First Author: A. H.Abdel Hamid EGYPT
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To report the efficacy and safety of combined intravitreal dexamethasone implant (IDI) and micropulse laser for antiVEGF resistant diabetic macular edema (DME).
Ophthalmology department ,Hadi hospital, Kuwait.
Prospective, non-controlled study that included twenty eyes with center involving DME not responding to anitVEGF therapy. All eyes had underwent complete ophthalmic examination starting from best corrected visual acuity (BCVA) assessment , slit lamp examination, intraocular pressure (IOP) measurement, indirect ophthalmoscopy and bio microscopy. Central macular thickness (CMT) was measured by optical coherence tomography (OCT) within one week prior to IDI injection. Ozurdex IDI was injected to all eyes with subsequent micropulse yellow laser to the area of DME one month after the injection. All eyes were followed up after one, three, four, six, nine and twelve months. The primary outcome measure is change in BCVA after one year, and secondary outcome measures are change in CMT after one year from injection as well as the safety of both IDI and micropulse laser. Reinjection with subsequent laser was done for those eyes with recurrent edema after four months.
The mean age of the patients was 58.8 ±7.94 years. The mean BCVA was 0.6±0.14 , 0.57±0.12, 0.51±0.15, 0.59±0.12, 0.6±0.12 and 0.59±0.14 after one ,three, four, six, nine and twelve months in comparison to 0.45±0.14 as initial BCVA [SS,P<0.05]. The mean CMT was 302.5±30.01 um, 297.6±20.24 um, 307.6±32.15 um, 285.4±19.95 um, 292.9±25.068 um and 285±14.99 um after one, three, four, six, nine and twelve months in comparison to 420.7 ±38.73 um as initial CMT [HS, P<0.01]. Cataract occurred in 6 eyes from 14 phakic eyes (42.8%).Transient ocular hypertension (>25 mmhg) occurred in 6 eyes (30%) after one to two months from injection. Serious intraocular bleeding or infection did not occur in any eye. Reinjection was done for eight eyes (40%).
Combined IDI and micropulse laser is an effective and safe treatment modality for antiVEGF resistant DME.