Abstract
Purpose :
To assess functional outcomes and biomarkers changes after intravitreal dexamethasone implant (DEXI) in eyes with diabetic macular edema (DME), naïve and non-responders to vascular endothelial growth factor inhibitors (antiVEGF).
Methods :
Retrospective real-world study conducted on consecutive DME patients with DEXI and were controlled at 2, 6 and 12 months. Subjects were divided in groups: naïve patients and non-responders to previously treated eyes with ≤3 antiVEGF injections (early switch) or >3 antiVEGF injections (late switch). Outcomes were best-corrected visual acuity (BCVA) and biomarkers with spectral domain optical coherence tomography (OCT) according to The European School for Advanced Studies in Ophthalmology (ESASO) classification and retreatments after DEXI.
Results :
A total of 112 eyes were finally included in the study. At baseline, there were no statistically significant differences between gender, BCVA, CRT, type of diabetes mellitus, DME subtype and state of the lens. At month 2, the BCVA (logMAR) changed from 0.4 ± 0.52 to 0.35 ± 0.30, 0.52 ± 0.46 to 0.40 ± 0.52 and 0.70 ± 0.35 to 0.52 ± 0.44 in naïve, early and late switch group, respectively (p<0.001 between all groups). BCVA decreased at 6 and 12-month visit in naïve and early switch group and was stable in late switch from 6 month to final visit. Retinal thickness (T) improved at month 2, 6 and 12 in all groups (p<0.001). There was similar size cyst (C) reduction in all groups with statistically significant differences at 2 and 6-months (p<0.001 and p=0.003, respectively, between all groups). Presence of disorganization of the inner retinal layers (D) and subretinal fluid (F) improved at 12-month visit from baseline in all groups (p=0.04 at 6-month visit in both biomarkers). Hyperreflective foci (H) decreased in all groups over the study period (p< 0.01 at final visit). We found better results in D, F and H biomarkers over study period in late switch group. We did not found differences in the ellipsoid zone and/or external limiting membrane (E) and vitreoretinal relationship (V) alterations between groups in all time investigated. 89 (79.46%) eyes received additional treatment after first DEXI.
Conclusions :
There were similar results in BCVA and biomarkers after DEXI in all groups with better findings in late switch group.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.