Combined Intravitreal Dexamethasone Implant and Cataract Surgery in Patients with Diabetic Retinopathy: Effect on Retinal Morphology and Function

Minnella, Angelo Maria; Picardi, Stefano Maria; Placidi, Giorgio; Siena, Elisa De; Rizzo, Stanislao; Falsini, Benedetto

doi:10.1007/s12325-020-01506-8

Cited by 4 publications

(4 citation statements)

References 28 publications

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“…32,33 Previous literature showed the effectiveness of DexI in DME undergoing cataract surgery. [21][22][23][24][25][26]34 Our results fit with them. However, it is no easy to compare our study with the current evidence, since in addition to their shorter follow-up, most of these studies have done DEX implantation at the time of cataract surgery [21][22][23][24][25][26] and only one 26 performed DEX implantation within one month before cataract surgery.…”

Section: Discussionsupporting

confidence: 83%

“…Although, up to now, there is not standard of care approach for improving cataract surgery functional outcomes in DME patients, the capacity of corticosteroids for inhibiting different process involved in the progression of DME, by anti-inflammatory properties 19 and vascular endothelial growth factor (VEGF) inhibition, 20 found clinical confirmation in the increasing evidence suggesting that perioperative use of DexI in DME patients undergoing cataract surgery may improve surgical outcomes. [21][22][23][24][25][26] This study aimed to assess the impact of preoperative DexI on functional and anatomic outcomes in DME patients who underwent phacoemulsification cataract surgery.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study

Vadalà

Trapani

Amato

et al. 2021

European Journal of Ophthalmology

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Purpose To assess the impact of preoperative intravitreal dexamethasone implant (DexI) on functional and anatomic outcomes in patients with diabetic macular edema (DME) who underwent phacoemulsification cataract surgery. Methods Prospective and non-comparative study conducted on consecutive DME patients undergoing cataract surgery. DexI was administered 15 days before surgery and in a pro re nata regime after surgery. Main outcome measures were mean change in central retinal thickness (CRT), central subfield thickness (CST), total macular volume (TMV), and central subfield volume (CSV) from baseline to month-12. Secondary outcome was mean change in best corrected visual acuity (BCVA). Results Forty eyes were included in the study. CRT significantly decreased from 410.4 ± 64.8 µm at baseline to 303.2 ± 24.3 µm at month-12, p < 0.0001. Similarly, CST was significantly reduced from 436.4 ± 120.4 µm at baseline to 322.9 ± 54.2 µm at month-12, p < 0.0001. Total macular volume and CSV were significantly reduced from 9.95 ± 1.68 mm3 and 0.38 ± 0.11 mm3 at baseline to 8.49 ± 0.83 mm3 and 0.31 ± 0.05 mm3 at month-12, respectively ( p < 0.0001 each, respectively). BCVA significantly improved from 0.26 ± 0.17 Snellen equivalent at baseline to 0.65 ± 0.19 at month-12, p < 0.0001. Mean DexI administered during the study were 2.0 ± 0.3. Neither DME subtype nor previous treatment status had any effect on functional or anatomic outcomes. Regarding safety, one (2.5%) eye developed ocular hypertension, which was successfully controlled with topical hypotensive treatment. Conclusions DexI was and effective and safe strategy for managing DME in diabetic patients undergoing uneventful cataract surgery.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study

Vadalà

Trapani

Amato

et al. 2021

European Journal of Ophthalmology

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“…There is a growing evidence base for the use of intraoperative Ozurdex® in diabetic patients requiring cataract surgery. Many studies are small in scale [ 20 - 21 ], with resultant limited power making a conclusion on efficacy and risk more challenging, although positive conclusions are consistent, including in larger studies [ 18 ]. In this study, the vast majority of patients either improved or remained stable in terms of CMT over the three months post-operative monitoring period.…”

Section: Discussionmentioning

confidence: 99%

Combined Phacoemulsification and Intravitreal Dexamethasone Is an Effective Option for High-Risk Diabetic Macula Oedema Patients

