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Anastasios Sepetis, Georgios Tsokolas, Spyridon Mourtzoukos; Safety and efficacy of Dexamethasone intravitreal implant (Ozurdex ®) for the treatment of diabetic macular oedema in pseudophakic patients. The Portsmouth experience. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4818.
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© ARVO (1962-2015); The Authors (2016-present)
Dexamethasone 700 μg intravitreal implant (Dex) is recommended by the National Institute for Health and Care Excellence in UK as an option for treating diabetic macular oedema (DMO) in pseudophakic patients that do not respond to other treatment, or such treatment is unsuitable. We performed a retrospective audit to assess the efficacy and safety of Dex in real world settings at Queen Alexandra Hospital in Portsmouth, UK.
Thirty eyes from 25 pseudophakic patients with DMO were investigated to evaluate visual and anatomical characteristics at baseline, 6, 12 and 18 months post Dex (n=27, 23 and 17 eyes, respectively).We studied the best corrected visual acuity (VA), central macular thickness (CMT), central macular volume (CMV) and intraocular pressure (IOP).
There were 14 males and 11 females with an average age 73.4 (53-89) and average of 30 months DMO duration. At baseline, mean VA, CMT and CMV were 63.8 (35-76) letters, 436.8 (330-748) μm and 0.34 (0.21-0.59) μm3, respectively (range). 10 eyes had previously received antiVEGF treatment and 3 eyes had received both antiVEGF and intravitreal steroid injections.At 6, 12 and 18 months post the first implant VA was 71.4±9.2, 65.5±13.32, and 65.6±11.85 letters, respectively. CMT and CMV were 343.9±77.8 and 0.27±0.06, 341.4±82.4 and 0.27±0.07, 321.5±71 and 0.25±0.06, respectively (mean±SD). CMT and CMV were reduced significantly in every follow-up visit comparing to baseline while VA was improved significantly in month 6 (p<0.01, paired t test).The average number of implants received since the baseline was 1.9, 3.0 and 3.6, at months 6, 12 and 18, respectively. 7 patients had drops to normalize their IOP. There is no report of endophthalmitis or other injection related complication. 3 eyes received intravitreal Ranibizumab rescue treatment and 3 eyes had pan-retinal photocoagulation.
Dex is safe and efficient in improving anatomical characteristics in patients with DMO. A small percentage of patients received IOP lowering medication without any further problems. The anatomical improvement in all time points, does not necessarily reflect a functional improvement. The chronicity of the DMO, the initial VA and the timing of captured clinical visits could explain the functional discrepancies from previous studies.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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