Abstract
Purpose :
To evaluate the long-term functional and anatomical outcomes of eyes undergoing cataract surgery combined with dexamethasone (DEX) implant in eyes with persistent diabetic macular edema (DME), and to compare with a matched sample undergoing the same procedure but with a 1-month deferred steroid injection.
Methods :
Retrospective observation of all the institutional patients undergoing combined cataract surgery and intravitreal DEX from January 2010 to October 2017. Clinical data were collected by means of the institutional electronic medical chart NIDEK nLIFE. In the investigational combined group, best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were extracted at baseline (combined surgery and DEX), 1, 4, 12 and 24 months after procedure. The deferred group was analyzed the day of surgery, the day of DEX injection (baseline), then according to the same time points of the investigational group.
Results :
Forty eyes were analyzed, 20 in the combined and 20 in the deferred group. BCVA disclosed akin trends in both, increasing from similar starting values (p=0.9913) to comparable scores 1 month after DEX (p=0.4229). After 4 months BCVA similarly dropped down in both groups, with nonsignificant variations within each group. CRT was similar at the time of surgery (p=0.6134). DEX injection positively reduced CRT in both sample, with a superior beneficial effect in the combined group after 1 month (p=0.001003). At 4 months, CRT further elevated and remained overall stable, without differences between the two samples.
By 12 months 19 (95%) eyes received further injections: 1 (5%) fluocinolone, 3 (15%) received 1 DEX and 1 fluocinolone, 13 (65%) at least 1 DEX only, and 2 (10%) anti-VEGFs. Throughout the second year 6 additional eyes (from the 13 receiving DEX) switched to fluocinolone, reaching a total of 10 (50%). Similar results were observed in the deferred group.
Conclusions :
DEX implant performed at the time of surgery achieved the same long-term functional and anatomical outcomes of 1-month deferred DEX implant in treating eyes with persistent DME that should undergo cataract extraction. Combined treatment might protect the diabetic eye by lessening the surgical inflammatory load, and additionally reduce the burden of repeated series of visits required for deferred procedures.
This is a 2020 ARVO Annual Meeting abstract.