Combined Phacoemulsification and Intravitreal Dexamethasone Implant (Ozurdex®) in Diabetic Patients with Coexisting Cataract and Diabetic Macular Edema

Abstract

Purpose To investigate the effectiveness and safety of combined phacoemulsification and dexamethasone intravitreal implant in patients with cataract and diabetic macular edema. Methods In this two-center, retrospective, single-group study, the charts of 16 consecutive patients who underwent combined phacoemulsification and intravitreal dexamethasone implant were retrospectively reviewed. These 16 patients, 7 men and 9 women, were observed at least 3 months of follow-up. Primary outcome was the change of the central retinal thickness (CRT); secondary outcome was the change of best-corrected visual acuity (BCVA). Any ocular complications were recorded. Results Mean CRT decreased significantly from 486 ± 152.4 μm at baseline to 365.5 ± 91 μm at 30 days (p = .005), to 326 ± 80 μm at 60 days (p = .0004), and to 362 ± 134 μm at 90 days (p = .001). Mean BCVA was 20/105 (logMAR, 0.72 ± 0.34) at baseline and improved significantly (p ≤ .007) at all postsurgery time points. One case of ocular hypertension was observed and successfully managed with topical therapy. No endophthalmitis or other ocular complications were observed. Conclusion Intravitreal slow-release dexamethasone implant combined with cataract surgery may be an effective approach on morphologic and functional outcomes for patients with cataract and diabetic macular edema for at least three months after surgery.

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

“…Regarding the optimal time of intravitreal dexamethasone implant insertion in patients with DME and cataract, there are various approaches. Previous studies have used dexamethasone implant either at the beginning or immediately after surgery in an attempt to prevent or control postoperative macular edema [27][28][29][30][31]35 . Agarwal et al used intravitreal dexamethasone implant in 18 eyes with DME and cataract, at the beginning of phacoemulsification, reporting 15-18 letters gain in visual acuity compared to stable visual acuity in controls associated with a decrease in CMT 35 , while Sze et al also showed improvement in BCVA and CST using dexamethasone implant just before initiation of cataract surgery, but about 10% of patients required further treatment due to recurrence of macular edema in about 21 weeks post-operation 28 .…”

“…Agarwal et al used intravitreal dexamethasone implant in 18 eyes with DME and cataract, at the beginning of phacoemulsification, reporting 15-18 letters gain in visual acuity compared to stable visual acuity in controls associated with a decrease in CMT 35 , while Sze et al also showed improvement in BCVA and CST using dexamethasone implant just before initiation of cataract surgery, but about 10% of patients required further treatment due to recurrence of macular edema in about 21 weeks post-operation 28 . Other authors preferred to insert the intravitreal dexamethasone implant at the end of the surgery, when potential intraoperative complications were overcome and a better visualization of the implant in the vitreous was possible, also demonstrated good anatomical and functional outcomes 27,[29][30][31] . In our study, however, about 35% of patients presented recurrent macular edema 3 months postoperatively, suggesting that re-insertion of dexamethasone implant may be needed.…”

Combined Intravitreal Triamcenolone Acetonide And Bevacizumab For Refractory Diabetic Macular Edema

“…Currently dexamethasone slow release implant (Ozurdex 0.7 mg) has been used in various studies in refractory diabetic macular edema and has shown promising results. [16][17][18] The availability of this implant is a major limitation for its use in our setup.…”

Progression of macular oedema following cataract surgery in a diabetic patient

“…DME je najčešći uzročnik gubitka vida kod pacijenata s dijabetičkom retinopatijom i zahvaća oko 25 % pacijenata s dijabetičkom retinopatijom (DR, engl. diabetic retinopathy) 11 . Kod DME-a, osim disfunkcije hematookularne barijere i kronične subkliničke upale, ulogu ima oksidativni stres uzrokovan hiperglikemijom, gubitak pericita, hipoksija, depoziti završnih produkata uznapredovale glikacije (AGE, engl.…”

“…Munk i sur. opisali su OCT promjene po kojima se može 11 . "Prevention of macular edema after cataract surgery" je studija čiji je cilj uspostaviti algoritam liječenja baziran na dokazima postoperativnog CME-a kod pacijenata sa ili bez šećerne bolesti.…”