Abstract
IntroductionThe purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implant and to determine the predictive factors for the final visual outcome.MethodsThe study included 54 patients with DME refractory to previous antivascular endothelial growth factor (anti-VEGF) who were treated with intravitreal dexamethasone implant. Predictive factors for visual outcome were assessed. In addition, the change in best-corrected visual acuity (BCVA) and the percentage of patients with edema resolution were evaluated.ResultsAt the end of the 12-month follow-up, patients with DME gained + 5.2 letters (about 1 Snellen line), while 57.4% of patients presented total resolution of macular edema. Negative predictive factors for the final visual outcome were found to be increasing age, increasing macular thickness, phakic status, the presence of intraretinal fluid, hyperreflective foci, hard exudates, as well as external limiting membrane and ellipsoid zone disruption. The mean number of injections was 2.1.ConclusionsThe various predictive factors that determine the visual outcome and possibly define patient prognosis after dexamethasone intravitreal implant in DME cases have been studied. The long follow-up showed that dexamethasone intravitreal implant seems to be a safe and effective treatment for this disease, requiring a limited number of injections.
Highlights
The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implant and to determine the predictive factors for the final visual outcome
Inflammation seems to be implicated in the pathophysiology of DME, since several cytokines and chemokines, such as vascular endothelial growth factor (VEGF), tumor necrosis factor-a (TNF-a), intercellular adhesion molecule-1 (ICAM-1), interleukin-6 (IL-6), and monocyte chemotactic protein-1 (MCP-1), have been found to be overexpressed in DME, increasing vascular permeability and leukostasis and altering fluid homeostasis within the neuroretinal tissue [4,5,6]
The principal conclusion of this study is that dexamethasone intravitreal implant appeared to be safe and effective for the treatment of DME based on a relatively long follow-up period of 12 months in real-life clinical practice
Summary
The purpose of the study was to evaluate the long-term anatomical and functional outcomes in patients with diabetic macular edema (DME) treated with intravitreal dexamethasone implant and to determine the predictive factors for the final visual outcome. Methods: The study included 54 patients with DME refractory to previous antivascular endothelial growth factor (anti-VEGF) who were treated with intravitreal dexamethasone implant. The treatment of choice in DME is intravitreal anti-VEGF agents, which have been proven to be safe and effective at improving visual acuity (VA) and reducing macular thickness in patients with DME in large clinical trials [8,9,10,11]. The need for frequent injections and the fact that some patients do not respond to anti-VEGF agents mean that there is an unmet need for additional treatment alternatives for patients with DME [9, 12]. Since inflammation plays a significant role in the pathogenesis of DME, intravitreal steroids have been shown to be useful in the treatment of DME, as they inhibit inflammation, leukostasis, and phosphorylation of cell-junction proteins, and they block the production of VEGF and other inflammatory mediators in DME [13, 14]
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