Abstract
Aim: To share our experience in eyes with severe DME (exhibiting serous retinal detachment or large cysts) treated with simultaneous intravitreal ranibizumab and dexamethasone implant administration at the same setting as the first treatment step. Subjects and Results: Five eyes of three patients with DME who were either treatment naive or relatively undertreated were presented in this report. As optical coherence tomography exhibited serous retinal detachment or severe cystoid edema with large cysts, intravitreal ranibizumab and dexamethasone implant were simultaneously employed at the same setting as the first treatment step in those eyes. Panretinal photocoagulation was also commenced bilaterally a week after the start of injections when at least one eye had retinal neovascularization. Subsequent treatments of intravitreal ranibizumab and/or dexamethasone implant were administered. Patients were followed up for seven, eight and 13 months respectively. All five eyes achieved a relative anatomic stability and experienced visual improvement at the end of follow-up. Conclusion: In some cases with severe DME with or without proliferative diabetic retinopathy, simultaneous intravitreal ranibizumab and dexamethasone implant administration at the same setting may be a better option to initiate the treatment over mono ranibizumab treatment. A randomized study comparing the mono anti-VEGF therapy and mono dexamethasone implant administration with simultaneous treatment may outline the place of this type of therapy in the treatment armamentarium of severe DME.
Highlights
Diabetic macular edema (DME) can be classified into three morphological types as diffuse retinal thickening, cystoid macular edema and serous retinal detachment (SRD) with the help of optical coherence tomography (OCT) [1]
Study of 27 aqueous humor cytokines in patients with type 2 diabetes with or without retinopathy demonstrated that VEGF, interleukin-1β (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), monocyte chemoattractant protein-1 (MCP-1) and interferon induced protein 10 (IP-10) levels in the aqueous humor were increased in accordance with the severity of diabetic retinopathy [5]
At least in some eyes with DME, simultaneous anti-VEGF and steroid treatment can be preferred over mono anti-VEGF therapy in order to suppress both the VEGF and inflammatory cytokines
Summary
Diabetic macular edema (DME) can be classified into three morphological types as diffuse retinal thickening, cystoid macular edema and serous retinal detachment (SRD) with the help of optical coherence tomography (OCT) [1]. Inflammatory factors besides the VEGF play an important role in the pathogenesis of diabetic retinopathy [4]. Study of 27 aqueous humor cytokines in patients with type 2 diabetes with or without retinopathy demonstrated that VEGF, interleukin-1β (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), monocyte chemoattractant protein-1 (MCP-1) and interferon induced protein 10 (IP-10) levels in the aqueous humor were increased in accordance with the severity of diabetic retinopathy [5]. It may be reasonable to administer intravitreal ranibizumab and dexamethasone implant simultaneously in eyes with severe DME in order to suppress both the VEGF and inflammatory cytokines at least at the initiation of pharmacological therapy. We hereby report five eyes of three patients that were treated with simultaneous intravitreal ranibizumab and dexamethasone implant at the same setting as the initial therapeutic procedure
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
