Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema

Seung Hee Lee; Si Yeol Kim; Han Sang Park

doi:10.3341/jkos.2018.56.8.1201

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Lee, Kim, and Park: Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema

Original Article

J Korean Ophthalmol Soc 2018;56(8):1201-1207.

Published online: 29 August 2018

DOI: https://doi.org/10.3341/jkos.2018.56.8.1201

Short-Term Results of Dexamethasone Intravitreal Implant in Patients with Refractory Diabetic Macular Edema

Seung Hee Lee, M.D., Si Yeol Kim, M.D., PhD, Han Sang Park, M.D., PhD

Nune Eye Hospital, Daegu, Korea

Address reprint requests to Han Sang Park, MD, PhD Nune Eye Hospital, #2397 Dalgubeol-daero, Suseong-gu, Daegu 706-817, Korea Tel: 82-53-715-3301, Fax: 82-53-715-3440 E-mail: fhak02@naver.com

Received 16 January 20158 April 2015 Accepted 25 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the effectiveness of a dexamethasone intravitreal implant (Ozurdex^®) in the treatment of diabetic macular edema refractory to combined treatment of bevacizumab and triamcinolone.

Methods

We reviewed 9 eyes of 9 patients with diabetic macular edema treated with dexamethasone intravitreal implant. The patients were included in the study if presenting with refractory diabetic macular edema of more than 3 months despite combined treatment of intravitreal bevacizumab injection with posterior subtenon triamcinolone injection or intravitreal triamcinolone injection. We assessed the best-corrected visual acuity (BCVA) and central macular thickness (CMT) using optical coherence to-mography at initial visit and 1, 3 and 4 months.

Results

The mean follow-up was 6.7 ± 2.2 months. The baseline mean BCVA was 0.81 ± 0.47 logarithm of the minimum angle of resolution (log MAR), which improved to 0.61 ± 0.37 log MAR ( p = 0.017), 0.57 ± 0.38 log MAR ( p = 0.011) and 0.62 ± 0.36 log MAR ( p = 0.027) at 1 month, 3 months and 4 months, respectively. The baseline mean CMT was 558.0 ± 110.32 μ m and de-creased to 325 ± 64.21 μ m ( p = 0.008) and 300.22 ± 59.46 μ m ( p = 0.008) at 1 month and 3 months, respectively, then increased to 468.44 ± 150.85 μ m ( p = 0.058) at 4 months after injection.

Conclusions

Dexamethasone intravitreal implant showed short-term efficacy in the treatment of diabetic macular edema re-fractory to combined treatment of bevacizumab and triamcinolone and produced significant improvements in BCVA and CMT until 3 months after injection. The CMT then increased, but BCVA was sustained until the fourth month.

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Keywords: Dexamethasone implant, Diabetic macular edema, Intravitreal injection

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Figure 3.

Optical coherence tomography images of 2 patients with persistent diabetic macular edema nonresponsive to pre-vious combined treatment of bevacizumab and triamcinolone, before combined treatment (A, F), at baseline (B, G) and after treatment (C-E, H-J) with dexamethasone intravitreal implant. Patient 1 shows complete resolution of the macular edema, Patient 2 shows nearly complete resolution of the macular edema.

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Figure 1.

A change in the visual acuity (log MAR) after dex-amethasone intravitreal implant injection. Mean visual acuity prior to injection was 0.81 ± 0.47. Visual acuity improved to 0.61 ± 0.37, 0.57 ± 0.38, 0.62 ± 0.36 in 1, 3 and 4 months after injection.

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Figure 2.

A change in the central macular thickness after dex-amethasone intravitreal implant injection. Mean central mac-ular thickness prior to injection was 558.0 ± 110.32 μ m. Central macular thickness decreased to 325 ± 64.21 μ m and 300.22 ± 59.46 μ m, 1 and 3 months after injection. Then it in-creased to 468.44 ± 150.85 μ m in 4 months after injection.

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Table 1.

Demographic characteristics of the patients

Variable	Value
Patients (eyes)	9 (9)
Age (years)	63.4 ± 9.51
Male:female	5:4
Follow-up time (months)	6.7 ± 2.2
Baseline visual acuity (log MAR)	0.81 ± 0.47
Baseline CMT (μ m)	558.0 ± 110.32

Values are presented as mean ± SD unless otherwise indicated. log MAR = logarithm of the minimum angle of resolution; CMT = central macular thickness.

Table 2.

Previous medical history of the patients

Patient No.	Focal laser	Number of IVB	Number of IVB + PST	Number of IVB + IVT
1	Yes	3	2	0
2	Yes	5	2	0
3	Yes	2	1	2
4	Yes	2	1	2
5	Yes	8	2	0
6	Yes	2	1	1
7	Yes	2	2	2
8	Yes	2	0	1
9	Yes	8	0	1

IVB = intravitreal bevacizumab injection; PST = posterior sub-tenon triamcinolone injection; IVT = iIntravitreal triamcinolone injection.

Table 3.

Mean changes in visual acuity and central macular thickness after dexamethasone intravitreal implant injection

	BCVA (log MAR)	CMT (μ m)
Baseline	0.81 ± 0.47	558.0 ± 110.32
1 month	0.61 ± 0.37 ( p = 0.017)	325 ± 64.21 ( p = 0.008)
3 months	0.57 ± 0.39 ( p = 0.011)	300.22 ± 59.46 ( p = 0.008)
4 months	0.62 ± 0.36 ( p = 0.027)	468.44 ± 150.85 ( p = 0.058)

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; CMT = central macular thickness.

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