Microaneurysm Turnover after the Use of Dexamethasone and Bevacizumab to Treat Diabetic Macular Edema

Seon Tae Kim; Woo Jin Jeong

doi:10.3341/jkos.2018.59.4.332

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Kim and Jeong: Microaneurysm Turnover after the Use of Dexamethasone and Bevacizumab to Treat Diabetic Macular Edema

Original Article

J Korean Ophthalmol Soc 2018;59(4):332-337.

Published online: 7 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.4.332

Microaneurysm Turnover after the Use of Dexamethasone and Bevacizumab to Treat Diabetic Macular Edema

Seon Tae Kim, MD, Woo Jin Jeong, MD, PhD

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

Address reprint requests to Woo Jin Jeong, MD, PhD Department of Ophthalmology, Dong-A University Hosptial, #26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: 82-51-240-5222, Fax: 82-51-248-1510, E-mail: wjeye@dau.ac.kr

Received 26 October 2017 Revised 4 January 2018 Accepted 25 March 2018

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 microaneurysm (MA) turnover and changes in central retinal thickness after intravitreal dexamethasone implantation or intravitreal bevacizumab injection to treat diabetic macular edema.

Methods

Sixty eyes with diabetic macular edema were evaluated. In all, 30 eyes received intravitreal dexamethasone implants (group A) and 30 received bevacizumab injections (group B). All patients were followed-up at 3 and 6 months. MA formation, disappearance, and turnover (MA formation rate minus disappearance rate) were evaluated. When the disappearance rate was greater than the formation rate (so the turnover was 30), the microaneurysms were considered to have resolved. Central retinal thickness (CRT) was measured using optical coherence tomography at all visits.

Results

In group A, MA turnover was 86.6% at 3 months and 53.3% at 6 months, and thus decreased slightly over time, but was not eliminated. In group B, MA turnover was 56.6% at 3 months and 13.3% at 6 months; the between-group difference was statistically significant (p = 0.014). CRT decreased in both groups, but significantly less so in group B 3 months after injection. However, no significant between-group difference was apparent 6 months after injection.

Conclusions

There were no significant between-group differences in either CRT or MA turnover 3 months after injection. However, at 6 months, dexamethasone implantation showed slightly better results than intravitreal bevacizumab injection. However, further research on long-term MA turnover is required.

Keywords: Bevacizumab, Central macular thickness, Dexamethasone, Microaneurysm turnover, Microaneurysm

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Figure 1.

The Microaneurysm of pre-injectional state (A, B) and at 3 and 6 months post-injectional state (C, D and E, F). The yellow circle is in radius of optic disc and macula (A, C, E = dexamethasone implant) (B, D, F = bevacizumab injection).

Table 1.

Patients demographics

	Dexamethasone implant	Bevacizumab	p-value
Study population (n)	30	30
Male:Female (n)	18:12	16:14	0.591
Mean age (years)	68.80 ±7.18	62.30 ±7.92	0.161*
Mean baseline BCVA (logMAR)	0.46 ±0.53	0.37 ±0.28	0.579*
Mean baseline CMT (pm)	403.85 ± 114.61	459.08 ± 104.90	0.243*
Initial number of MAs	33.42 ±3.92	32.75 ±2.81	0.131*

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; CMT = central macular thickness; MA = microaneurysm.

^* Statistically significance is p < 0.05 Mann-Whitney U test.

Table 2.

Best corrected visual acuity

	Baseline	3 months	6 months
Dexamethasone implant	0.46 ±0.53	0.35 ±0.39	0.23 ± 0.40
Bevacizumab	0.27 ±0.28	0.33 ±0.26	0.19 ±0.15
p-value	0.547	0.186	0.419

Values are presented as mean ± SD unless otherwise indicated.

Table 3.

Central macular thickness (μm)

	Baseline	3 months	6 months
Dexamethasone implant	403.85 ± 114.61	264.25 ± 29.22	306.10 ± 32.27
Bevacizumab	459.08 ± 104.90	324.15 ± 64.85	334.56 ± 92.79
p-value	0.054	0.048*	0.122

Values are presented as mean ± SD unless otherwise indicated.

^* Statistically significance is p < 0.05 Student t-test.

Table 4.

Number of microaneurysms

	Baseline	3 months	6 months
Dexamethasone implant	33.42 ± 3.92	16.23 ± 4.12	18.52 ± 2.94
Bevacizumab	32.75 ± 2.81	21.25 ± 5.22	25.25 ± 3.02
p-value	0.169	0.048*	0.032*

Values are presented as mean ± SD unless otherwise indicated.

^* Statistically significance is p < 0.05 Student t-test.

Table 5.

Microaneurysm (MA) turnover

	3 months		6 months
	MA turnover < 0	MA turnover ≥0	MA turnover < 0	MA turnover ≥0
Dexamethasone implant (n, %)	26 (86.6)	4 (23.4)	16 (53.3)	14 (46.7)
Bevacizumab (n, %)	17 (56.6)	13 (33.4)	4 (13.3)	26 (86.7)
p-value	0.041*		0.022*

Values are presented as n (%) unless otherwise indicated.

^* Statistically significance is p < 0.05 Student t-test.

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