Short-Term Outcomes of Refractory Diabetic Macular Edema Switch From Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real World Experience

Abstract

Introduction: To evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implants in refractory diabetic macular edema (DME) treated by intravitreal ranibizumab.Materials and Methods: We retrospectively analyzed DME patients who received DEX implant treatment after being refractory to at least 3 monthly intravitreal ranibizumab injections. The main outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP).Results: Twenty-nine eyes of 26 patients who had previously received an average of 8.1 ± 4.4 ranibizumab injections were included. Patients received between one and three DEX implants during 12.4 ± 7.4 months of follow-up. The mean final CRT significantly decreased from 384.4 ± 114.4 μm at baseline to 323.9 ± 77.7 μm (p = 0.0249). The mean final BCVA was 51.4 ± 21.3 letters, which was not significant compared to baseline (44.9 ± 30.2 letters, p = 0.1149). Mean IOP did not increase significantly. All patients tolerated the treatment well without serious adverse events. Higher baseline CRT and worse BCVA correlated with better therapeutic responses.Conclusion: Switching to DEX implant is feasible and safe for treating patients of DME refractory to intravitreal ranibizumab in real world. Further larger-scale or multicenter studies would be conducted to explore different DEX treatment strategies for DME, such as first-line or early switch therapy, for better BCVA improvement.

Early-switch versus late-switch in patients with diabetic macular edema: a cost-effectiveness study

“…Regarding the anatomic outcomes, our study found a significant reduction in CRT, without differences between groups. These findings are in agreement with the current evidence [ 19 , 20 , 33 – 36 ].…”

“…The results of these studies point in the same general direction, indicating that in patients who did not adequately respond to anti-VEGF therapy, switching to DEX-i provides better functional and anatomical outcomes [ 19 , 20 , 33 – 36 ].…”

Optical Coherence Tomography Biomarkers in Predicting Treatment Outcomes of Diabetic Macular Edema After Dexamethasone Implants

“…More importantly, we performed multivariate analysis and lens status was not significantly associated with outcomes. Previous studies have found similar conclusions that the lens status was not significantly associated with differences in BCVA ( 10 , 27 ). Lastly, if we had divided our subjects into two groups, the smaller case number in each group would make the outcomes less reliable.…”

“…The biodegradable intravitreal dexamethasone (DEX) implant (Ozurdex ® , Allergan, Inc., Irvine, CA, United States) has been identified as an effective treatment of DME and is approved by the US Food and Drug Administration (FDA) ( 9 ). In addition, the beneficial effects of DEX implant in anti-VEGF non-responders are well-established in several studies ( 9 , 10 ).…”

Comparison of Optical Coherence Tomography Biomarkers between Bevacizumab Good Responders and Nonresponders Who were Switched to Dexamethasone Implant in Diabetic Macular Edema

“…Other studies performed consecutive anti-VEGF injections (range 3 to 8) and then evaluated the responsiveness 12,13,30,31 . Consecutive injection without evaluation of treatment effect could lead to unnecessary injection and increased financial burden for the patient.…”