópticas. La SC con este implante combinado se asemeja en VL a la de pacientes implantados con LIOMNF excepto para la frecuencia espacial de 18 cpg, mientras que en VP la SC del implante combinado es menor a la de las LIOMNF para las frecuencias espaciales medias y altas. Los pacientes refieren poca incidencia de fenómenos disfotópsicos y elevada satisfacción con el resultado de la intervención. En el Capítulo 6 se presenta un estudio clínico para valorar la validez de las medidas de autorefractómetro (AR) en ojos implantados con la LIOMTFRF Lentis Mplus. Se comparan las mediciones de AR con la refracción subjetiva (RS) en 86 ojos implantados con dicha LIO, haciendo uso del formalismo vectorial. Mediante gráficos de Bland Altman y coeficientes de correlación se llega a la conclusión de que la AR es válida para obtener una estimación de la esfera, para lo que hay que sumar 1.25 D al resultado de la esfera de la AR. Con respecto al cilindro, la mejor estimación se obtiene partiendo del resultado del cilindro queratométrico. En el Capítulo 7 se presentan 4 casos de pacientes implantados con LIOMTFRF Lentis Mplus en los que una mala interpretación de los resultados de la AR, y un desconocimiento de la curva de desenfoque de dicha LIO, llevan a considerar miopes o emétropes a ojos que en realidad han quedado hipermétropes tras la intervención. Se detalla una explicación original de los errores cometidos y se plantea un método, también original e ideado por el autor de esta Tesis Doctoral, para verificar si la RS obtenida en ojos implantados con LIOMTFRF Lentis Mplus es correcta, o si por el contrario está influenciada por el “error de foco”, derivado del hecho de poder obtener la RS a través del foco de cerca de la LIO. En el Capítulo 8 se compara el resultado visual obtenido en 4 grupos distintos, de 20 pacientes cada uno de ellos, implantados con diversas LIOMTFs. El estudio es retrospectivo y se recogen datos un año tras la intervención. En el primer grupo se incluyen sujetos implantados bilateralmente con LIOMTFDF trifocal Acri.LISA 839MP, en el segundo grupo se incluyen pacientes implantados bilateralmente con LIOMTFDF bifocal Acri.LISA 366D, en el tercer grupo se implanta bilateralmente la LIOMTFRF Lentis Mplus, y en el último grupo se realiza el implante combinado o “Mix&Match” presentado en el Capítulo 5. Tras comparar sus curvas de desenfoque se llega a la conclusión de que las soluciones con mejor funcionalidad son el implante bilateral de la LIOMTFDF Acri.Lisa trifocal y el implante “Mix&Match” combinando LIOMTFRF Lentis Mplus en un ojo y LIOMTFDF Acri.LISA bifocal en el contralateral. En el Capítulo 9 se exponen las conclusiones finales derivadas del análisis de los datos obtenidos en todos los estudios. Finalmente, en el Capítulo 10 se plantean futuras líneas de investigación necesarias para seguir obteniendo mayor conocimiento de los implantes de LIOMTFs.Presbyopia and cataracts are two ocular conditions related to the aging of the eye lens, which present a high joint incidence above 60 years old. Given the trend, clearly visible in population pyramid studies, to the aging of the world population due to the greater life expectancy, both conditions will have an enormous impact in the future. Both share a common therapeutic option: replacement of the lens with a multifocal intraocular lens (MTFIOL), which allows patients to restore their vision obtaining a wide range of distances with functional vision without the need for optical aids. Nowadays there are several MTFIOL designs, each of them with its virtues and its limitations. The bifocal diffractive MTFIOLs shifted the first refractive MTFIOL models with annular design, given the better near vision results; but their results in intermediate vision were insufficient. For this reason, refractive MTFIOL with a rotationally asymmetric segmented design were developed, with which the intermediate vision problem was solved almost completely. However, the results of these IOLs in near vision were more discrete than with diffractive bifocal models. For this reason, combined implants were performed, with refractive segmented MTFIOL in one eye and diffractive MTFIOL in the contralateral eye of the same patient, thus increasing the range of vision by adding the advantages of each of the models. Recently there has been a further step in the MTFIOL designs: trifocal MTFIOLs, which are an evolution of bifocal models, with one more focus for intermediate vision. This Doctoral Thesis investigates the performance of segmented refractive MTFIOLs, and its comparison with the performance of other multifocal systems. The guiding principle of the studies presented in this Doctoral Thesis is the direct clinical application to patients with whom I work in my daily optometric practice in an ophthalmologic clinic. Chronologically, the patients we attend seeking independence of optical aids, have consecutively passed through the solutions proposed in each of the chapters, until arriving at the solution we are currently working with, presented in Chapter 8 of this Doctoral Thesis. Chapter 1 presents a general introduction, exposing several aspects related to presbyopia and cataracts, and discusses the therapeutic options for both conditions. Once all the treatment options have been presented, the objective is focused on the study of the only option