Vitrectomy Combined with Intraoperative Dexamethasone Implant for the Management of Refractory Diabetic Macular Edema

Abstract

Purpose To evaluate the 1-year results of vitrectomy performed in combination with intraoperative dexamethasone implant for tractional and nontractional refractory diabetic macular edema (DME). Methods Thirteen eyes from 13 subjects who were diagnosed with tractional DME and 17 eyes from 17 subjects who were diagnosed with nontractional refractory DME underwent vitrectomy and dexamethasone implant injection. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) during the one year following vitrectomy were evaluated in each group. Additionally, changes in intraocular pressure and other complications were investigated postoperatively. Results In eyes with tractional DME, a statistically significant improvement in BCVA was noted at 3, 6, and 12 months, and a statistically significant improvement in CMT was noted at 1, 3, 6, and 12 months from baseline after vitrectomy ( p < 0.05). In eyes with nontractional refractory DME, a statistically significant improvement in BCVA was noted at 12 months, but there were no significant improvements in CMT despite the tendency to decrease from baseline. Sixteen (53.3%) of the 30 eyes included in this study showed intraocular pressure elevation, which was addressed using antiglaucoma medication, and there were no other severe complications. Conclusions Vitrectomy combined with intraoperative dexamethasone implant may be safe and effective in treating DME, especially tractional DME. In this study, patients with nontractional DME required more additional treatments and time for anatomical and functional improvement compared to patients with tractional DME.

Three-year outcomes of vitrectomy combined with intraoperative dexamethasone implantation for non-tractional refractory diabetic macular edema

“…www.nature.com/scientificreports/ temporary deterioration between 3 and 6 months postoperatively. The temporary increase of CMT a few months after surgery was also shown in previous studies [22][23][24]37 . This is consistent with the fact that the Ozurdex implant releases high concentrations of dexamethasone for approximately 2 months and subsequently releases relatively lower concentrations of dexamethasone afterward, extending the therapeutic period to 6 months 38 .…”

Benefit Of Vitrectomy And Internal Limiting Membrane Peeling In The Treatment Of Resistant Diabetic Macular Edema

“…There are publications in the literature reporting that IVD implant injection in eyes that had previously undergone PPV was not associated with an increased risk (39)(40)(41)(42). There are studies report that combined application of vitrectomy and IVD implant is safe and effective in terms of anatomical and functional improvement in DME treatment (43,44). We have never faced any uncontrolled increase of intraocular pressure in our patients.…”

Pars Plana Vitrectomy for Resistant Cystoid Macular Edema

“…5 Threshold for type 1 error (alpha) was kept at 0.05, for type II error (beta) the rate was 0.20, effect size was kept at 0.1; while standard deviation in the outcome (visual acuity outcome at 6 months) was taken as 0.17 from published literature. 6 The calculated sample size was 23. One eye of patients 18 years or older with central macular thickness greater than 300 micrometers (µm) which was refractory to medical treatment were included in the study.…”