Comparison of efficacy and safety of intravitreal triamcinolone acetonide vs dexamethasone implant (Ozurdex) in treatment of diabetic macular edema

Abstract

Purpose : Retrospective chart review to compare the effect of triamcinolone acetonide (TA) and dexamethasone implant (DX) on visual function, anatomy, and safety in patients with diabetic macular edema (DME)

Methods : Adults with DME seen at a tertiary care center between 2012 and 2016, who had undergone intravitreal injection of TA or DX, were included. Patients using anti-VEGF agents within one month prior to initial injection were excluded. Change in visual function (logMAR equivalent of Snellen best corrected visual acuity) and anatomy (central subfield thickness (CST) and cube volume (CV) as measured by SD-OCT) were compared at one, three, and six months after initial injection. Number of intravitreal injections over 6 months and adverse events such as ocular hypertension requiring anti-pressure drops and cataract extraction, were also examined. Student’s t-test was used to analyze data for statistical significance.

Results : Sixty-seven eyes of 58 patients (mean age 68.1, 50% male) were included. Baseline visual acuity (P= 0.7), CST (P=0.8), and CV (P=0.8) did not significantly differ between groups. DX was associated with improvement in visual function at one month (0.38, P<0.001) and 6 months (0.42, P=0.02), while TA was not associated with a change in visual function (P>0.05 for all). Both TA and DX were associated with significant decrease in CST and CV at one month (-129.8 and -1.1 for TA, -165.4 and -1.5 for DX, P<0.001 for all) and 3 months (-74.1 and -0.6 for TA, P<0.01 for both; -108.8 and -1.0 for DX, P<0.001 for both), with no significant difference between groups (P>0.05). However, only DX was associated with sustained decrease in both CST and CV at 6 months (-101.4 and -1.0, P<0.001 for both). Post-injection IOP was significantly higher in both TA (19, P=0.003) and DX (17, P=0.02); IOP change did not differ between groups (P=0.1). TA was associated with significantly greater number of injections over 6 months compared to DX (2, P=0.002). There was no significant difference in the number of glaucoma medications added (P=0.8) or need for cataract surgery (P=0.2). No patients developed endophthalmitis.

Conclusions : While both TA and DX improved anatomy up to 3 months after injection, only DX was associated with better visual function and sustained anatomical improvements. TA may have a greater injection burden than DX.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.