Thirunavukarasu

Malem

Mourtzoukos

2021

Cureus

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Cataract surgery in diabetic patients carries an increased risk of post-operative macula oedema, particularly in those with a history of diabetic macula oedema (DMO) treatment or DMO at the time of surgery. We investigated whether simultaneous phacoemulsification with intravitreal Ozurdex ® reduces the risk of developing new, or deteriorating current, DMO. MethodsWe conducted a retrospective review of 79 consecutive 'high-risk' diabetic patients who underwent phacoemulsification with intraocular lens insertion and intravitreal Ozurdex ® implantation immediately subsequently. 'High risk' was defined as diabetic patients with prior treatment history for DMO or current DMO. Central macula thickness (CMT), best-corrected visual acuity and intraocular pressure were recorded pre-operatively, at two to four weeks and at three months post-operatively. A significant change in CMT was defined as a change of ≥0.1 LogOCT units. ResultsThe mean age was 72.6 years; 52% were males. The mean pre-operative CMT was 365um. Thirty-seven per cent (37%) patients had prior DMO history that had resolved; 63% had confirmed DMO in surgery. Two to four weeks post-operatively, 82% of patients had stable CMT and 18% showed improvement. No patients deteriorated. Three months post-operatively, 48% of patients had stable CMT relative to pre-operative measurements, 38% improved, and 14% deteriorated. Analysis of variance (ANOVA) indicated no significant differences in response with demographical or pathological factors, including diabetic retinopathy grade and treatment history. ConclusionPhacoemulsification surgery combined with Ozurdex ® insertion at the end of the procedure is a highly effective strategy for protecting against the formation of new, or the deterioration of current DMO, in the highest risk diabetic patients undergoing cataract surgery.

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“…More recently, increasing attention has been drawn to the use of the 0.7 mg dexamethasone intravitreal implant (DEX) combined with cataract surgery in patients with DMO. Anatomic and functional outcomes of this combined procedure seem promising [8,9,[14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis

Fallico

Lotery

Maugeri

et al. 2021

Eye

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To compare outcomes of cataract surgery combined with either anti-Vascular Endothelial Growth Factor (anti-VEGF) therapy or dexamethasone implant (DEX) in patients with diabetic macular oedema (DMO). METHODS: Pubmed and Embase databases were searched for studies reporting outcomes of diabetic cataract surgery combined with either anti-VEGF or DEX, with a follow-up ≥3 months. The primary outcome was the mean change in central macular thickness (CMT). Mean change in best corrected visual acuity (BCVA) was considered as a secondary outcome. The mean difference between baseline and post-treatment values (MD) with 95%-Confidence Interval (95%CI) was calculated and meta-analyses were performed. RESULTS: Nine-teen studies were included, 8 in the DEX group and 11 in the anti-VEGF group. A significant reduction of macular thickness was shown in the DEX group at 3 months (MD = −98.35 µm; 95% CI, −147.15/−49.54), while mean CMT change was nonsignificant in the anti-VEGF group (MD = −21.61 µm; 95% CI, −59.46/16.24; test of group differences, P < 0.001). At 3 months, no difference in visual gain was found between the two groups (P = 0.13). CONCLUSIONS: In DMO patients, cataract surgery combined with DEX seems to provide better anatomical outcomes compared with cataract surgery combined with anti-VEGF therapy. However, our evidence was limited by significant heterogeneity. Randomised trials comparing these two different combined approaches are warranted.

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Combined Intravitreal Dexamethasone Implant and Cataract Surgery in Patients with Diabetic Retinopathy: Effect on Retinal Morphology and Function

Cited by 4 publications

References 28 publications

Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study

Intraoperative dexamethasone intravitreal implant in diabetic macular edema patients undergoing phacoemulsification: The CataDex study

Combined Phacoemulsification and Intravitreal Dexamethasone Is an Effective Option for High-Risk Diabetic Macula Oedema Patients

Intravitreal dexamethasone implant versus anti-vascular endothelial growth factor therapy combined with cataract surgery in patients with diabetic macular oedema: a systematic review with meta-analysis

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