Dexamethasone Implant as an Adjunct Therapy in Refractory Diabetic Macular Edema: Real-World Experience in a Turkish Population.

Abstract

INTRODUCTION: To evaluate,in a real-world setting, the effects of intravitreal dexamethasone (DEX) implants in patients with refractory diabetic macular edema after 3 initial anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: Each enrolled patient received a DEX implant after suboptimal response to 3 monthly anti-VEGF injections and was followed for 12 months. A second DEX implant was allowed at least 6 months later. Anti-VEGF injections were administered on a pro re nata (PRN) regimen after DEX implant. Predictive factors for visual and morphological outcomes and additional therapies during follow-up were evaluated. RESULTS: Among 81 included eyes, mean central macular thickness (CMT) decreased from 583+-178 µm to 259+-119 µm, and 28 eyes (35%) gained more than 5 ETDRS letters after 1 month. Visual acuity significantly improved most commonly in patients with intact ellipsoid zones. The decrease in CMT was positively correlated with baseline CMT and cyst size. Despite the PRN protocol, significant losses in improvements were seen after 6 months compared to 1 month in the percentage of eyes with CMTs smaller than 300 µm (47% vs 75%) and losing at least5 ETDRSletters (16% vs 5%; P <0.001). The values at 6 and 12 months were not statistically different. DISCUSSION AND CONCLUSION: A DEX implant is an option in eyes with suboptimal responses to 3 monthly anti-VEGF injections. In a real-world setting, anti-VEGF injections on a PRN regimen is not sufficient to preserve the benefits of a DEX implant for a period of 6 months.

Keywords

• dexamethasone
• diabetic macular edema
• intravitreal implant
• real-world data
• steroid