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Maria Vittoria Cicinelli, Michele Cavalleri, Lea Querques, Alessandro Rabiolo, Riccardo Sacconi, Adriano Carnevali, Chiara Giuffre, Livia Tomasso, Francesco Bandello, Giuseppe Querques; Early Response to Ranibizumab Predictive of Functional Outcome after Dexamethasone for Unresponsive Diabetic Macular Edema. Invest. Ophthalmol. Vis. Sci. 2017;58(8):916. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze the effects of intravitreal dexamethasone implant (Ozurdex®) in patients suffering from diabetic macular edema (DME) on the basis of their visual and functional response to anti-vascular endothelial growth factor (VEGF) loading dose, in order to justify early shift to corticosteroids in poor responders.
Retrospective clinical practice study. Data of diabetic patients poorly-responder to ranibizumab (RNB) shifted to 0.7mg Ozurdex® implant injection and followed up to 12 months were reviewed. Main outcome was the evaluation of short-term changes after Ozurdex® injection, stratifying patients on the basis of best-corrected visual acuity (BCVA) and central macular thickness (CMT) after RNB loading dose. Secondary outcome was to investigate clinical gain maintenance at long-term follow up.
Overall, 45 eyes of 45 patients (23 males, 51.1%), mean age 69.7±9 years, were included in the analysis. After 3 injections of RNB, 30 eyes (66.7%) had a poor visual response (-4.3±10.7 letters), while 15 eyes (33.3%) disclosed good visual outcome (+13.9±9.2 letters). Patients with poor visual response were associated with limited morphological improvement (p=0.04). After 1 month from Ozurdex®, only poor responders showed relevant increase in BCVA (p=0.006) and reduction in CMT (p=0.002), in comparison to good visual response patients, featuring only minor clinical effects (p=0.3). The same trend was maintained up to 12 months, after a mean of 1.9±1.1 Ozurdex® administrations.
Visual and anatomical responses after RNB loading dose are significant predictors of both early- and long-term visual acuity improvement after switching to corticosteroids in patients with DME unresponsive to anti-VEGF.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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