Efficacy of Intravitreal Dexamethasone Implant in Vitrectomized Eyes With Diabetic Macular Edema Recalcitrant to Anti-Vascular Endothelial Growth Factor Therapy

Abstract

Purpose: To determine the efficacy of an intravitreal dexamethasone implant (IDI) in vitrectomized eyes recalcitrant to previous treatment with intravitreal anti-vascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME).

Methods: This is a retrospective chart review of all patients with vitrectomized eyes that received anti-VEGF therapy (ranibizumab or bevacizumab) and then subsequently underwent IDI placement for treatment of recalcitrant DME between June 2011 and June 2014 as identified by billing records. A total of 10 eyes of 10 patients met inclusion criteria. The primary endpoints were the change in visual acuity (VA) and central retinal thickness (CRT) from pre-treatment with IDI to 1 month post-treatment. Secondary endpoints were VA and CRT changes at 3 months. Two-tailed paired t-tests were used for statistical analysis of eyes pre and post intervention.

Results: An average of 6.40 ± 3.20 (Range 1-12) anti-VEGF injections and 1.90 ± 1.51 (Range 0-4) triamcinolone injections were given prior to IDI placement. One month after IDI placement, there was significant improvement in logMAR VA from 0.81 (20/129 Snellen Equivalent) ± 0.51 to 0.64 (20/87 Snellen Equivalent) ± 0.51 (p<0.001) and CRT from 443.40 ± 118.59 to 287.20 ± 82.78 microns (p=0.003).

Conclusions: Among patients with previously vitrectomized eyes and treated with anti-VEGF therapy, treatment with IDI appears to be efficacious at improving VA and CRT at 1-month with benefits that last at least 3 months.