that can treat both conditions simultaneously: the replacement of the eye lens by a MTFIOL. A review of the different MTFIOL technologies is presented. Among all the options available, the Doctoral Thesis focuses on the study of a particular MTFIOL: the refractive MTFIOL Lentis Mplus (Oculentis, Germany). This MTFIOL seems a balanced solution, with functional vision at various working distances, with little incidence of photic phenomena, and which can provide patients with independence of optical aids for their daily tasks. In Chapter 2, the importance of the study of a combined solution for cataracts and presbyopia is justified and the hypothesis and objectives of the Doctoral Thesis are presented. Chapter 3 describes the general methodology that will be followed in the clinical studies composing this Doctoral Thesis. The characteristics of the samples of subjects studied and the inclusion and exclusion criteria are presented. The characteristics of the implanted IOLs are detailed and the measurement instruments used in subsequent chapters to obtain the results are described, as well as the statistical procedures to evaluate the results and draw conclusions from them. Chapter 4 focuses on describing the visual performance in a sample of 32 patients bilaterally implanted with the Lentis Mplus MTFIOL. Refractive and visual results are presented 6 months after the surgery. The monocular defocus curve is described, which allows to know the IOL performance at different distances. The contrast sensitivity (CS) curves are presented in the subjects implanted with this MTFIOL and compared to those obtained in patients implanted with monofocal IOLs. Subjects are also given a visual quality questionnaire to know their subjective appreciation of the vision after the intervention. The results show an excellent IOL behavior in far and intermediate vision, and a somewhat more discrete result in near vision, with very little incidence of photic phenomena, and similar CS to that of monofocal IOLs in far vision, with a worse result at high spatial frequencies for near vision. Chapter 5 describes a method proposed to improve the results obtained with the bilateral implante of the Lentis Mplus MTFIOL: to implant this IOL monocularly in one eye combined with an implant of an Acri.LISA diffractive bifocal IOL in the contralateral eye of the same subject. The results in a sample of 40 patients indicate that this combined implant, known as "Mix & Match", allows to maintain the advantages of each of the MTFIOLs separately, and overcome their limitations when combined, obtaining a greater range of distances with functional vision without optical aids. The CS with this combined implant resembles in far vision to that of patients implanted with monofocal IOLs except for the 18 cpd spatial frequency. The CS of the combined implant in near vision is lower than that of the monofocal IOL for the middle and higher spatial frequencies. The patients reported low incidence of photic phenomena and high satisfaction with the outcome of the intervention. Chapter 6 presents a clinical study to assess the validity of the measurements of automated refraction (AR) in eyes implanted with the Lentis Mplus MTFIOL. Subjective refraction (SR) measurements were compared to AR measurements in 86 eyes implanted with this IOL, using vector formalism. By means of Bland Altman's graphs and intraclass correlation coefficients, it can be concluded that the AR is valid to obtain an estimate of the SR sphere, just adding +1.25 D to the result of the sphere of AR. With respect to the cylinder, the best estimate is obtained from the result of the keratometric cylinder. In Chapter 7, four cases of patients implanted with Lentis Mplus MTFIOL are presented, in which a misinterpretation of the results of AR, and a lack of knowledge of the IOL's defocus curve, lead to an incorrect determination of the refractive status of those eyes. An original explanation of the error is presented and a method, also original and devised by the author of this Doctoral Thesis, is presented to verify if the SR obtained in eyes implanted with Lentis Mplus MTFIOL is correct, or if on the contrary it is influenced by the "error of focus", derived from performing SR through the near focus of the IOL. In Chapter 8 the visual result obtained in 4 different groups, with 20 patients each, implanted with various MTFIOLs is presented. The study is retrospective and data were collected one year after the surgery. In the first group subjects were bilaterally implanted with Acri.LISA 839MP trifocal IOL; in the second group, patients were bilaterally implanted with Acri.LISA 366D bifocal IOL; in the third group Lentis Mplus MTFIOL was bilaterally implanted; and in the last group patients were implanted with the combined or "Mix & Match" system presented in Chapter 5. After comparing their defocus curves it can be concluded that the solutions with better functionality are the bilateral implant of the Acri.Lisa trifocal IOL and the "Mix & Match" implant combining Lentis Mplus MTFIOL in one eye and Acri.LISA bifocal IOL in the contralateral eye. General conclusions derived from the analysis of the data obtained in all studies are presented in Chapter 9. Finally, Chapter 10 discusses future lines of research necessary to achieve better knowledge of MTFIOL implants performance

