Abstract
Purpose This retrospective study aimed to compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) for pseudophakic vitrectomized eyes with diabetic macular edema (DME) in a single institution. Methods Pseudophakic vitrectomized eyes with treatment-naïve center-involved DME were enrolled, with one eye in each patient. They were divided into two groups: one group receiving IDI every 3 to 4 months and another group receiving IVR using 3 monthly plus treat-and-extend injections, all with monthly follow-up for 6 months. Switch of intravitreal drugs or deferred macular laser was not allowed. Primary outcome measures included change in central foveal thickness (CFT) in 1 mm by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) at Month 6. Results Twenty-two eyes were included in the IDI group and 26 eyes in the IVR group. The baseline demographics, glycosylated hemoglobin level, intraocular pressure (IOP), BCVA, and CFT did not significantly differ (p > 0.05). Compared to baseline data, CFT decreased and BCVA improved significantly after either IDI or IVR at Month 6 (p < 0.05). Significantly better mean final BCVA (0.38 logMAR vs. 0.62 logMAR, p=0.04), more mean visual gain (−0.30 logMAR vs. −0.15 logMAR, p=0.02), lower mean final CFT (310.9 μm vs. 384.2 μm, p=0.04), and larger mean CFT decrease (−150.0 μm vs. −60.1 μm, p=0.03) were found in the IDI group compared to those in the IVR group. A smaller mean treatment number (2.6 vs. 5.6, p < 0.001) and higher rate of postinjection ocular hypertension requiring topical hypotensive agent therapy (27.3% vs. 0%, p=0.0002) were demonstrated in the IDI group than those in the IVR group. Conclusion We concluded that IDI and IVR can both effectively treat vitrectomized eyes with DME. Dexamethasone implants had significantly better visual/anatomical improvement, smaller treatment number, and higher rate of elevated IOP after injection than IVR in pseudophakic vitrectomized eyes with DME in a 6-month period.
Highlights
Macular edema is an important cause of visual impairment in patients with diabetes
Diabetic macular edema (DME) is associated with ischemia caused by disturbance of microvascular circulation in the diabetic retina [1]. e evidence is that the intraocular vascular endothelial growth factor (VEGF) level is elevated in eyes with DME and proportional to the severity of DME, such as increased macular thickness, enlarged macular volume, and presence of submacular fluid [2]
We provided advice for patients’ selection of management for DME according to the 2017 EURETINA guidelines and outcomes of one previous ranibizumab and dexamethasone implants head-to-head multicenter randomized comparison study (MAGGIORE study) [22, 23]. e doctor’s suggestions were presented as follows: (1) comparably and significantly visual and anatomical improvement can be achieved following intravitreal injections between ranibizumab and dexamethasone implants in nonvitrectomized eyes, and both treatments were more effective than macular laser
Summary
Macular edema is an important cause of visual impairment in patients with diabetes. Diabetic macular edema (DME) is associated with ischemia caused by disturbance of microvascular circulation in the diabetic retina [1]. e evidence is that the intraocular vascular endothelial growth factor (VEGF) level is elevated in eyes with DME and proportional to the severity of DME, such as increased macular thickness, enlarged macular volume, and presence of submacular fluid [2]. Various increased inflammatory cytokines can be detected in the aqueous or vitreous of the eyes with DME, such as monocyte chemoattractant protein 1 (MCP-1), intercellular adhesion molecule 1, interleukin- (IL-) 6, and IL8 Higher levels of these cytokines are related to more severe macular edema in diabetic eyes [10, 11]. E doctor’s suggestions were presented as follows: (1) comparably and significantly visual and anatomical improvement can be achieved following intravitreal injections between ranibizumab and dexamethasone implants in nonvitrectomized eyes, and both treatments were more effective than macular laser. Dexamethasone implants were reinjected in a minimum of 3-month intervals if macular edema persisted or recurred with CFT >300 μm or presence of apparent submacular fluid and/or intramacular cysts.
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