Korean J Ophthalmol.  2019 Jun;33(3):249-258. 10.3341/kjo.2018.0100.

Vitrectomy Combined with Intraoperative Dexamethasone Implant for the Management of Refractory Diabetic Macular Edema

• Kim KT
• Jang JW
• Kang SW
• Chae JB
• Cho K
• Bae K

• KMID: 2448864
• DOI: http://doi.org/10.3341/kjo.2018.0100

Abstract

PURPOSE
To evaluate the 1-year results of vitrectomy performed in combination with intraoperative dexamethasone implant for tractional and nontractional refractory diabetic macular edema (DME).
METHODS
Thirteen eyes from 13 subjects who were diagnosed with tractional DME and 17 eyes from 17 subjects who were diagnosed with nontractional refractory DME underwent vitrectomy and dexamethasone implant injection. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) during the one year following vitrectomy were evaluated in each group. Additionally, changes in intraocular pressure and other complications were investigated postoperatively.
RESULTS
In eyes with tractional DME, a statistically significant improvement in BCVA was noted at 3, 6, and 12 months, and a statistically significant improvement in CMT was noted at 1, 3, 6, and 12 months from baseline after vitrectomy (p < 0.05). In eyes with nontractional refractory DME, a statistically significant improvement in BCVA was noted at 12 months, but there were no significant improvements in CMT despite the tendency to decrease from baseline. Sixteen (53.3%) of the 30 eyes included in this study showed intraocular pressure elevation, which was addressed using antiglaucoma medication, and there were no other severe complications.
CONCLUSIONS
Vitrectomy combined with intraoperative dexamethasone implant may be safe and effective in treating DME, especially tractional DME. In this study, patients with nontractional DME required more additional treatments and time for anatomical and functional improvement compared to patients with tractional DME.

Keyword

Dexamethasone implant; Nontractional diabetic macular edema; Tractional diabetic macular edema; Vitrectomy

MeSH Terms

Dexamethasone*
Humans
Intraocular Pressure
Macular Edema*
Traction
Visual Acuity
Vitrectomy*
Dexamethasone

Figure

• 

  Fig. 1 Graph illustrating changes in logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) and central macular thickness (CMT) at baseline and 1, 3, 6, and 12 months after vitrectomy combined with intraoperative dexamethasone implant for the treatment of diabetic macular edema (DME). Statistical significance was determined using repeated measures analysis of variance. Asterisks indicate statistically significant results after Bonferroni's correction. (A) The logMAR BCVA was significantly improved at 12 months in nontractional DME and at 3, 6, and 12 months in tractional DME after surgery. (B) The CMT was significantly decreased at 1, 3, 6, and 12 months in tractional DME after surgery, but there was no significant decrease in nontractional DME postoperatively despite the tendency to decrease from baseline. *Statistical significance.

• 

  Fig. 2 Color fundus photographs and optical coherence tomography scans. The left column (A–F) represents a case of a 68-year-old male with nontractional diabetic macular edema (DME), and the right column (G–L) represents a case of a 55-year-old male with tractional DME. (A,G) Each of the patients had received multiple intravitreal bevacizumab injections for persistent DME preoperatively. (B) Preoperative central macular thickness (CMT) was 459 µm and best-corrected visual acuity (BCVA) was 0.2 in decimal equivalent. (C) One month postoperatively, CMT decreased to 404 µm. (D) At postoperative month 3, CMT was increased to 482 µm. (E) At postoperative month 6, CMT was 458 µm, and dexamethasone implant injection was conducted. (F) At postoperative month 12, CMT was maintained at 382 µm and BCVA was 0.5. (H) Preoperative CMT was 634 µm and BCVA was 0.1 in decimal equivalent. Vitreomacular traction was observed on optical coherence tomography (arrowhead). (I) One month postoperatively, CMT decreased to 267 µm. (J) At postoperative month 3, CMT increased to 298 µm. (K) At postoperative month 6, CMT was 390 µm and dexamethasone implant injection was conducted. (L) At postoperative month 12, CMT was maintained at 244 µm and BCVA was 0.6.

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