Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

Doyeon Kim; Dong-Geun Park; Gahyung Ryu; Min Sagong

doi:10.3341/jkos.2020.61.1.51

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Kim, Park, Ryu, and Sagong: Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(1): 51-58.

Published online: 15 January 2020

DOI: https://doi.org/10.3341/jkos.2020.61.1.51

Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

Doyeon Kim, MD, Dong-Geun Park, MD, Gahyung Ryu, MD, Min Sagong, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

Address reprint requests to Min Sagong, MD, PhD. Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3443, Fax: 82-53-626-5936, msagong@ynu.ac.kr

Received 16 August 2019 Revised 30 September 2019 Accepted 30 December 2019

The Korean Ophthalmological Society

(open-access):

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 compare the efficacy of intravitreal dexamethasone implants according to previous response to bevacizumab treatment in patients with diabetic macular edema (DME).

Methods

Forty-nine eyes of 49 patients who received intravitreal dexamethasone implants for DME were reviewed retrospectively. Of these patients, 13 were treatment-naïve and 36 had previously received intravitreal injections of bevacizumab. Of the 36 previously treated patients, 24 comprised a refractory group showing no response to previous injections, and 12 comprised a responder group showing a response to previous treatments. The best-corrected visual acuity, central macular thickness (CMT), and retreatment percentages were assessed monthly for 6 months.

Results

After the intravitreal dexamethasone implants, visual acuity improved significantly over 6 months in the treatment-naïve group, while in the responder group, a significant improvement in visual acuity was seen at the 2-month follow-up. In the refractory group, there was no significant improvement in visual acuity during the follow-up period. The CMT showed a significant decrease in all three groups, and there was no significant difference in the CMT among the three groups at any time point. Five patients in the treatment-naive group (38.5%), 19 patients in the refractory group (79.2%), and nine patients in the responder group (75.0%) needed retreatment for recurrent macular edema, and there was a significant difference among the three groups in the rate of recurrence (p = 0.034).

Conclusions

In DME patients, intravitreal dexamethasone implants were associated with a significant anatomical improvement irrespective of previous bevacizumab treatment response. However, the treatment-naïve and responder groups showed improvements in visual acuity, whereas the refractory group showed limited improvement.

Keywords: Bevacizumab, Dexamethasone, Diabetic macular edema, Intravitreal injection, Macular edema

Figures and Tables

Figure 1

Mean changes in BCVA from baseline during the follow-up period. At each visit of 6-month follow-up, the BCVA improved significantly from baseline in the treatment-naïve group. On the other hand, the responder group showed significant improvement after 2 months of follow-up, and the refractory group did not show improvement during the follow-up period. Among different groups, there were significant differences at 1, 2, and 3 months (p = 0.049 at 1 month, p = 0.023 at 2 months, p = 0.006 at 3 months). BCVA = best corrected visual acuity; logMAR = logarithm of the minimal angle of resolution; Naïve = treatment-naïve group; Refractory = refractory group; Responder = responder group. ^*Wilcoxon signed rank test vs. baseline; ^†Kruskal-W allis test for comparisons among the treatment groups.

Figure 2

Mean changes in CMT from baseline during the follow-up period. The CMT showed significant decrease at each visit in all groups. Treatment-naïve group tended to have a more reduction of CMT than other groups, but there were no significant differences between the groups at each visit. CMT = central macular thickness; Naïve = treatment-naïve group; Refractory = refractory group; Responder = responder group. ^*Wilcoxon signed rank test vs. baseline; ^†Kruskal-Wallis test for comparisons among the treatment groups.

Table 1

Demographics and baseline characteristics of the patients

Values are presented as mean ± standard deviation unless otherwise indicated.

Naïve = treatment-naïve group; Refractory = refractory group; Responder = responder group; DR = diabetic retinopathy; NPDR = non proliferative retinopathy; PDR = proliferative retinopathy; PRP = panretinal photocoagulation; BCVA = best corrected visual acuity; logMAR = logarithm of the minimal angle of resolution; CMT = central macular thickness.

^*Fisher exact test; ^†Kruskal-Wallis test; ^‡post-hoc test (Tukey method) between group comparison. (Naïve vs. Refractory, p<0.001; Naïve vs. Responder, p<0.001; Refractory vs. Responder, p=0.601).

Table 2

Summary of treatments before and after the study

Values are presented as mean ± standard deviation or number (%).

Naïve = treatment-naïve group; Refractory = refractory group; Responder = responder group.

^*The p-value was calculated using Kruskal-Wallis test.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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