Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes

Abstract

Objectives: To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyes Materials and Methods: Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded. Results: Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p<0.01). CRT decreased significantly from 452 μm at baseline to 310, 368±34 and 375 μm after 1, 3 and 6 months, respectively (p<0.04). Mean IOP was 16±1.2 mmHg at baseline and 18.2, 18.8 and 18.5 mmHg after 1, 3, and 6 months (p>0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections. Conclusion: Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.

Comparison of Intravitreal Dexamethasone Implant and Posterior Subtenon Triamcinolone Injection in the Treatment of Diabetic Macular Edema in Vitrectomized Eyes

“…In vitrectomized eyes with DME, an increase in IOP was reported in the first 3 months after intravitreal DEX and TA injection, but no significant increase was reported after PSTA injection [1, 7-9, 11, 27, 30, 31, 33]. Similarly, we observed no significant increase in IOP at all follow-ups in the PSTA group and a significant increase in the DEX group at 1 and 3 months after injection.…”

“…It is also reported that vitrectomy did not change the efficacy of DEX in patients with DME [8, 30]. As reported in the literature, the highest effect of DEX occurs at 3 months in vitrectomized eyes with DME; although it is reported to decrease after that, some studies have reported that its effectiveness may last up to 6 months [1, 31, 32]. We also observed the maximum decrease in CMT at month 1 in our DEX group.…”

“…Diabetes mellitus is the leading cause of macular edema. Diabetic patients may need pars plana vitrectomy (PPV) for refractory diabetic macular edema (DME) as well as vitreous hemorrhage, proliferative diabetic reti-DOI: 10.1159/000526172 nopathy (PDR), and tractional retinal detachment [1][2][3]. Macular edema may occur, persist, or recur after PPV in eyes with diabetic retinopathy [4,5].…”

Evaluation of the Effect of Intravitreal Dexamethasone (Ozurdex^®) Implant on Intraocular Pressure in Vitrectomized and Non-Vitrectomized Eyes with Macular Edema

“…In another study evaluating the results of IVD implantation in patients with DME, IOP values between 21 and 35 mmHg were measured in both vitrectomized and non-vitrectomized eyes 1 to 3 months after administration and were controlled with topical treatment alone. 22 Özdemir et al 23 also showed in their study that vitrectomized eyes receiving IVD for a diagnosis of DME had significant IOP elevation at 1, 3, and 6 months after implantation. In a retrospective study of 59 vitrectomized and 127 non-vitrectomized eyes, the frequency of IOP higher than 25 mmHg or at least 10 mmHg over baseline was 21.3% in non-vitrectomized eyes and 29.3% in non-vitrectomized eyes, IOP-lowering medication was required in 26.0% of non-vitrectomized eyes and 28.8% of vitrectomized eyes, and there was no significant difference between vitrectomized and non-vitrectomized eyes in terms of the incidence of ocular hypertension in patients with DME.…”

Diabetic Macular Oedema Guidelines: An Australian Perspective

“…It is further well accepted that intravitreal corticosteroid implants are effective in improving VA and reducing macular oedema in patients with DMO [129][130][131][132][133][134][135][136][137][138][139][140][141][142][143][144][145][146][147][148]. To date, there are three potent synthetic corticosteroids used in the treatment of DMO: dexamethasone, fluocinolone acetonide, and triamcinolone acetonide.…”