Intravitreal dexamethasone implant in naïve and previously treated patients with diabetic macular edema: a retrospective study

Medina-Baena, Marta; Cejudo-Corbalán, Olga; García-Pulido, Juan Ignacio; Huertos-Carrillo, María Jesús; Girela-López, Eloy

doi:10.18240/ijo.2020.10.14

Cited by 5 publications

(5 citation statements)

References 56 publications

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“…These results suggest the possibility of achieving better results with earlier DEX implantation. This agrees with the results of a study by Medina-Baena, which demonstrated that at month 12, naïve patients exhibited a greater improvement in BCVA from baseline and achieved this BCVA improvement significantly faster than previously treated patients [53]. Similar results were observed in a study by Iglicki et al [54].…”

Section: Diabetic Macular Edemasupporting

confidence: 92%

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

Grzybowski

Markeviciute

Žemaitienė

2021

JCM

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Macular edema (ME) is associated with various conditions; however, the main causes of ME are retinal vein occlusion (RVO) and diabetes. Laser photocoagulation, formerly the gold standard for the treatment of ME, has been replaced by anti-vascular endothelial growth factor (anti-VEGF) intravitreal injections. Despite its efficiency, this treatment requires frequent injections to preserve the outcomes of anti-VEGF therapy, and as many patients do not sufficiently respond to the treatment, ME is typically a chronic condition that can lead to permanent visual impairment. Generalized recommendations for the treatment of ME are lacking, which highlights the importance of reviewing treatment approaches, including recent anti-VEGFs, intravitreal steroid implants, and subthreshold micropulse lasers. We reviewed relevant studies, emphasizing the articles published between 2019 and 2021 and using the following keywords: macular edema, diabetic macular edema, retinal vein occlusion, laser photocoagulation, anti-VEGF, and intravitreal injections. Our results revealed that a combination of different treatment methods may be beneficial in resistant cases. Additionally, artificial intelligence (AI) is likely to help select the best treatment option for patients in the near future.

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Section: Diabetic Macular Edemasupporting

confidence: 92%

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

Grzybowski

Markeviciute

Žemaitienė

2021

JCM

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“…Multiple hypotheses relate certain anatomical characteristics with a better response to DEX-I implants, such as the presence of subretinal fluid. In a previous analysis by the authors [ 31 ], the presence of subretinal fluid was significantly associated with the proportion of patients achieving a BCVA improvement ≥5 letters. This could lead to the conclusion that the cost of treatment in these patients would be reduced if DEX-i implant was used as a first-line treatment.…”

Section: Discussionmentioning

confidence: 96%

Cost-Effectiveness of Dexamethasone Intravitreal Implant in Naïve and Previously Treated Patients with Diabetic Macular Edema

Medina-Baena

Cejudo-Corbalán

Labella-Quesada

et al. 2023

IJERPH

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Purpose: To compare the direct costs associated with the dexamethasone intravitreal implant (DEX-i) in treatment-naïve and previously treated eyes with diabetic macular edema (DME) in a real clinical setting. Methods: Retrospective and single-center study conducted in a real clinical scenario. Consecutive DME patients, either naïve or previously treated with vascular endothelial growth factor inhibitors (anti-VEGF), who received treatment with one or more DEX-i between May 2015 and December 2020, and who were followed-up for a minimum of 12 months, were included in the study. The cost analysis was performed from the perspective of the Andalusian Regional Healthcare Service. The primary effectiveness endpoint was the probability of achieving an improvement in best-corrected visual acuity (BCVA) ≥ 15 ETDRS letters after 1 year of treatment. The incremental cost-effectiveness ratio (ICER) of different improvements in BCVA was calculated. Results: Forty-nine eyes, twenty-eight (57.1%) eyes from the treatment-naïve group and twenty-one (42.9%) from the previously treated group, were included in the analysis. The total cost of one year of treatment was significantly lower in the treatment-naïve eyes than in the previously treated eyes [Hodges-Lehmann median difference: EUR 819.1; 95% confidence interval (CI): EUR 786.9 to EUR 1572.8; p < 0.0001]. The probability of achieving a BCVA improvement of ≥15 letters at month 12 was significantly greater in the treatment-naïve group than in the previously treated group (rate difference: 0.321; 95% CI: 0.066 to 0.709; p = 0.0272). The Cochran–Mantel–Haenszel Odds Ratio of achieving a BCVA improvement of ≥15 letters at month 12 was 3.55 (95% CI: 1.09 to 11.58; p = 0.0309). In terms of ICER, the treatment-naïve group showed cost savings of EUR 7704.2 and EUR 5994.2 for achieving an improvement in BCVA ≥ 15 letters at month 12 and at any of the measured time points, respectively. Conclusions: DEX-i was found to be more cost-effective in treatment-naïve eyes than in those previously treated with anti-VEGF. Further studies are needed to determine the most cost-effective treatment based on patient profile.

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“…Steroid therapy can be considered as first-line therapy in cases where there is clear evidence of inflammatory signs on OCT, but also as second-line treatment by performing an early switch if edema is not responsive to antiangiogenic treatment. 22,23 The purpose of this study was to investigate the effects of DEXi on retinal microvasculature in diabetic patients. We used OCTA as main imaging technique to investigate the FAZ and retinal superficial and deep vascular densities in patients with DR complicated by center-involving Regarding FAZ area, mean size in entire series of patients remained substantially unchanged after a single steroid injection.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of intravitreal dexamethasone implant in treatment-naive and previously-treated patients with diabetic macular edema

Nikolopoulou

Sacconi

Lorusso

et al. 2022

European Journal of Ophthalmology

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Purpose To document the effects of intravitreal dexamethasone implant on retinal microvasculature in patients with diabetic retinopathy complicated by center-involving macular edema. Methods 35 eyes of 35 patients affected by retinopathy due to type 2 diabetes (15 treatment-naïve and 20 previously treated) were included in this retrospective study with a follow-up of 4 months. Foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) and deep capillary plexus (DCP) densities in the foveal and parafoveal areas were measured by optical coherence tomography angiography (OCTA) at baseline and 2 and 4 months post-injection. Intraocular pressure, morphological and functional parameters were evaluated. Results a significant difference was found in both groups at 2 months after injection in terms of functional (BCVA, p < 0.05) and morphological (CMT, p < 0.05) parameters. During follow-up, FAZ area, SCP, and DCP in the foveal and parafoveal areas did not change significantly. Conclusions intravitreal dexamethasone implant is effective in the treatment of diabetic center-involving macular edema and was associated with significant improvements in BCVA and CMT at 2 months after injection. After a single dexamethasone implant injection, FAZ area and retinal vascular density does not show significant variations in both naive and non-naive DME patients subgroups.

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Intravitreal dexamethasone implant in naïve and previously treated patients with diabetic macular edema: a retrospective study

Cited by 5 publications

References 56 publications

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

Treatment of Macular Edema in Vascular Retinal Diseases: A 2021 Update

Cost-Effectiveness of Dexamethasone Intravitreal Implant in Naïve and Previously Treated Patients with Diabetic Macular Edema

Effect of intravitreal dexamethasone implant in treatment-naive and previously-treated patients with diabetic macular edema

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