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Elena Gusson, Giacomo Panozzo, Stefano Casati; Dexamethasone Intravitreal Implant at the Time of Cataract Surgery in Patients with Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2384.
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It is well known that the presence of chronic and persistent diabetic macular edema (DME) can vanish the visual benefits of phacoemulsification (PE) in these patients. Nevertheless cataract extraction can be necessary both to maintain residual visual function and for a correct follow up of retinopathy. The use of dexamethasone intravitreal implant (Dex-I) at the time of surgery has an elevate rationale in these patients due to its combined high anti-inflammatory and anti-VEGF properties together with its long lasting effect and absence of systemic side effects. We here report the functional and anatomic results of a combined surgical procedure of Dex-I and PE in 7 patients with cataract and chronic DME followed for six months after surgery.
Seven consecutive type-2 diabetic patients with cystoid chronic DME and advanced nuclear cataract (N3-5 at LOCS-III chart) underwent PE. Dex-I was injected as the first surgical maneuver and than PE and IOL implantation proceeded as usual. Postop topical therapy for the first month included combined steroid/antibiotic and combined acetazolamide/β-blocker eye drops. Follow up visits were scheduled at one week and than monthly for 6 months. We measured variations in foveal thickness (FT) at SD-OCT, changes in ETDRS-visual acuity (VA) and in intraocular pressure (IOP).
Mean preop FT was 344μ (range 278-489), preop visual acuity was 18 letters (range 5-26) and mean IOP 17mmHg (range 14-19). Mean preop glicated haemoglobin (HbA1c) was 7.2% (range 6.2-9.8). no complications were registered during or after the surgical procedure. During follow up, mean FT decreased by 122μ (range 81-213) at 1W, 137μ (76-198) at M1, remained unchanged at M2/M3 and than at M4 the gain reduced to 56μ (12-109) to progressively return to preop values at M5 and M6 (final mean FT 356μ). Mean VA change was +5 letters at 1W (range -1/+13), +8 (range +2/+12) at 1M, +11/13 (range +1/+16) at M2-3-4-5, and +9 (range +3/+8) at M6. IOP remained <23mmHg in all patients (hypotensive eye drops maintained until M6 in 3 patients).
In this small case series, Dex-I avoided worsening of chronic DME after cataract extraction and also improved foveal thickness for up to 4-5 months. Dex-I appears to be a good surgical adjuvant in these cases, but larger studies are necessary to confirm these data.
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