Efficacy and Safety of Intravitreal Dexamethasone Implants for Treatment of Refractory Diabetic Macular Edema

Abstract

PurposeTo evaluate the safety and efficacy of intravitreal dexamethasone (IVD) implants in eyes with diabetic macular edema that did not respond to previous treatment.MethodsWe included 46 eyes of 46 patients in this retrospective study. Each month, we recorded patient visual acuity with logarithm of the minimum angle of resolution using the Early Treatment Diabetic Retinopathy Study chart, central macular thickness measurements with optical coherence tomography, intraocular pressure (IOP), and posttreatment complication occurrence.ResultsThe mean follow-up time was 8.95 ± 1.33 months (range, 6 to 12). Best-corrected visual acuity improved significantly in the first 4 months after IVD, but no statistically significant change was observed over the following 2 months. Although a statistically significant decrease in central macular thickness was observed in the first 3 months, the change was not statistically significant in the following 3 months. There was a statistically significant increase in IOP in the first 2 months, but no statistically significant change was observed in the following months. IOP was controlled with medication in all patients with elevated IOP. Of the 26 phakic patients, two had cataracts requiring surgery.ConclusionsCases of refractory diabetic macular edema that did not respond to previous treatment, such as anti-vascular endothelial growth factor injections and laser photocoagulation, exhibited improvements in visual acuity and decreases in retinal thickness after IVD implantation. Both functional and anatomical effects were observed in the first 3 months after injection. Repeat injections and frequent examination might be required for continued improvement. Side effects, such as cataracts and elevation of IOP, may require medical or surgical treatment.

The Efficacy of Single Dose Intravitreal Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-VEGF Therapy: A Real-Life Results

“…Moreover, topical antiglaucoma medication required in five (4.9%) eyes in the sixth month after the injection. While Kim et al (9), Unsal et al (21), and Kaldirim et al (22) reported IOP elevation in 8.6%, 17.3%, and 11.4% patients after a single dose of IDI injection, Dutra Medeiros et al did not report a significant IOP elevation in 58 patients after a single dose of IDI injection (10). MEAD study reported IOP elevation in 38.1% eyes receiving anti-VEGF therapy and IDI injection for a mean of 4.1 times during 3 years (23).…”

Comparison of Anatomical and Functional Outcomes of Intravitreal Dexamethasone Implant between Phakic and Pseudophakic Eyes with Diabetic Macular Edema

“…In the same study, they also reported that 48.9% of the eyes received additional treatment with anti-VEGF or DEX implants. Unsal et al [ 15 ], investigated the efficacy of intravitreal DEX implants in 46 eyes with DME that were unresponsive to previous treatments and reported that BCVA improved significantly in the first 4 months, and CMT decreased significantly in the first 3 months. In a recent meta-analysis of 3,859 patients from 15 studies, intravitreal DEX implant was found to be associated with significant mean improvement in BCVA in patients with DME who have a suboptimal response to anti-VEGF therapy [ 16 ].…”

Polymeric, injectable, intravitreal hydrogel devices for posterior segment applications and interventions

“…Therapeutics employed in the reviewed hydrogel devices include an anti-inflammatory corticosteroid, dexamethasone and monoclonal antibodies ranibizumab and bevacizumab and antibody fragment aflibercept (Table 3). Dexamethasone has been used in IVT for the treatment of uveitis [13] and macular edema [59]. Despite the success of the use of steroidal compounds for the aforementioned conditions, the use of corticosteroids in the ocular setting, is marred by the fact that it, as a steroidal compound, might produce unwanted side effects as it is known to induce side effects in many systems.…”