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Giacomo Panozzo, Elena Gusson, Stefano Casati; Dexamethasone Intravitreal Implant for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2385.
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To evaluate the anatomical and functional efficacy of a single injection of dexamethasone intravitreal implant 0.7mg (Ozurdex, Allergan) for diabetic macular edema (DME).
We administered a single dose of dexamethasone intravitreal implant in 18 eyes of 18 consecutive patients with type 2 diabetes and cystoid macular edema. Of these 18 eyes, 10 eyes (Group 1) had DME refractory to previous intravitreal anti-VEGF treatment (plus focal laser in 3 eyes), and 8 eyes received dexamethasone implant as a first line therapy (Group 2). Follow up was scheduled 1 week after injection and than monthly for four months. We measured variations in foveal thickness (FT) and macular volume (MV) at SD-OCT, changes in ETDRS visual acuity, intraocular pressure and lens opacity (LOCS chart III) in phakic eyes. Patients were further divided in two sub-groups based on glycated haemoglobin (HbA1c) ± 8.5%.
Changes in FT and MV between preop and follow up visits were statistically similar in both Groups. Mean FT decreased by 142μ (36.9%) at 1W, 154 μ (40%) at M1, and remained than stable at M2 and M3. At M4 this gain reduced to 104μ (27%) in patients with HbA12c <8.5%, and only to 21μ (5,4%) in patients with HbA1c > 8.5%. In Group 1 mean preop VA was 23 letters and increased by 3 letters (13%) at 1W, 12 letters (52,2%) at M1 remaining stable until M4, when decreased by 2 letters (-10%) from initial values, independently from HbA1c. In Group 2, VA improved from 41 letters at baseline to 50 (21,9%) at 1W, to 56 (36,6%) at M1, 59 (43,9%) at M2 and M3, and than at M4 returned to 42 (+2,4%) in patients with HbA1c >8.5% and remained at 51 (+24,4%) if HbA1c < 8.5%. No differences in lens opacity were registered in phakic eyes. Intraocular pressure remained < 23mmHg in all eyes (11 patients required topical ipotensive therapy).
In this small case series, a single dexmethasone intravitreal injection was effective in reducing DME and improving VA for up to four months both in naïve and refractory DME. Better glycemic control influenced the duration but not the amount of the results. Further studies are necessary to confirm these data
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