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Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results

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Abstract

Aims

To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant.

Methods

Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months.

Results

In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, − 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; − 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; − 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344).

Conclusions

The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.

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Author information

Author notes

  1. Dinah Zur and Matus Rehak have contributed equally.

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Leipzig, Liebigstr. 10-14, 04103, Leipzig, Germany

    Catharina Busch, Valentin Degenhardt, Jan-Darius Unterlauft & Matus Rehak

  2. Department of Ophthalmology, Sydney University, Sydney, Australia

    Samantha Fraser-Bell

  3. Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina

    Matias Iglicki

  4. Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, Perugia, Italy

    Marco Lupidi & Carlo Cagini

  5. Department of Ophthalmology, Hôpital Lariboisière, AP-HP, Université Paris, 7 – Sorbonne Paris Cité, Paris, France

    Aude Couturier & Valérie Mané-Tauty

  6. Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Voraporn Chaikitmongkol

  7. Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy

    Ermete Giancipoli & Giuseppe D’Amico Ricci

  8. Department of Biomedical Sciences, University of Sassari, Sassari, Italy

    Ermete Giancipoli & Giuseppe D’Amico Ricci

  9. Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, Monterrey, Mexico

    Patricio J. Rodríguez-Valdés

  10. Department of Ophthalmology, Dijon University Hospital, Dijon, France

    Pierre-Henry Gabrielle

  11. UMR1324, INRA, Center for Taste and Feeding Behaviour, Dijon, France

    Pierre-Henry Gabrielle

  12. Faculty of Medicine, University of Coimbra, Coimbra, Portugal

    Inês Laíns

  13. Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal

    Inês Laíns & Ana Rita Santos

  14. Massachusetts Eye and Ear, Harvard Medical School, Boston, USA

    Inês Laíns

  15. School of Allied Health Technologies, Polytechnic Institute of Porto, Porto, Portugal

    Ana Rita Santos

  16. Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Zafer Cebeci

  17. Department of Ophthalmology, Faculty of Medicine, Rajavithi Hospital, Rangsit University, Bangkok, Thailand

    Atchara Amphornphruet

  18. Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany

    Valentin Degenhardt

  19. Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Isaac Hindi, Anat Loewenstein & Dinah Zur

  20. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Isaac Hindi, Anat Loewenstein & Dinah Zur

  21. Jupiter Hospital, Thane, India

    Kushal Agrawal

  22. UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA

    Jay Chhablani

  23. L.V. Prasad Eye Institute, Banjara Hills, Hyderabad, India

    Jay Chhablani

  24. Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel

    Anat Loewenstein

Authors
  1. Catharina Busch
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  2. Samantha Fraser-Bell
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  3. Matias Iglicki
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  4. Marco Lupidi
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  5. Aude Couturier
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  6. Voraporn Chaikitmongkol
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  7. Ermete Giancipoli
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  8. Patricio J. Rodríguez-Valdés
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  9. Pierre-Henry Gabrielle
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  10. Inês Laíns
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  11. Ana Rita Santos
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  12. Zafer Cebeci
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  13. Atchara Amphornphruet
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  14. Valentin Degenhardt
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  15. Jan-Darius Unterlauft
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  16. Carlo Cagini
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  17. Valérie Mané-Tauty
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  18. Giuseppe D’Amico Ricci
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  19. Isaac Hindi
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  20. Kushal Agrawal
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  21. Jay Chhablani
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  22. Anat Loewenstein
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  23. Dinah Zur
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  24. Matus Rehak
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Corresponding author

Correspondence to Catharina Busch.

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Busch, C., Fraser-Bell, S., Iglicki, M. et al. Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results. Acta Diabetol 56, 1341–1350 (2019). https://doi.org/10.1007/s00592-019-01416-4

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  • DOI: https://doi.org/10.1007/s00592-019-01416-4

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