Patient Preference and Adherence (Dec 2023)
Safety and Efficacy of Dexamethasone Intravitreal Implant Given Either First-Line or Second-Line in Diabetic Macular Edema
Abstract
Andrea Taloni,1,* Giulia Coco,2,* Davide Rastelli,3 Giacinta Buffon,2 Vincenzo Scorcia,1 Giuseppe Giannaccare4 1Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy; 2Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy; 3Department of Ophthalmology, Policlinico Casilino, Rome, Italy; 4Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy*These authors contributed equally to this workCorrespondence: Giuseppe Giannaccare, Full Professor of Ophthalmology, Eye Clinic, Department of Surgical Sciences, University of Cagliari, Via Università 40, Cagliari, 09124, Italy, Tel +0039 09613647041, Fax +0039 09613647094, Email [email protected]: Diabetic macular edema (DME) is a common sight-threatening complication of diabetic retinopathy (DR) and the leading cause of severe visual impairment among the working-age population. Several therapeutic options are available for the management of DME, including intravitreal corticosteroids. They have been traditionally used as second-line treatment, due to the risk of intraocular pressure increase and cataract-related adverse events. However, attention has recently been focused on the primary or early use of intravitreal corticosteroids, due to growing evidence of the crucial role of inflammation in the pathogenesis of DME. Furthermore, intravitreal steroid implants offer the additional advantage of a longer duration of action compared to anti-vascular endothelial growth factor agents (anti-VEGF). This review aims to summarize the available evidence on the efficacy and safety profile of dexamethasone (DEX) intravitreal implant, with a specific focus on clinical scenarios in which it might be considered or even preferred as first-line treatment option by adequate selection of patients, considering both advantages and possible adverse events. Patients with contraindications to anti-VEGF, DME with high inflammatory OCT biomarkers, pseudophakic patients and phakic patients’ candidates to cataract surgery as well as vitrectomized eyes may all benefit from first-line DEX implant. Additionally, DME not responders to anti-VEGF should be considered for a switch to DEX implant and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent DME.Keywords: diabetic macular edema, DME, dexamethasone intravitreal implant, DEX implant, corticosteroids, Ozurdex
