Effects of dexamethasone treatment on serous retinal detachment in ranibizumab-resistant diabetic macular edema

Abstract

Purpose: To evaluate outcome of intravitreal dexamethasone implant (IDI) treatment on serous retinal detachment (SRD) in patients with ranibizumab-resistant diabetic macular edema (DME). Materials and methods: Forty-eight eyes of 48 patients with DME resistant to ranibizumab were enrolled in this retrospective and comparative study. Patients were divided into two groups according to presence of serous retinal detachment: (1) SRD or (2) non-SRD groups. All patients had at least three monthly ranibizumab injections, after which they were treated with IDI. The best-corrected visual acuity (BCVA), central retinal thickness (CRT), use of antiglaucomatous drugs, and presence of cataract progression were noted at 1, 3, and 6 months post-IDI treatment. Results: There was not any statistically significant difference in terms of baseline characteristics of the patients. The mean CRT was declined in both groups at 1, 3, and 6 months ( p < 0.001). After IDI treatment, the mean BCVA was improved in both groups at 1, 3, and 6 months ( p < 0.001). When groups were compared, the change in CRT was higher in the SRD group ( p = 0.018), while there was no statistically significant difference between groups in terms of BCVA changes ( p = 0.448). Conclusion: The presence of SRD resulted in higher anatomical gain. SRD had no effects on visual changes after dexamethasone treatment in patients with ranibizumab-resistant DME.

Comparison of Optical Coherence Tomography Biomarkers between Bevacizumab Good Responders and Nonresponders Who were Switched to Dexamethasone Implant in Diabetic Macular Edema

“…Lower VA due to SRD type of DME at baseline may be the reason for more favorable visual acuity gain according to previous studies [ 28 , 29 ]. Other studies in which baseline BCVA was comparable between SRD and non-SRD type of DME showed similar improvements in BCVA which was also the case in our study [ 12 , 13 ].…”

“…Of several previous studies, Demircan A and colleagues 22 manually measured SRD height to quantitatively analyze OCT biomarkers and Bayat AH and colleagues 13 included non-SRD patients as a control group. Other studies lacked quantitative analysis of SRD and a control group.…”

“…Other studies performed consecutive anti-VEGF injections (range 3 to 8) and then evaluated the responsiveness 12,13,30,31 . Consecutive injection without evaluation of treatment effect could lead to unnecessary injection and increased financial burden for the patient.…”

“…In agreement with our study, these studies advocate anti-VEGF agent as being more effective in non-SRD type of DME and corticosteroids more effective in SRD type of DME. Of several previous studies, Demircan et al [ 22 ] manually measured SRD height to quantitatively analyze OCT biomarkers and Bayat and Elcioglu [ 13 ] included non-SRD patients as a control group. Other studies lacked quantitative analysis of SRD and a control group.…”

“…11 Due to the anti-inflammatory property of corticosteroids, some studies have advocated the use of dexamethasone intravitreal implants over anti-VEGF agents in treating SRD type DME. [12][13][14][15] In the current study, clinical manifestations and volumetric OCT biomarkers of DME patients who were responsive to bevacizumab, and others switched to the dexamethasone implant due to lack of response, were analyzed. Dexamethasone implant was the initial choice over aflibercept mainly due to the cost and recommended 5 monthly loading dose which may be burdensome to the patient in a real-world clinic setting.…”