Validation of a set of compact and low-cost Stokes lenses aimed at refractive astigmatism measurement for optometric practice

We describe the construction and characterization of three Stokes lenses that can be used in optometric practice to measure different ranges of refractive astigmatism using subjective routines. The proposed set of Stokes lenses is assembled from Risley prism mounts coming from a Nidek phoropter in which the optical prisms are replaced by three different sets of cylindrical lenses ( ± 0.75, ± 1.25, and ± 1.75 D) coming from a trial lens case to cover a different astigmatism range (1.5, 2.5, and 3.5 D in modulus, respectively). We present the experimental characterization of the three Stokes lenses with the power vector notation and use an automatic lensmeter (Topcon CL-300) for dioptric power measurement. The measured dioptric power profiles are in concordance with the theoretical predictions, and statistical testing reveals no differences between measured and theoretical values for the three lenses, neither in spherical nor in cylindrical components (p ≥ 0.05 for all cases). Bland-Altman plots show very good agreement between measured and theoretical values with limits of agreement below 0.12 D for both M and J components for the three lenses. These Stokes lenses can be easily constructed from regular Risley prism mounts, so they can be used in almost any phoropter model for refractive error compensation

Artiflex Toric Phakic Intraocular Lens Implantation in Congenital Nystagmus

Case: A 44-year-old woman with congenital nystagmus and myopic astigmatism in both eyes who was submitted to phakic intraocular lens (pIOL) implantation. Methods: Full ophthalmologic examination including refractive status, corrected (CDVA) and uncorrected (UCVA) monocular and binocular visual acuities, ocular motility, slit-lamp evaluation, tonometry and fundoscopy before and after implantation of toric pIOLs (Artiflex; Ophtec BV, The Netherlands) in both eyes. Results: Preoperative logMAR CDVA were 0.699 and 0.420 in the right and left eye, respectively. Three months after surgery, logMAR UCVA were 0.398 and 0.182, reaching binocular logMAR UCVA of 0.132. There were no changes in nystagmus characteristics after surgery. Conclusions: pIOL implantation may be a safe and suitable treatment to correct high refractive errors in patients with congenital nystagmus. Significant improvement in CDVA and UCVA can be achieved

Visual Performance of Two Designs of Myopia Management Soft Contact Lenses Compared with a Monofocal One in Young Adults

