Clinical Ophthalmology (Mar 2021)
Outcome of Single Dexamethasone Implant Injection in the Treatment of Persistent Diabetic Macular Edema After Anti-VEGF Treatment: Real-Life Data from a Tertiary Hospital in Jordan
Abstract
Motasem Al-Latayfeh,1,2 Mohammad Abdel Rahman,2 Raed Shatnawi1,2 1Department of General and Special Surgery, School of Medicine, The Hashemite University, Zarqa, Jordan; 2Department of Ophthalmology, Prince Hamza Hospital, Amman, JordanCorrespondence: Motasem Al-LatayfehThe Hashemite University, P.O. Box 150495, Zarqa, 13115, JordanTel +962797397711Email [email protected]: To analyze the real-life clinical outcome of a single dexamethasone implant (DEX) injection in the treatment of persistent diabetic macular edema (DME) after anti-vascular endothelial growth factor (anti-VEGF) agents in a sample of the Jordanian population.Methods: An observational case study design that involved a retrospective chart review analysis in a tertiary hospital in Amman, Jordan. Patients who showed persistent DME after receiving at least six doses of anti-VEGF agents for DME treatment were included.Results: The study population consisted of 72 participants (29 females, 43 males) having an average age of 66 years. All patients had best-corrected visual acuity (BCVA) less than 0.7 (6/9) and SD-OCT documented center-involved DME. The study results showed that the average baseline BCVA improved from 0.205± 0.1 before DEX injection to 0.358± 0.1 at 3 months post-injection (p< 0.0001). The central mean thickness (CMT) showed significant improvement also (539.347± 132.402 to 379.041± 99.430, p< 0.0001). There was a mean of 3 mmHg increase in intraocular pressure at 3 months post-injection (p< 0.0001), however, only 4% of patients required medical treatment. Other inflammatory biomarkers in OCT, such as intraretinal hyper-reflective dots (HRD), showed significant improvement also (23.67± 16 to 14.83± 13, p< 0.0001). No other significant safety concerns were noticed.Conclusion: A single DEX injection showed significant clinical and anatomical improvement in DME cases that are persistent after anti-VEGF treatment in our sample, with an excellent safety profile. In case of supply shortage of intravitreal injections, which occurs frequently at our center, a single DEX injection may be utilized as an effective DME therapy. Further research is mandated to identify clinical response in a larger sample and more frequent injections.Keywords: diabetic macular edema, dexamethasone, anti-VEGF, Ozurdex, Jordan
