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Journal List > J Korean Ophthalmol Soc > v.56(8) > 1010049

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

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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jkos-56-1201f3.tif
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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jkos-56-1201f1.tif
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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jkos-56-1201f2.tif
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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