Dexamethasone implant as an adjuvant therapy to ranibizumab loading dose in persistent diabetic macular edema
This study evaluates the effectiveness of a single-dose dexamethasone implant (DI) as an auxiliary therapy to continued intravitreal ranibizumab (IVR) treatment in patients with persistent diabetic macular edema (DME).
Twenty-five pseudophakic eyes of 25 patients with DME who underwent a single injection of DI as an adjuvant therapy following an IVR loading dose were examined retrospectively. All patients were treatment naive and had a poor response to a loading dose of three consecutive monthly IVR injections. IVR treatments were continued pro re nata after the DI. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1, 3, 6 and 8 months post-DI treatment.
After the IVR loading dose, the mean BCVA and CMT were 0.9 ± 0.6 LogMAR and 478.2 ± 107.8 µm, respectively. One month after the DI, the mean BCVA and CMT had improved to 0.6 ± 0.4 LogMAR (p = 0.005) and 313.8 ± 62.7 µm (p < 0.001), respectively. This improvement was maintained with mean 0.8 ± 0.8 IVR injections throughout the follow-up period. The final mean BCVA and CMT were 0.5 ± 0.5 LogMAR and 298.4 ± 71.5 µm. Subgroup analyses revealed that different DME types did not have any effect on CMT or BCVA improvement (p = 0.188, p = 0.136; respectively).
Adding DI results in rapid anatomical and visual improvement in patients who respond poorly to an IVR loading dose. Improvements may be maintained with additional IVR in follow-up.
KeywordsDexamethasone Diabetic macular edema Adjuvant therapy
The authors have no financial interest in any materials used in the study.
Compliance with ethical standards
Conflict of interest
None of the authors has any financial/conflicting interests to disclose.
- 8.Grover D, Li TJ, Chong CC (2008) Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev 1:CD005656Google Scholar
- 13.Ferris FL III, Maguire MG, Glassman AR, Ying GS, Martin DF (2016) Evaluating effects of switching anti-vascular endothelial growth factor drugs for age-related macular degeneration and diabetic macular edema. JAMA Ophthalmol 1:22. https://doi.org/10.1001/jamaophthalmol.2016.4820 CrossRefGoogle Scholar
- 15.Maturi RK, Glassman AR, Liu D et al (2017) Diabetic Retinopathy Clinical Research Network. Effect of adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema: a DRCR Network Phase 2 randomized clinical trial. JAMA Ophthalmol Nov:11. https://doi.org/10.1001/jamaophthalmol.2017.4914 CrossRefGoogle Scholar
- 16.Ying GS, Maguire MG, Daniel E et al (2015) Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group. Association of baseline characteristics and early vision response with 2-year outcomes in the Comparison of AMD Treatments Trials (CATT). Ophthalmology 122(12):2523.e1–2531.e1CrossRefGoogle Scholar