Acta Diabetologica

, Volume 55, Issue 6, pp 541–547 | Cite as

Progression of diabetic retinopathy severity after treatment with dexamethasone implant: a 24-month cohort study the ‘DR-Pro-DEX Study’

  • Matias Iglicki
  • Dinah Zur
  • Catharina Busch
  • Mali Okada
  • Anat Loewenstein
Original Article



Intravitreal anti-vascular endothelial growth factor agents have been shown to reduce diabetic retinopathy (DR) progression; data on the effects of intravitreal corticosteroids on modifying disease severity are limited. This study evaluates the long-term effect of intravitreal dexamethasone implant (DEX) on the severity and progression of non-proliferative DR (NPDR).


This was a retrospective cohort study. Sixty eyes from 60 consecutive patients with NPDR and diabetic macular edema (DME) treated with dexamethasone implant (DEX group) and 49 eyes from consecutive 49 patients without DME requiring observation only. Fundus angiography images from baseline and after 24 months were graded by two masked assessors into mild, moderate and severe NPDR and PDR, according to the ETDRS classification. Patients were followed up 1–3 and 4–6 months after each DEX implant. Re-treatment with DEX implant was on a pro re nata basis. Records were reviewed for performance of panretinal photocoagulation. Main outcome was as follows: change of DR ≥ 1 grade and progression to proliferative diabetic retinopathy (PDR).


Three eyes (5%) in the DEX group and 43 (87.8%) eyes in the control group progressed to PDR (P < 0.0001). Twenty-five eyes (41.7%) in the DEX group but none in the control group demonstrated an improvement in DR severity (P < 0.0001).


This study provides the first long-term evidence that DEX implant has the potential to not only delay progression of DR and PDR development, but may also improve DR severity over 24 months. Better understanding of the effects of corticosteroids will help guide its use in the treatment pathway of DR.


Diabetic retinopathy Severity Progression Dexamethasone implant Panretinal photocoagulation 



Anat Loewenstein is a consultant for Allergan. Matias Iglicki, Dinah Zur, Catharina Busch and Mali Okada receive travel support by Allergan.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was obtained through the individual IRBs at the participating institutes for a retrospective consecutive chart review. The research adhered to the tenets of the Declaration of Helsinki.

Informed consent



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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Retina Private OfficeUniversity of Buenos AiresBuenos AiresArgentina
  2. 2.Division of OphthalmologyTel Aviv Sourasky Medical CenterTel AvivIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of OphthalmologyUniversity of LeipzigLeipzigGermany
  5. 5.Royal Victorian Eye and Ear HospitalMelbourneAustralia
  6. 6.Incumbent, Sydney A. Fox Chair in OphthalmologyTel Aviv UniversityTel AvivIsrael

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