Place of intravitreal dexamethasone implant in the treatment armamentarium of diabetic macular edema

Abstract

Diabetic macular edema (DME) is a very important and well-known cause of visual loss in diabetics. Blood–retina barrier disruption and consequent intraretinal fluid accumulation may lead to retinal thickening at the posterior pole namely DME. Even though it is not clearly understood, current evidence suggests that chronic low-grade inflammation characterized with various cytokines has a major role in the occurrence of DME. Clinical trials are continuously shaping our treatment approaches for the eyes with DME. Today, vascular endothelial growth factor (VEGF) inhibitor and steroid administrations are the main alternatives in DME treatment. Dexamethasone (DEX) implant (Ozurdex ®; Allergan, Inc., Irvine, CA, United States) was approved by the United States Food & Drug Administration in 2014 for DME treatment. The implant is made up of a biodegradable solid copolymer that is broken down by releasing its active ingredient into the vitreous cavity over time. Biphasic release feature of this sustained-release drug delivery system ensures its efficacy for up to 6 mo with an acceptable and manageable safety profile. DEX implant provides a favorable anatomical and functional outcome in DME as shown in several randomized-controlled studies but has a relatively higher ocular side-effect profile such as increased risk of cataract formation and raised intraocular pressure when compared to the gold standard anti-VEGF agents. Thus, DEX implant becomes the second-line treatment option demonstrating inadequate clinical response to anti-VEGF therapy. However, it can be preferred as the first-line treatment in vitrectomized and pseudophakic eyes. Even in some selected conditions DEX implant is favored over anti-VEGF agents where the use of VEGF-inhibitors is either inappropriate or contraindicated such as the patients with a recent history of a major cardiovascular or cerebrovascular event, pregnancy and noncompliant to frequent visits. This mini-review briefly overviews the efficacy, safety profile and complications of DEX implant and summarizes the outcome of DEX implant administration in major clinical studies on DME treatment.

Comparison of intravitreal aflibercept and dexamethasone implant in the treatment of macular edema associated with diabetic retinopathy or retinal vein occlusion: a Meta-analysis and systematic review

“…The sustained dexamethasone intravitreal implant (DEX implant; Ozurdex), a biodegradable device, was first approved by the Food and Drug Administration in 2009 for the treatment of ME with RVO. Its unique dosage form can overcome the ocular administration barrier and prolong the action time of dexamethasone in the eye [11,16] . In previous studies, both the aflibercept and dexamethasone implant have been shown to be effective in the treatment of ME [17][18][19][20][21][22][23][24] .…”

Off-label uses of Aflibercept, Ranibizumab and Dexamethasone implant for diabetic retinopathy in Turkey

“…Recent studies report that especially the presence of intraretinal hyperreflective dots and serous macular detachment is associated with inflammation and intravitreal corticosteroid injections are beneficial in improving these findings [17]. However, intravitreal steroid injections are not generally preferred as firstline therapy because they accelerate the development of glaucoma and cataracts [18]. Dexamethasone implant is the only corticosteroid licensed for DME treatment in Turkey.…”

One Intravitreal Dexamethasone Implant versus Multiple Intravitreal Injections of Triamcinolone Acetonide for Post-Surgical Macular Edema: Efficacy and Safety

“…Several studies have shown the e cacy and safety of TA in the treatment of post-operative CME [17]- [21]. The most recent method of treatment used is the intravitreal dexamethasone implant (IDI) which is a biodegradable copolymer that has an extended release for 6 months, with peak response at 60 days [22].…”