ABSTRACT

Purpose:

In the retrospective single center study, we evaluated the effectiveness of Dexamethasone implant (DEX) and fluocinolone acetonide (FAc) implant in patients with diabetic macular edema (DME) who insufficiently responded to anti-VEGF therapy.

Methods:

In total 30 eyes without improvement of best corrected visual acuity (BCVA) and central foveal thickness (CFT) after treatment with 3-14 anti-VEGF injections (ranibizumab and/or aflibicept) were analyzed. After anti-VEGF treatment, the direct switch to fluocinolone implant was performed in 16 eyes (group A), in 14 eyes dexamethasone (Ozurdex®) was implanted (group B) before fluocinolone treatment was initiated. A complete ophthalmic examination with measurement of (BCVA in logMAR) and SD-OCT were performed at baseline and at all follow-up visits every 3 months up to months 36 after FAc implantation.

Results:

After anti-VEGF treatment, the BCVA improved only non-significantly from0.45±0.22 to 0.43±0.26 logMAR (p=0.46). In the group A two months after DEX implantation significant improvement of BCVA (from 0.46±0.23 to 0.36±0.21 logMAR; p=0.05) and CFT from 485.7±163.1µm to 293.4±175.2µm; p=0.048) was observed. At month 6 after dexamethasone implant BCVA decreased to 0.41±0.24 logMAR and CFT increased to 371.9±167.1µm. The baseline BCVA and CFT before FAc implantation was in all 30 eyes 0.48±16 logMAR and 432.7±191.5µm respectively and improved significantly at month 3 and 6 to 0.36±0.21 logMAR and 0.38±0.22 logMAR with 278.2±142.3µm and 289.6±158.3µm respectively (p=0.012). At the final visit with mean of follow-up of 21 months (range: 10-36 months) the CFT was 289.4±176.3µm (p=0.03) and BCVA was 0.40±0.26 logMAR (p=0.05). The elevation of IOP was observed in 7 (23%) eyes and could be treated with IOP lowering drops without surgical intervention.

Conclusions:

The results of our retrospective analysis showed that FAc implant is an effective treatment for DME eyes not responding to anti-VEGF treatment. The improvement of BCVA and reduction of CFT were comparable to the treatment with DEX implant but with significantly longer effect.


CONTACT DETAILS

Matus Rehak, Catharina Busch, Claudia Jochmann, Peter Wiedemann
Department of Ophthalmology, University of Leipzig, Germany