International Ophthalmology

, Volume 36, Issue 2, pp 207–216 | Cite as

Efficacy of Ozurdex implant in recalcitrant diabetic macular edema—a single-center experience

  • Pooja Bansal
  • Vishali Gupta
  • Amod Gupta
  • Mangat Ram Dogra
  • Jagat Ram
Original Paper


The purpose of this study is to report the efficacy of intravitreal Ozurdex implant in managing recalcitrant diabetic macular edema. Retrospective interventional non-randomized study of patients with recalcitrant diabetic macular edema who received intravitreal Ozurdex implant. Main outcome measures were change in the central macular thickness, visual acuity, and intraocular pressure. Sixty-seven eyes of 52 patients with recalcitrant diabetic macular edema with a mean duration of 45.4 ± 22.5 months (range 6–96 months) were studied. Mean central macular thickness decreased from 514.2 ± 177.8 µm at baseline to 394.3 ± 152.2 µm (p = 0.007), 301.8 ± 93.0 µm (p < 0.000), 316.4 ± 115.6 µm (p < 0.000), and 419.9 ± 186.3 µ (p = 0.03) at 1, 6, 12, and 24 weeks, respectively. Mean best corrected visual acuity changed from 0.82 ± 0.46 log MAR to 0. 69 ± 0.44 log MAR (p = 0.122), 0.61 ± 0.40 log MAR (p = 0.007), 0.65 ± 0.37 log MAR (p = 0.024), and 0.68 ± 0.49 log MAR (p = 0.091) at 1, 6, 12, and 24 weeks, respectively. Single injection of intravitreal Ozurdex implant led to progressive decrease in central macular thickness with maximum percentage decrease at 6 weeks (41.2 %) from the baseline which was maintained up to 12 weeks. Eight eyes showed transient rise in intraocular pressure at 2 months which was controlled by antiglaucoma medications.


Bevacizumab Dexamethasone intravitreal implant Ozurdex Recalcitrant diabetic macular edema Triamcinolone 


