Combined Intravitreal Dexamethasone Implant And Micropulse Yellow Laser For Treatment Of Anti-VEGF Resistant Diabetic Macular Edema.

Ahmed Hosni Abd Elhamid

doi:10.2174/1874364101711010164

Abstract

Purpose:To report the efficacy and safety of combined intravitreal dexamethasone implant and micropulse laser for anti-VEGF resistant diabetic macular edema.Patients and Methods:Prospective, non-controlled study that was conducted for twenty eyes with center-involved diabetic macular edema not responding to anti-VEGF therapy. Ozurdex intravitreal implant was injected to all eyes with subsequent micropulse yellow laser one month after the injection. All eyes were followed up after one, three, four, six, nine and twelve months. The primary outcome measure is the change in best corrected visual acuity (BCVA) after one year and secondary outcome measures are central macular thickness (CMT) change and safety of both dexamethasone implant and micropulse laser. Reinjection was done for those eyes with recurrent edema.Results:The mean age was 58.8 ±7.94 years. The mean BCVA was 0.6± 0.14, 0.57 ±0.12, 0.51±0.15, 0.59±0.12, 0.6± 0.12 and 0.59±0.14 after one, three, four, six, nine and twelve months in comparison to 0.45± 0.14 as initial BCVA [SS,P<0.05]. The CMT was 302.5±30.01, 330.6±20.24, 357.6±32.15, 285.4±19.95, 292.9±25.07 and 285.2±14.99 after one ,three, four ,six , nine and twelve months µm in comparison to initial CMT of 420.7 ±38.74µm [HS, P<0.01]. Cataract occurred in 6 eyes from 14 phakic eyes (42.8%). Transient ocular hypertension occurred in 6 eyes (30%). Reinjection was done for eight eyes (40%).Conclusion:Intravitreal dexamethasone implant and micropulse laser are both effective and safe treatment options for anti-VEGF resistant diabetic macular edema.

Highlights

Diabetic retinopathy is a well-known cause of vision loss, diabetic macular edema (DME) is the commonest cause of vision loss in diabetic retinopathy [1]
Many options are available for treatment of DME like focal/grid laser photocoagulation and pharmacologic therapy including intravitreal injection of various anti-vascular endothelial growth factor (VEGF) agents and corticosteroids [3]
Long acting intravitreal dexamethasone implant (IDI) 0.7 mg (Ozurdex; Allergan, Irvine, CA, USA) is a sustained release biodegradable implant of poly lactic-co-glycolic acid (PLGA) which is approved for use in DME and retinal vein occlusion [5, 6]

Summary

Introduction

Diabetic retinopathy is a well-known cause of vision loss, diabetic macular edema (DME) is the commonest cause of vision loss in diabetic retinopathy [1]. Many options are available for treatment of DME like focal/grid laser photocoagulation and pharmacologic therapy including intravitreal injection of various anti-VEGF agents and corticosteroids [3]. Intravitreal injection of corticosteroids can reduce macular edema by stabilization of capillary walls and by preventing release of leucocytes, VEGF, prostaglandins and other pro inflammatory cytokines [4]. Dexamethasone is one of the potent anti-inflammatory steroids. It is about six times more potent than intravitreal triamcinolone acetonide. Long acting intravitreal dexamethasone implant (IDI) 0.7 mg (Ozurdex; Allergan, Irvine, CA, USA) is a sustained release biodegradable implant of poly lactic-co-glycolic acid (PLGA) which is approved for use in DME and retinal vein occlusion [5, 6]. Some small retrospective reports have noted success of IDI for DME and recalcitrant macular edema of other causes [8, 9]

Objectives

Methods

Results

Discussion

Conclusion