Abstract
Purpose:
To evaluate the early effect of dexamethasone intravitreal implant (Ozurdex®; Allergan Inc, Irvine, CA, USA) in patients with recalcitrant diabetic macular edema (DME).
Methods:
Prospective, non-randomized, interventional clinical series. Patients (n = 20 eyes) with recalcitrant DME, 4 or more months after one or more treatments of macular laser photocoagulation and/or intravitreal anti-vascular endothelial growth factor (VEGF), injections, best-corrected visual acuity (BCVA) of 20/32 to 20/200 Snellen equivalent, and central retinal thickness (CRT) of ≥300 μm by optical coherence tomography (OCT) were recruited. Exclusion criteria included history of corticosteroid-responsive intraocular pressure (IOP) rise, cataract extraction, or other intraocular surgery within 3 months; vitrectomized eyes were also excluded. Patients underwent single implant with Ozurdex® implant 0.7 mg, followed at 3 hours, 3,7, and 30 days after treatment. The main outcome was change in central macular thickness on OCT in response to Ozurdex® injection. Secondary outcome measures included visual acuity and changes in IOP following intravitreal implant.
Results:
Mean age of patients was 65 years. Mean duration of diabetes mellitus was 14.4 years. Systemic control of DM as assessed by FBS/PPBS and HbA1c. The pre-operative mean central macular thickness was 744 μm and improved to 626 μm, 470 μm, 325 and 240 μm at 3 hours, 3, 7 and 30-day respectively. Preoperative mean BCVA was 0.6 logMAR units and improved to 0.3 and 0.45 logMAR units at 7 and 30 days, respectively. All patients experienced a controlled IOP after the injection with 2 out of 20 eyes affected by transient increasing IOP during follow-up
Conclusions:
Ozurdex® appears efficacious in management of recalcitrant diabetic macular edema with significant improvements in best-corrected visual acuity and central macular thickness from the third hour of implant in DME sufferers, and this improvement was sustained during follow-up.