Purpose: To compare the visual performance of two distinct types of soft contact lenses (CL) aimed at slowing down myopia progression with the performance of a monofocal soft CL. Methods: In a prospective double-masked, crossover trial, 18 myopic adults (aged 18–30 years old) were fitted in a randomized order with three types of disposable CL: MiSightTM (dual-focus), MyloTM (extended depth of focus -EDOF-), and ClaritiTM (single distance vision). Measurements were taken after wearing the CL for five days with five days off in between at two different optometry centers. High contrast distance visual acuity (VA) with spectacles and for each of the different CL, subjective refraction, slit lamp exam, aberrometry, stereopsis, monocular and binocular amplitude of accommodation and accommodative facility, and horizontal phorias were measured. Results: The high contrast distance VA was better for the single vision CL compared to the myopia control CL. No significant differences were observed between the r two myopia control CL. The overall root mean square (RMS) was higher for the double focus CL (RMS = 1.18 ± 0.29 μm), followed by the EDOF CL (RMS = 0.76 ± 0.35 μm) and then the single vision CL (RMS = 0.50 ± 0.19 μm). The primary spherical aberration (SA) mean value was low for all of the three CL, without statistical differences among them. No other significant differences were detected. Conclusion: The overall RMS resulted in a higher value for the dual-focus than the EDOF CL, but no differences in high contrast distance VA and binocularity were detected between them. The monofocal CL’s performance was better than the myopia control CL

Influence of instrumental factors in the measurement of power profiles of intraocular lenses with a commercial deflectometer

Deflectometry is an optical technique for determining properties such as power distribution, wavefront, etc., and measurement of the optical properties of an intraocular lens can provide relevant information for clinicians. The aim of the current study was to establish a protocol for measuring lens power maps and profiles of various optical designs of intraocular lenses with a deflectometer based on the phase-shifting Schlieren principle (NIMO TR1504, Lambda-X, Nivelles, Belgium). The results are discussed with respect to accuracy and repeatability, the influence of the use of filters, and whether to consider the intraocular lens as a thin or thick len

Impact of lens material on objective refraction in eyes with trifocal diffractive intraocular lenses

Purpose: Compare subjective (Rx) and objective (ObjRx) refractions outcomes with two autorefractors models and an aberrometer in eyes implanted with a hydrophobic trifocal IOL (FineVision POD F GF, Physiol, Liége, Belgium) and a hydrophilic one (FineVision POD F, Physiol, Liége, Belgium). Methods: Prospective comparative cohort study, with 100 subjects randomly assigned to either the POD F group (n = 50) or the POD F-GF group (n = 50). Postoperative eye examinations at 1-month visit included seven result sets, one for each assessment method: Rx, AR (automated refraction measured with the autorefractor KR8800), WF-P (Zernike-coefficients-based objective refraction, photopic pupil size), WF-M (Zernike-coefficients-based objective refraction, mesopic pupil size), WF-4 (Zernike-coefficients-based objective refraction, 4 mm pupil), OPD-C (automated refraction measured with the aberrometer OPD in the central pupil/photopic conditions), and OPD-M (automated refraction measured with the aberrometer OPD under mesopic conditions). Results: Mean differences between ObjRx and Rx reached statistical significance for sphere and spherical equivalent (M) only with OPD-C in the POD F-GF group. All ObjRx methods showed significant differences with Rx in the POD F group, with some values differing by more than 0.50 D (-0.58 D in M for the WF-P). Bland Altman plots showed better agreement for the astigmatic components, and for sphere and spherical equivalents in both IOL groups measured with AR and OPD-M. Conclusions: None of the objective methods of refraction evaluated in this study were as reliable as the subjective refraction, irrespective of the lens material, but POD F-GF ObjRx seems to differ less with Rx than POD F ObjRx values.Award-winningPostprint (author's final draft

Changes in anterior chamber eye during accommodation as assessed using a Dual Scheimpflug system

Purpose: To study the changes in anterior chamber depth (ACD), anterior chamber angle (ACA), and pupil diameter (PD) during accommodation. Methods: Eighty eyes of 80 subjects, aged 22 to 40 years, were included. The rotating Dual Scheimpflug and a Placido disc system (Galilei G4, Ziemer Ophthalmic Systems AG, Switzerland) was used to measure the changes in ACD, ACA, and PD during accommodation. ACD measurement was taken for the central zone and for 4 more positions, each in different orientation (nasal, superior, temporal and inferior), 4 mm away from the centre. ACA was measured for the whole eye as well for the nasal, superior, temporal, and inferior quadrants. These metrics were obtained for various accommodation stimuli, ranging from +1 D to -4 D in 1-D steps. Results: For a given position, the ACD did not vary significantly with accommodation. For the central ACD, the percentage of relative change between far and near vision was -4.11%. The ACA was significantly lower at the inferior, temporal, and superior positions. There was no change in the ACA of the whole eye and that of the nasal orientation. These two eye metrics were significantly lower in the superior-nasal than in the inferior-temporal region. At each vergence studied, the PD decreased significantly with accommodation. The relative change after the -4 D stimulus was -8.13%. Conclusion: ACA and PD varied significantly with accommodation, whereas no such variation of ACD was observed. Further, the anterior chamber was found to be asymmetrical, with the nasal-superior area becoming significantly shallower than the inferior temporal region

