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Acta Diabetol. 2018 Aug;55(8):789-796. doi: 10.1007/s00592-018-1151-x. Epub 2018 May 5.

Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema.

Author information

1
Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany. busch.catharina@gmail.com.
2
Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
3
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
4
Department of Ophthalmology, Sydney University, Sydney, Australia.
5
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
6
Association for Innovation and Biomedical Research on Light, Coimbra, Portugal.
7
Massachusetts Eye and Ear, Harvard Medical School, Boston, USA.
8
School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal.
9
Section of Ophthalmology, Department of Biomedical and Surgical Sciences, University of Perugia, Perugia, Italy.
10
Ophthalmology Department, Dijon University Hospital, Dijon, France.
11
Center for Taste and Feeding Behaviour, INRA, UMR1324, Dijon, France.
12
Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris 7, Sorbonne Paris Cité, Paris, France.
13
Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.
14
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
15
Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
16
Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico.
17
Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
18
Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand.
19
L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India.
20
Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel.
21
Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina.
22
Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany.

Abstract

AIMS:

To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting.

METHODS:

To be included in this retrospective multicenter, case-control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ≤ 5 letters or reduction in central subfield thickness (CST) ≤ 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group.

RESULTS:

A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was - 0.4 ± 10.8 letters (anti-VEGF group), and + 6.1 ± 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 ± 145.9 µm (anti-VEGF group) and - 92.8 ± 173.6 µm (DEX group) (P < 0.001). Eyes in the DEX group were more likely to gain ≥ 10 letters (OR 3.71, 95% CI 1.19-11.61, P = 0.024) at month 12.

CONCLUSIONS:

In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy.

KEYWORDS:

Anti-VEGF therapy; Dexamethasone implant; Intravitreal therapy; Long-term outcome; Refractory diabetic macular edema

PMID:
29730822
DOI:
10.1007/s00592-018-1151-x
[Indexed for MEDLINE]

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