## 4 Discussion
Overall, they demonstrated that an increased reflectivity of the EZ, the presence of SRF, and the absence of DRIL at baseline are associated with greater functional recovery following intravitreal injection [36]. In the present study, we did not assess functional visual outcomes. However, we aimed to analyze and integrate qualitative and quantitative retinal biomarkers indicative of inflammation [37], evaluating their influence on inducing changes in choroidal and retinal vascularization, specifically in relation to the CVI. Our statistical analysis did not show any significant influence of these inflammatory parameters on the CVI. The reason for this observation is unclear and remains a relationship that has not yet been explored in the literature. A potential explanation for the independence of the CVI from inflammatory biomarkers in our study, despite intravitreal dexamethasone injections, could be that the inflammatory parameters remained largely stable without statistically significant changes, unlike CMT, which did exhibit expected variations following intravitreal dexamethasone treatment. Further studies are needed to investigate this relationship more deeply and to clarify the potential role of the CVI as a marker for inflammatory changes in retinal conditions following different therapeutic interventions. Our study has some limitations: the retrospective design, the relatively small sample size, and the short follow-up time. In the present study, we did not include systemic health variables, such as glycated hemoglobin (HbA1c), average blood pressure, or lipid profiles of the analyzed patients. These factors are known to influence systemic and microvascular circulation, potentially affecting vascular health. Elevated blood glucose, poor blood pressure control, and dyslipidemia can all contribute to endothelial dysfunction, increased vascular inflammation, and oxidative stress, which are key mechanisms in the pathogenesis of diabetic vascular complications [38; 39]. These systemic factors may also affect the choroidal vasculature and, consequently, the CVI [40; 41]. However, data specifically linking these parameters to CVI changes, particularly in response to intravitreal dexamethasone treatment, are currently limited. In conclusion, the CVI, as previously shown, is a reliable and repeatable parameter for evaluating the vascular and structural features of the choroid. It tends to decrease in diabetic patients in direct proportion to disease severity. The reduction in CVI in diabetic patients with DME treated with intravitreal dexamethasone suggests that the therapy influences choroidal circulation. The CVI could potentially serve as an objective biomarker for treatment response in DME. However, further investigations with larger prospective studies with longer follow-up periods are needed to clarify the choroidal changes caused by intravitreal dexamethasone implants. Conceptualization, M.D.P. and S.A.; methodology, M.D.P., D.F. and E.M.; resources, M.D.P. and F.R. ; data curation, D.F., E.M. and S.A.; writing--original draft preparation, M.D.P., F.R. and E.M.; writing--review and editing, D.F. and S.A.; visualization, M.D.P. and D.F. ; supervision, M.D.P. and S.A. All authors have read and agreed to the published version of the manuscript. This research received no external funding. This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Sapienza University n\({}^{\circ}\)5602/2020, (15/09/2020). Informed Consent Statement: Informed consent was obtained from all subjects involved in this study. Written informed consent has been obtained from the patients to publish this paper. Data Availability Statement: The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author. The authors declare no conflicts of interest.