Abstract
Introduction: To evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implants in refractory diabetic macular edema (DME) treated by intravitreal ranibizumab.Materials and Methods: We retrospectively analyzed DME patients who received DEX implant treatment after being refractory to at least 3 monthly intravitreal ranibizumab injections. The main outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP).Results: Twenty-nine eyes of 26 patients who had previously received an average of 8.1 ± 4.4 ranibizumab injections were included. Patients received between one and three DEX implants during 12.4 ± 7.4 months of follow-up. The mean final CRT significantly decreased from 384.4 ± 114.4 μm at baseline to 323.9 ± 77.7 μm (p = 0.0249). The mean final BCVA was 51.4 ± 21.3 letters, which was not significant compared to baseline (44.9 ± 30.2 letters, p = 0.1149). Mean IOP did not increase significantly. All patients tolerated the treatment well without serious adverse events. Higher baseline CRT and worse BCVA correlated with better therapeutic responses.Conclusion: Switching to DEX implant is feasible and safe for treating patients of DME refractory to intravitreal ranibizumab in real world. Further larger-scale or multicenter studies would be conducted to explore different DEX treatment strategies for DME, such as first-line or early switch therapy, for better BCVA improvement.
Highlights
To evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implants in refractory diabetic macular edema (DME) treated by intravitreal ranibizumab
Oxidative stress and inflammation induce the upregulation of growth factors, such as vascular endothelial growth factor (VEGF) and cytokines, which contribute to the breakdown of the blood-retinal barrier (BRB) by disrupting the integrity of retinal vascular endothelial cell tight junctions and increasing vascular permeability [3]
Prior to receiving DEX implant treatment, all patients had been treated with an average of 8.1 ± 4.4 injections of intravitreal ranibizumab
Summary
To evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implants in refractory diabetic macular edema (DME) treated by intravitreal ranibizumab. A microvascular complication of diabetes, has an estimated prevalence of 34.6% among patients with diabetes. Diabetic macular edema (DME), a manifestation of diabetic retinopathy, develops in ∼6.8% of patients with diabetes and is a major cause of visual loss in this population [2]. Hyperglycemia in diabetes increases oxidative stress, inflammation, and vascular dysfunction. Oxidative stress and inflammation induce the upregulation of growth factors, such as vascular endothelial growth factor (VEGF) and cytokines, which contribute to the breakdown of the blood-retinal barrier (BRB) by disrupting the integrity of retinal vascular endothelial cell tight junctions and increasing vascular permeability [3]. The ensuing fluid accumulation, in addition to the persistent presence of inflammatory factors, causes dysfunction of the inner nuclear layer and subsequent development of DME [4]
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