  1. 1.
    Bhagat N, Grigorian RA, Tutela A, Zarbin MA (2009) Diabetic macular edema: pathogenesis and management. Surv Ophthalmol 54:1–32Google Scholar
  2. 2.
    Early treatment diabetic retinopathy study research group: photocoagulation for diabetic macular edema: early treatment diabetic retinopathy study report no 1. Arch Ophthalmol 1985;103:1796–1806Google Scholar
  3. 3.
    Schatz H, Madeira D, McDonald HR, Johnson RN (1991) Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol 109:1549–1551CrossRefPubMedGoogle Scholar
  4. 4.
    Funatsu H, Noma H, Mimura T, Eguchi S, Hori S (2009) Association of vitreous Inflammatory factors with diabetic macular edema. Ophthalmology 116:73–79CrossRefPubMedGoogle Scholar
  5. 5.
    Karim R, Tang B (2010) Use of antivascular endothelial growth factor for diabetic macular edema. Clin Ophthalmol 4:493–517CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Intravitreal steroids for macular edema: the past, the present, and the future. Surv Ophthalmol 2008;53:139–149Google Scholar
  7. 7.
    Gillies MC, Islam FM, Zhu M, Larsson J, Wong TY (2007) Efficacy and safety of multiple intravitreal triamcinolone injections for refractory diabetic macular edema. Br J Ophthalmol 91:1323–1326CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jonas JB, Kreissig I, Sofker A, Degenring RF (2003) Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol 121:57–61CrossRefPubMedGoogle Scholar
  9. 9.
    Sutter FKP, Simpson JM, Gillies MC (2004) Intravitreal triamcinolone for diabetic macular edema that persists after laser treatment: three-month efficacy and safety results of a prospective, randomized, double-masked, placebo-controlled clinical trial. Ophthalmology 111:2044–2049CrossRefPubMedGoogle Scholar
  10. 10.
    Gillies MC, Sutter FK, Simpson JM, Larsson J, Ali H, Zhu M (2006) Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a doublemasked, placebo-controlled, randomized clinical trial. Ophthalmology 113:1533–1538CrossRefPubMedGoogle Scholar
  11. 11.
    Martidis A, Duker JS, Greenberg PB, Rogers AH, Puliafito CA, Reichel E (2002) Intravitreal triamcinolone for refractory diabetic macular edema. Ophthalmology 109:920–927CrossRefPubMedGoogle Scholar
  12. 12.
    Aiello LP, Beck RW, Bressler NM, Browning DJ, Chalam KV, Davis M et al (2011) Rationale for the diabetic retinopathy for the diabetic retinopathy clinical research network treatment protocol for center-involved diabetic macular edema. Diabetic Retinopathy Clinical Research Network; Writing Committee. Ophthalmology 118:5–14CrossRefGoogle Scholar
  13. 13.
    Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR et al (2009) Diabetic retinopathy clinical research network (,: three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol 127:245–251CrossRefPubMedGoogle Scholar
  14. 14.
    Vanrell RH, Cardillo JA, Kuppermann BD (2011) Clinical applications of the sustained-release dexamethasone implant for treatment of macular edema. Clin Ophthalmol 5:139–146Google Scholar
  15. 15.
    Kupperman BD, Blumenkranz MS, Haller JA et al (2007) Dexamethasone DDS Phase II Study Group. Randomized controlled study of an intravitreal dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol 125:309–317CrossRefGoogle Scholar
  16. 16.
    Haller JA, Dugel P, Weinberg DV, Chou C, Whitcup SM (2009) Evaluation of the safety and performance of an applicator for a novel intravitreal dexamethasone drug delivery system for the treatment of macular edema. Retina 29:46–51CrossRefPubMedGoogle Scholar
  17. 17.
    Haller JA, Kuppermann BD, Blumenkranz MS, Williams GA, Weinberg DV, Chou C et al (2010) Dexamethasone DDS Phase II Study Group: randomized controlled trial of an intravitreal dexamethasone drug delivery system in patients with diabetic macular edema. Arch Ophthalmol 128:289–296CrossRefPubMedGoogle Scholar
  18. 18.
    Boyer DS, Faber D, Gupta S, Patel SS, Tabandeh H, Li XY et al (2011) Ozurdex Champlain study group: dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina 5:915–923CrossRefGoogle Scholar
  19. 19.
    Zucchiatti I, Lattanzio R, Querques G, Turco C, Cascavilla M, Bandello F et al (2012) Intravitreal dexamethasone implant in patients with persistent diabetic macular edema. Ophthalmologica 228:117–122CrossRefPubMedGoogle Scholar
  20. 20.
    Rishi P, Rishi E, Kuniyal L, Mathur G (2012) Short-term results of intravitreal dexamethasone implant (OZURDEX®) in treatment of recalcitrant diabetic macular edema: a case series. Oman J Ophthalmol 5:79–82CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Callanan D, Gupta S, Boyer D, Ciulla T, Singer M, Kuppermann B et al (2013) Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology 120:1843–1851CrossRefPubMedGoogle Scholar
  22. 22.
    Staurenghi Giovanni, Sadda Srinivas, Chakravarthy Usha, Spaide Richard F (2014) Proposed lexicon for anatomic landmarks in normal posterior segment spectral- domain optical coherence tomography. Ophthalmology 121:1572–1578CrossRefPubMedGoogle Scholar
  23. 23.
    Sakamoto A, Hangai M, Yoshimura N (2008) Spectral domain optical coherence tomography with multiple B-scan averaging for enhanced imaging of retinal diseases. Ophthalmology 115:1071–1078CrossRefPubMedGoogle Scholar
  24. 24.
    Puliafito CA, Hee MR, Lin CP, Rechiel E, Schuman JS, Duker JS et al (1995) Imaging of macular diseases with optical coherence tomography. Ophthalmology 102:217–229CrossRefPubMedGoogle Scholar
  25. 25.
    Otani T, Yamaguchi Y, Kishi S (2010) Correlation between visual acuity and foveal microstructural changes in diabetic macular edema. Retina 30:774–780CrossRefPubMedGoogle Scholar
  26. 26.
    Shin HJ, Lee SH, Chung H, Kim HC (2012) Association between photoreceptor integrity and visual outcome in diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 250:61–70CrossRefPubMedGoogle Scholar
  27. 27.
    Coscas G, Coscas F, Zucchiatti I, Glacet-Bernard A, Soubrane G, Souied E (2011) SD-OCT pattern of retinal venous occlusion with cystoid macular edema treated with Ozurdex ®. Eur J Ophthalmol 21:631–636CrossRefPubMedGoogle Scholar
  28. 28.
    Shin HJ, Chung H, Kim HC (2011) Association between integrity of foveal photoreceptor layer and visual outcome in retinal vein occlusion. Acta Ophthalmol 89:35–40CrossRefGoogle Scholar
  29. 29.
    Ota M, Tsujikawa A, Murakami T, Yamaike N, Sakamoto A, Kotera Y et al (2008) Foveal photoreceptor in eyes with persistent cystoid macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 145:273–280CrossRefPubMedGoogle Scholar
  30. 30.
    Ianetti L, Spinucci G, Abbouda A, De Geronimo D, Tortorella D, Accorinti M (2012) Spectral domain optical coherence tomography in uveitic macular edema: morphological features and prognostic factors. Ophthalmologica 228:13–18CrossRefGoogle Scholar
  31. 31.
    Guigou S, Hajjar C, Parrat E, Merite PY, Pommier S, Matonti F et al (2014) Multicenter Ozurdex® assessment for diabetic macular edema: MOZART study. J Fr Ophtalmol 37:480–485CrossRefPubMedGoogle Scholar
  32. 32.
    Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ et al (2014) Ozurdex MEAD study group. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 121:1904–1914CrossRefPubMedGoogle Scholar
  33. 33.
    Gillies MC, Lim LL, Campain A, Quin GJ, Salem W, Li J et al (2014) A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology 121:2473–2481CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Pooja Bansal
    • 1
  • Vishali Gupta
    • 1
  • Amod Gupta
    • 1
  • Mangat Ram Dogra
    • 1
  • Jagat Ram
    • 1
  1. 1.Department of Ophthalmology, Advanced Eye CentrePost Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia

Personalised recommendations