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Christoph Mitsch, Sonja Karst, Christoph Scholda, Katharina Kriechbaum, Stefan Sacu, Ursula Schmidt-Erfurth; Intravitreal Dexamethasone Implants as Second Line Treatment for Diabetic Macular Edema – A Retrospective Analysis on 119 Eyes. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2598.
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© ARVO (1962-2015); The Authors (2016-present)
At the Department of Ophthalmology and Optometry of the Medical University of Vienna, patients with recalcitrant diabetic macular edema (DME) receive intravitreal 0.7mg Dexamethasone implants (Ozurdex) as a second-line treatment usually after at least 6 monthly intravitreal Anti-VEGF injections without significant functional response. This study evaluated the efficacy of Ozurdex in eyes with DME as second line treatment in a real world setting.
Retrospective analysis of eyes treated with Ozurdex between July 2014 and July 2018. Data included demographic details, best-corrected-visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). Exclusion criteria were other retinal disease and surgical or intravitreal intervention between baseline and follow-up. Results were split into subcohorts receiving first and consecutive injections and by follow-up interval: early(>21 days), regular(21-56 days), and late(>56 days).
360 implantations in 119 DME eyes of 94 patients (61 male, 58 female, age 64.28±9.54 years) were included into statistical analysis. Baseline characteristics differences between groups and the whole cohort were not statistically significant. Baseline BCVA was Sn 0.37±0.25, IOP was 15.1±3.7 mmHg, and CRT was 422.9±143.9 in the global cohort. At regular follow-up (n=236), after an initial implant (n=31), mean change in BCVA was Sn 0.05±0.18, in IOP 2.3±5.2 mmHg, and in CRT -199.9±191.6 µm.4 eyes (12.9%) gained at least 10 letters, 3 eyes (9.7%) at least 15 letters, whereas 1 eye (3.2%) lost 15 letters or more. After consecutive implants (n=205), mean change in BCVA was Sn 0.04±0.16, in IOP 1.4±3.7 mmHg, and in CRT –102.7±129.8 µm. 29 eyes (14.5%) gained at least 10 letters, 19 eyes (9.3%) gained 15 letters or more, whereas 7(3.41%) and 3 eyes (1.5%) lost 10 or 15 letters or more, respectively. No eye of the analysed cohort had to undergo filter surgery, all IOP increases were transient and manageable with topical IOP-lowering medication.
Ozurdex implants demonstrated a favourable safety-risk-profile. Although morphometric improvements were seen, functional responses scattered widely. Further research will have to be conducted to determine biomarkers apt to predict therapeutic response and to identify eyes with potential benefit.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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