{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:34:31Z","timestamp":1787027671991,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Ophthalmlogy, University Hospital Brussels"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Diabetic macular edema (DME) is the most common cause of vision loss among diabetic patients. The first-line treatments for DME are anti-vascular endothelial growth factor (VEGF)-drugs, while intravitreal steroids are generally reserved for second-line treatment. Limited data exist on the role of optical coherence tomography (OCT) biomarkers as predictors of success in non-responders to anti-VEGF treatment undergoing simultaneous cataract surgery and dexamethasone intravitreal implant (DEX-I). Methods: This study was designed as a retrospective analysis of patients with DME who were refractory to anti-VEGF treatment but underwent cataract surgery and received a DEX-I at the time of surgery. All procedures were performed between May 2021 and February 2024. The best-corrected visual acuity (BCVA) and central subfoveal thickness (CST) were recorded at baseline and at 1 week, 1 month, and 3 months. The following OCT-based biomarkers were also collected: ellipsoid zone (EZ) integrity, disorganization of the retinal inner layers (DRIL), CST, and hyperreflective foci (HRF). Correlations between the baseline biomarkers and the anatomical outcome were analyzed using linear mixed models (LMMs). Results: Eleven patients (eighteen eyes) met the inclusion criteria. The mean CST decreased significantly from 469.4 \u00b1 53.8 \u00b5m at baseline, to 373.1 \u00b1 34.7 \u00b5m at 1 week (p = 0.002) and 354.4 \u00b1 24.1 \u00b5m at 1 month (p = 0.011). The mean BCVA improved significantly from 0.47 LogMAR to 0.33 LogMAR at 1 week (p = 0.001), 0.23 LogMAR at 1 month (p &lt; 0.001), and 0.25 LogMAR at 3 months (p &lt; 0.001). Baseline predictors significantly influencing CST included the presence of DRIL, a disrupted\/absent EZ, and a higher CST. Conclusions: The administration of DEX-I for DME refractory to anti-VEGF treatment in patients undergoing cataract surgery promoted functional improvements persisting longer than the anatomical ones. Patients presenting with DRIL, disrupted EZ, and higher CST at baseline may be better candidates for the combination of DEX-I and cataract surgery.<\/jats:p>","DOI":"10.3390\/bioengineering12050556","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T13:59:43Z","timestamp":1747835983000},"page":"556","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Predictive Value of Optical Coherence Tomography Biomarkers in Patients with Persistent Diabetic Macular Edema Undergoing Cataract Surgery Combined with a Dexamethasone Intravitreal Implant"],"prefix":"10.3390","volume":"12","author":[{"given":"Giuseppe","family":"Fasolino","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium"},{"name":"Department of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Lazaar","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium"},{"name":"Department of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico Giovanni","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium"},{"name":"Department of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silke","family":"Oellerich","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium"},{"name":"Department of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorcha","family":"N\u00ed Dhubhghaill","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium"},{"name":"Department of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), 1090 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.2174\/1570161117666190405165911","article-title":"The Growing Epidemic of Diabetes Mellitus","volume":"18","author":"Lovic","year":"2020","journal-title":"Curr. 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