Results of dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema patients: Early versus late switch

Abstract

Purpose To assess the functional and anatomical outcomes of intravitreal dexamethasone implant Ozurdex® in eyes with diabetic macular edema that did not adequately respond to vascular endothelial growth factor inhibitors. Methods Multicenter, retrospective, and real-life case series study conducted on consecutive diabetic macular edema patients who underwent treatment with one or more dexamethasone implant injections and were followed up for a minimum of 12 months. Subjects were divided into three groups: I—naïve patients, II—previously treated eyes that received three intravitreal antivascular endothelial growth factor inhibitors injections before the study (early switch), and III—previously treated eyes that received >3 intravitreal antivascular endothelial growth factor inhibitors injections before the study (late switch). Primary endpoints were best-corrected visual acuity and central retinal thickness at month 12. Results A total of 129 eyes (21 naïve and 108 previously treated, Group II: 32 and Group III: 76) were included. At month 12, best-corrected visual acuity significantly improved from 0.27 ± 0.23 and 0.31 ± 0.22 at baseline to 0.36 ± 0.25 and 0.37 ± 0.23 at month 12 in naïve and previously treated eyes, respectively, and p = 0.0063 and 0.0060, respectively. Central retinal thickness, in naïve and previously treated eyes, was significantly reduced from 483.0 ± 143.4 and 431.3 ± 115.5 µm, at baseline, to 278.8 ± 72.1 and 269.3 ± 66.2 µm, at month 12, respectively, and p < 0.0001 each, respectively. Best-corrected visual acuity improvement was significantly greater in both absolute and percentage values, p = 0.0393 and 0.0118, respectively, in Group II than in Group III. Conclusion In eyes with insufficient response to antivascular endothelial growth factor inhibitors, switching to dexamethasone at the time to 3-monthly antivascular endothelial growth factor inhibitors injections provided better functional outcomes than those that received >3 antivascular endothelial growth factor inhibitors injections.

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

“…These results agree with those of a study by Ruiz-Medrano et al [45]. Superior functional outcomes were observed in eyes with insufficient responses to anti-VEGFs in patients switched to DEX who had been receiving three monthly anti-VEGF injections compared with those who had been receiving more than three monthly anti-VEGF injections [65].…”

Retinal Layers Changes in Patients with Diabetic Macular Edema Treated with Intravitreal Anti-VEGF Agents: Long-Term Outcomes of a Spectral-Domain OCT Study

“…Treatment response is a matter of controversy between studies since there is no univocal definition of responsiveness to treatment and there are different criteria of “successful” treatment response or “nonresponse,” while the time to assess treatment response varies among studies [27]. Although anti-VEGF agents were found to be effective in DME treatment, reducing retinal thickness as a whole and in all separate retinal layers and improving visual acuity in the 12-month follow-up, the definition of factors affecting visual outcome is significant to determine treatment response and consider early switch in treatment in cases of “nonresponders.” Although it has been supported that there may be a delayed treatment response and that patients with DME may benefit from sustained anti-VEGF treatment [28], a recent study by Ruiz-Medrano et al [29] has shown that in eyes with insufficient response to anti-VEGF agents, switching to dexamethasone implant after 3 intravitreal anti-VEGF injections provided better functional results than receiving >3 injections and then switching, supporting early switch in “nonresponders.”…”

Effectiveness and Safety of Coadministration of Intravitreal Dexamethasone Implant and Silicone Oil Endotamponade for Proliferative Diabetic Retinopathy with Tractional Diabetic Macular Edema

“…In the literature, many treatment methods have been identified in the treatment of DME. PRP, [7][8][9] grid or micropulse yellow laser, [10][11][12] intravitreal injection of anti-VEGF drugs, [13][14][15][16] subtenon or intravitreal injection of glucocorticoid drugs, 17,18 and PPV 19,20 are the most known options. PRP is a standard treatment that has been showing its benefit in PDR management for nearly 40 years by reducing VEGF release from ischemic areas.…”