The aim of this article is to provide an overview of characteristics and principles of use of dexamethasone implant in patients with diabetic macular edema (DME). The condensed information about patient selection, dosing, and postinjection management is provided to make the clinician’s decisions easier in real-life practice. DME is a common complication of diabetes and the leading cause of visual loss in the working-age population. Inflammation plays an important role in the pathogenesis of DME. The breakdown of the blood–retinal barrier involves the expression of inflammatory cytokines and growth factors, including vascular endothelial growth factor (VEGF). Steroids have proved to be effective in the treatment of DME by blocking the production of VEGF and other inflammatory cytokines, by inhibiting leukostasis, and by enhancing the barrier function of vascular endothelial cell tight junctions. Dexamethasone intravitreal implant has demonstrated efficacy in the treatment of DME resistant to anti-VEGF therapy and in vitrectomized eyes. Data from clinical trials suggest that dexamethasone implant can be considered as first-line treatment in pseudophakic eyes. Dexamethasone implant is also the first-line therapy in patients not suited for anti-VEGF therapy, pregnant women, and patients unable to return for frequent monitoring. It has been shown that the maximum effect of dexamethasone implant on visual gain and retinal thickness occurs approximately 2 months after injection. Various treatment regimens are used in real-life situations, and reported reinjection intervals were usually <6 months. The number of retreatments needed decreased over time. Treatment algorithms should be personalized. Postinjection management and follow-up should consider potential adverse events such as intraocular pressure elevation and cataract.

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Intravitreal bevacizumab (IVB) treatment of macular edema due to CRVO improved standard morphological measures and the electrophysiological function of outer and inner retinal layers, which was most evident in central retina.

SUMMARY The aim was to evaluate visual outcomes of the real-life usage of dexamethasone (DEX) implants in diabetic macular edema (DME) patients and evaluate the possible additional visual acuity (VA) gain with combined treatment. We retrospectively reviewed medical records of DME patients treated with DEX implants. The mean best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT) at baseline and one year were compared. BCVA improved from 58.4±14.9 letters at baseline to 62.4±14.5 letters at one-year evaluation (p=0.002). The mean change in BCVA was 5.2±11.1 letters. CRT decreased from 485.7±146.3 µm at baseline to 391.5±129.0 µm at one year (p<0.001). The mean change in CRT was -89.6±143.3 µm. Patients received a mean of 2.0±0.7 DEX implants. Study eyes were also divided into a group receiving DEX implant monotherapy and a group receiving DEX implant and vascular endothelial growth factor inhibitor (anti-VEGF) therapy. Changes in BCVA and CRT and the number of DEX implant injections were compared between the two groups. No difference in VA gain was found between the eyes receiving monotherapy and the eyes receiving combined treatment. In conclusion, DEX implant therapy was effective in gaining vision in DME patients. No additional VA gain was achieved with combined treatment.