Abstract
BackgroundTo identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting.Methods342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months.ResultsMean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates.ConclusionNaïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.
Highlights
To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting
This study reports better visual outcomes and reduced treatment burden in naïve DME eyes compared to previously treated DME eyes, based on a large cohort of DME patients treated with the IDI in routine clinical care
The results of this study support the use of the IDI in early DME stages in patients who do not qualify for anti-Vascular endothelial growth factor (VEGF) therapy and provide further evidence of better IDI response when used as first-line therapy compared to its use as second-line therapy, after previous failed intravitreal treatments
Summary
To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting. In clinical practice, the selection criteria are less strict, usually limited to failure of other therapies This fact is especially relevant as eyes treated with IDIs in routine clinical practice are often those in which other therapies have primarily failed (laser, anti-VEGFs, etc.) and are at risk of developing chronic macular edema, limiting their potential for greater visual gains. The potential loss of followup visits can produce an overestimation of the benefits and/or an underestimation of its side effects, affecting either way the outcomes reported in comparison to clinical trials For these different reasons, it is important to evaluate the IDI performance in real-life scenarios
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