Purchase this article with an account.
Qi N Cui, Jay M Stewart; Intravitreal Dexamethasone Implant (Ozurdex) as Primary Treatment for Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1780.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Recently, the intravitreal dexamethasone implant Ozurdex (Allergan, Inc.) 0.7mg has gained momentum as a possible option for the management of persistent diabetic macular edema (DME). In this case series, we evaluated the effectiveness of Ozurdex as primary treatment for DME.
Six patients (3 M, 3 F; 7 eyes) affected by persistent DME were selected. The average age was 69 ± 9 yrs (± SD; range 60-87) and the duration of DME was 808 ± 586 days (range 83-1618) at the time of initial Ozurdex injection. One patient received prior posterior subtenon triamcinolone, one received intravitreal triamcinolone, and 3 patients received prior focal and/or grid photocoagulation, all without a significant effect upon the DME. None of the patients had received previous treatment with anti-VEGF. Outcomes evaluated included central macular thickness (CMT), BCVA, and IOP prior to injection, and then at 1 & 3 months follow-up.
Baseline CMT prior to injection was 425 ± 101μm. Of the 6 eyes with available OCT, a decrease in CMT was detected with an average thickness of 310 ± 77μm (p < 0.05) at 1 month. The improvement from baseline persisted at 3 months with an average CMT of 319 ± 84μm (p < 0.05). The differences in CMT between 1 and 3 months were not significant. Mean BCVA (converted to LogMAR) did not differ significantly between baseline (0.55 ± 0.35), 1 month (0.57 ± 0.41), and 3 months (0.51 ± 0.42; p = 0.741875). In long-term follow-up, a trend towards improved visual acuity was observed in all eyes. One patient required vitrectomy and membrane peel for an ERM prior to observable visual improvement. Two patients required repeated injections at 3 - 4 month intervals for continued visual improvement. With an average follow-up of 492 ± 389 days (range 147-1210), no other ocular or systemic complications were noted. All patients had normal IOP (14.6 ± 3.2 mmHg) prior to injection, IOPmax during follow-up was 24.9 ± 7.2 mmHg, and 3 patients/4 eyes required topical therapy for IOP management. The only patient with a native lens at the time of placement experienced cataract progression resulting in cataract extraction 657 days post-injection.
In this small series, Ozurdex significantly decreased CMT with a trend towards improved BCVA in long-term follow-up. Duration of action appeared to be around 3 months. IOP elevation was observed requiring medical management alone in a subset of patients.
This PDF is available to Subscribers Only