J Korean Ophthalmol Soc.  2015 Aug;56(8):1201-1207. 10.3341/jkos.2015.56.8.1201.

Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema

• Lee SH
• Kim SY
• Park HS

• KMID: 2215071
• DOI: http://doi.org/10.3341/jkos.2015.56.8.1201

Abstract

PURPOSE
To evaluate the effectiveness of a dexamethasone intravitreal implant (Ozurdex(R)) in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone.
METHODS
We reviewed 9 eyes of 9 patients with diabetic macular edema treated with dexamethasone intravitreal implant. The patients were included in the study if presenting with refractory diabetic macular edema of more than 3 months despite combined treatment of intravitreal bevacizumab injection with posterior subtenon triamcinolone injection or intravitreal triamcinolone injection. We assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence tomography at initial visit and 1, 3 and 4 months.
RESULTS
The mean follow-up was 6.7 +/- 2.2 months. The baseline mean BCVA was 0.81 +/- 0.47 logarithm of the minimum angle of resolution (log MAR), which improved to 0.61 +/- 0.37 log MAR (p = 0.017), 0.57 +/- 0.38 log MAR (p = 0.011) and 0.62 +/- 0.36 log MAR (p = 0.027) at 1 month, 3 months and 4 months, respectively. The baseline mean CMT was 558.0 +/- 110.32 microm and decreased to 325 +/- 64.21 microm (p = 0.008) and 300.22 +/- 59.46 microm (p = 0.008) at 1 month and 3 months, respectively, then increased to 468.44 +/- 150.85 microm (p = 0.058) at 4 months after injection.
CONCLUSIONS
Dexamethasone intravitreal implant showed short-term efficacy in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone and produced significant improvements in BCVA and CMT until 3 months after injection. The CMT then increased, but BCVA was sustained until the fourth month.

Keyword

Dexamethasone implant; Diabetic macular edema; Intravitreal injection

MeSH Terms

Dexamethasone*
Follow-Up Studies
Humans
Intravitreal Injections
Macular Edema*
Tomography, Optical Coherence
Triamcinolone
Visual Acuity
Bevacizumab
Dexamethasone
Triamcinolone

Figure

• 

  Figure 3. Optical coherence tomography images of 2 patients with persistent diabetic macular edema nonresponsive to pre-vious combined treatment of bevacizumab and triamcinolone, before combined treatment (A, F), at baseline (B, G) and after treatment (C-E, H-J) with dexamethasone intravitreal implant. Patient 1 shows complete resolution of the macular edema, Patient 2 shows nearly complete resolution of the macular edema.

• 

  Figure 1. A change in the visual acuity (log MAR) after dex-amethasone intravitreal implant injection. Mean visual acuity prior to injection was 0.81 ± 0.47. Visual acuity improved to 0.61 ± 0.37, 0.57 ± 0.38, 0.62 ± 0.36 in 1, 3 and 4 months after injection.

• 

  Figure 2. A change in the central macular thickness after dex-amethasone intravitreal implant injection. Mean central mac-ular thickness prior to injection was 558.0 ± 110.32 μ m. Central macular thickness decreased to 325 ± 64.21 μ m and 300.22 ± 59.46 μ m, 1 and 3 months after injection. Then it in-creased to 468.44 ± 150.85 μ m in 4 months after injection.

Reference

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