Dexamethasone intravitreal implant (Ozurdex) in phakic patients with diabetic macular oedema resistant to anti‐VEGF therapy: Short‐term visual and anatomical outcomes in a real‐world study

Abstract

Aims/Purpose: To prospectively study and analyse the clinical effectiveness of using intravitreal dexamethasone (IVO) implant in treatment resistant phakic patients with centre involving diabetic macular oedema (DMO).Methods: Prospective interventional case series of phakic patients with persistent centre‐involving diabetic macular oedema, who received an IVO implant between May 2022 and February 2023 were included. Primary outcome measures include best corrected visual acuity (BCVA) and central retinal thickness (CRT) at baseline, 2 months and 6 months. Secondary efficacy outcome measures include, change in level of cataract and change in intraocular pressure (IOP) control requiring topical treatment or interventional procedures.Results: Nine eyes from eight patients were included. Mean age at treatment was 61.87 ± 11.07 years with male preponderance (8:1). There was no statistically significant difference in BCVA at baseline compared to 2 months following IVO (0.291 ± 0.185 vs. 0.287 ± 0.208, respectively, p = 0.919) or comparing BCVA at baseline to BCVA 6 months following IVO (0.291 ± 0.185 vs. 0.347 ± 0.153, respectively, p = 0.063). Reduction in CRT from baseline to 2 months following IVO was highly significant (436.4 ± 65.1 vs. 305.9 ± 58.6, respectively, p = 0.006) and reduction in CRT comparing baseline and 6 months following IVO which remained significant (436.4 ± 65.1 vs. 363.2 ± 96.1, p = 0.041). Mean intraocular pressures was raised in 44.4% eyes with medical management required in 33.3%. Recurrence of maculopathy was noted in 88.9% eyes. Cataract requiring surgery was performed in one eye.Conclusions: This prospective series shows that phakic patients, with persistent DMO following anti‐VEGF therapy undergoing IVO, resulted in a highly statistically significant reduction in CRT at 2 months following IVO which was maintained at 6 months (p = 0.04) although there is high recurrence. BCVA remains stable over the 6‐month period with no statistically significant change.