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Intravitreal dexamethasone implant as rescue treatment in patients with refractary diabetic macular edema

Session Details

Session Title: Quick Fire Free Paper Session 02

Session Date/Time: Thursday 26/09/2013 | 14:30-16:00

Paper Time: 15:10

Venue: Hall G1 (Level 2)

First Author: M.Lafuente SPAIN

Co Author(s):    L. Ort   M. Argente   J. Guindo   S. Mayor     

Abstract Details

Purpose:

To evaluate the efficacy of a single intravitreal Dexamethasone implant (IDI) over 6 and 9 months in eyes with diabetic macular edema (DME) that do not respond to standard treatments.

Setting:

Prospective interventional study. Nine months follow up.

Methods:

In this study, 20 eyes of 15 patients (10 males, 5 females; mean age 66 years) with Type 2 diabetes and decreased visual acuity due to persistent DME, despite of previous treatments with laser and / or at last three intravitreal injections of anti-vascular endothelial growth factor (VEGF), were treated with a single injection of IDI. Mean outcome measures included changes in best-corrected visual acuity (BCVA) and Central retinal thickness (CRT) at 6 and 9 months. The median follow-up was 6 months for the 20 eyes and 9 months for 11 eyes.

Results:

20 eyes with persistent DME were included. All patients had undergone previous treatments for DME (with laser photocoagulation or intravitreal injection of anti-VEGF). At baseline, the mean BCVA was 0.85 ±0.34 logMAR, and the mean CRT was, 562±100.3 µm. The mean BCVA improved to 0.69±0.26 logMAR after the first month. Improvement was maintained until the sixth month (mean BCVA, 0.71±0.28 log MAR; p=0.001). The BCVA decreased to 0.77±0.36 logMAR on the seventh month and to 0.8±0.34log MAR (p<0.05) on the ninth month. 40% of patients improved more than 15 letters at month three, this percentage decreased to 25% at month sixth. The mean CRT decreased to 271±53µm (p<0.05) after the first month, but increased again to 434±148µm and 479±161µm; p>0.05, at 4 and 6 months of follow up. Thickness keeps on increased in 75% of patients to 9 month of follow up. All of them needed retreatments. 25% of patients maintained stable values at 9 month of follow up. The mean intraocular pressure was 17,4±4 mmHg, only one patients developed a transient intraocular pressure increase 2 month after the injection but was treated successfully with topical medication. This medication could stop at month 6.

Conclusions:

Intravitreal implant of Dexamethasone seems effective in the short term for the treatment of diabetic patients with refractory DME. 25% of patients maintained stable values of VA and macular thickness until the 9 month of follow up. This study need more follow-up to know the long term results.

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