Subjective refraction using power vectors by updating a conventional phoropter with a Stokes lens for continuous astigmatic power generation

Purpose: To implement a pure power vector method for monocular subjective refraction using a regular phoropter with the only modification being the inclusion of a Stokes lens. The proposed methodology was tested with three different Stokes lenses, and the results were compared with conventional clinical refraction procedures. Methods: Power vector subjective refraction was performed by attaching a Stokes lens to the Risley prism holder. Stokes lenses allow for pure astigmatic compensation in the form of the J0, J45 components while the spherical lenses in the phoropter allow determination of the spherical component in the form of M (spherical equivalent). The proposed routine is presented step-by-step using three Stokes lenses having different astigmatic powers. Results: Monocular subjective refraction was performed on 26 healthy subjects with a mean age of 44 ± 16 years, mean spherical equivalent of −0.56 D (range −5.50 to +2.38 D) and refractive astigmatism ≤1.50 D. No differences were found between the results obtained with the conventional technique versus the vector-based procedure for the spherical equivalent (p = 0.28) or astigmatic components (p = 0.34). In addition, visual acuity (VA) was equivalent through the refractions measured with the conventional and vector procedures (p = 0.12). Repeatability coefficients for J0 and J45 with the new vector methodology were <0.38 D. Conclusions: The proposed routine could be helpful for cases where it is difficult to get a valid starting point for conventional refraction (e.g., irregular corneas and media opacities), for testing facilities with limited resources/equipment and/or for motivated clinicians who wish to know about alternative methods of refractive error determination

Influence of Intravitreal Therapy on Choroidal Thickness in Patients with Diabetic Macular Edema

Objective: This study aimed to analyze the variation in subfoveal choroidal thickness (SFCT) and its relationship with the variation in central macular thickness (CME) in response to intravitreal therapy with an antiangiogenic (anti-VEGF) drug or corticosteroid in type 2 diabetic patients with diabetic macular edema (DME). Material and methods: This retrospective study included 70 eyes of 35 patients: 26 eyes received 4−5 intravitreal injections of aflibercept, 26 eyes were treated with a single intravitreal implant injection of dexamethasone, and 18 eyes without DME did not receive intravitreal therapy. SPECTRALIS® optical coherence tomography (OCT) (Heidelberg Engineering, Heidelberg, Germany) was used to measure the SFCT and CME before and at the end of the follow-up period. Results: The mean reductions in CME were 18.8 +/− 14.7% (aflibercept) and 29.7 +/− 16.9% (dexamethasone). The mean reductions in SFCT were 13.8 +/− 13.1% (aflibercept) and 19.5 +/− 9.6% (dexamethasone). The lowering effects of both parameters were significantly greater in the group treated with the dexamethasone implant (p = 0.022 and p = 0.046 for CMT and SFCT, respectively). Both therapies significantly decreased both CME and SFCT, independent of factors such as age, sex, previous intravitreal therapy, antidiabetic treatment, and the time of diabetes progression. There were no changes in the mean values of CME and SFCT in the untreated eyes. Conclusions: SFCT significantly decreased in response to intravitreal therapy with anti-VEGF or corticosteroids, irrespective of age, sex, previous intravitreal therapy, antidiabetic treatment, and the time of diabetes progression. There was a correlation between the changes in CME and SFCT after intravitreal therapy with aflibercept or dexamethasone implantation. SFCT was not a good predictor of the CME response but could be used to monitor the response to treatment. Local intravitreal therapy only affected the treated eye