First Author: B.Erden TURKEY
Co Author(s): S. Bolukbasi S. Erdenoz A. Cakir M. Elcioglu
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To compare the short-term results of dexamethasone (Dex) implant with those of three consequtive ranibizumab injections in treatment of naive diabetic macular edema patients.
Okmeydani Education and Research Hospital, Istanbul, Turkey
In this retrospective study, 37 eyes of 34 diabetic macular edema patients were enrolled into the ranibizumab (R) group; 33 eyes of 30 patients were enrolled in the Dex (D) group. Both groups were treatment naive. The R group was treated with 3 consequtive monthly ranibizumab injections; the D group was injected only one Dex implant. Both groups underwent pre-injection, postinjection at 1st month, 2nd month and 4th month optic coherence tomography (OCT) exams. Best corrected visual acuity (BCVA; Snellen), biomicroscopy, fundoscopy and intraocular pressure (IOP) were recorded at each visit. Data were analysed with SPSS 11.0 statistically.
Mean age (R: 62.4; D:64.2), duration of diabetes (R:8.9 vs D: 9.3 years) and pre-treatment central macular thickness (CMT; R:423; D: 452) were statistically indifferent. The IOP changes were within and between both groups (R: 16.5,15.6, 16.2,15.4 mmHg vs D: 15.5,16.9,17.6,16.3 mmHg) insignificant. The BCVA increased in R group from 0.28 lines to 0.38; 0.42 and 0.49 (p<0.05); in D group from 0.18 to 0.29; 0.37 and 0.37 at final visit (p<0.05) . The comparison of visual gain at 4th month visit showed no difference (R: 0.21; D:0.19; p>0.05). The CMT decreased in R group from 423µ to 355µ, 344µ and to 313µ (p<0.05); in D group from 452µ to 313µ, 303µ and to 307µ (p<0.05). Although the comparison of CMT reduction between both groups at 1st and 2nd month visits revealed significant difference in favor of D group (139µ vs 68.5µ p<0.01 at 1th month; 149µ vs 78.9µ at 2th month p<0.01); the final CMT reduction in both groups was statistically insignificant (145µ vs 110.5µ p>0.05). In D group; 3 eyes (9%) had to be treated with topical anti-glaucomatous agents in the follow-up.
Both monthly ranibizumab injections and dexametasone implant are equally effective in short-term treatment of diabetic macular edema. Although the treatment effect of Dex implant was seen earlier in the follow-up, the elevation of IOP may be a clinical concern in some cases.