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Ophthalmologica. 2018;239(4):205-214. doi: 10.1159/000485852. Epub 2018 Feb 2.

Repeated Dexamethasone Intravitreal Implant for the Treatment of Diabetic Macular Oedema Unresponsive to Anti-VEGF Therapy: Outcome and Predictive SD-OCT Features.

Author information

1
Vista Klinik, Binningen, Switzerland.
2
Department of Ophthalmology, University of Basel, Basel, Switzerland.
3
Department of Ophthalmology, Inselspital, Bern, Switzerland.
4
Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland.

Abstract

PURPOSE:

To investigate dexamethasone intravitreal implant 0.7 mg (DEX implant) for the treatment of diabetic macular oedema (DME) refractory to anti-vascular endothelial growth factor (anti-VEGF) therapy and evaluate predictive factors.

METHODS:

Two-centre retrospective interventional case series, including 40 eyes of 31 patients treated with DEX implant for at least 2 consecutive cycles.

RESULTS:

Mean ± SD intervals from implantation to recurrence in the first (4.2 ± 1.0 months) and second cycles (4.0 ± 0.9 months) were not significantly different. Best corrected visual acuity improved significantly (p < 0.001) by 7.0 ± 8.4 letters from baseline to month 2, and by 5.1 ± 6.9 letters between the first and second cycles. Central retinal thickness reduction 2 months after implantation was greater after the first (-194 ± 172 µm) than the second cycle (-134 ± 150 µm). Ellipsoid zone-external limiting membrane (EZ-ELM) disruption score decreased from 1.39 ± 1.16 at baseline to 1.24 ± 1.16 (p = 0.0832) after cycle 1 and remained stable 2 months after cycle 2. Eyes with persisting severe EZ-ELM disruption (score >2, n = 10) 2 months after the first DEX implant showed significantly (p = 0.0153) smaller visual acuity (VA) gains than eyes with less severe (score ≤2) EZ-ELM disruption.

CONCLUSION:

Repeated intravitreal DEX injections with average intervals of 4 months are valuable in patients with DME refractory to anti-VEGF therapy. Disorganization of outer retinal layers (EZ-ELM) may predict smaller VA gains if evaluated after initial reduction of macular oedema.

KEYWORDS:

Dexamethasone implant; Diabetic macular oedema; Optical coherence tomography; Photoreceptor integrity

PMID:
29402873
PMCID:
PMC6008872
DOI:
10.1159/000485852
[Indexed for MEDLINE]
Free PMC Article

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