First Author: H.Kaymak GERMANY
Co Author(s): D. Breyer K. Klabe C. Pohl 0 0 0 0 0 0 0 0 0
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Diabetic macula edema (DME) are mainly treated with intravitreal injection of anti-vascular endothelial growth factors (anti-VEGF). Patients do often show recurring edema and can be classified as non-responsive to anti-VEGF. The present study investigates the efficiency of injection of a dexamethasone implant in patients who suffered from recurrent DME after several cycles of anti-VEGF therapy.
Breyer Kaymak Eye Surgery, Duesseldorf/Germany; Eye Clinic Marienhospital, Duesseldorf/Germany; Internationale Innovative Ophthalmosurgery IIO, Duesseldorf/Germany
9 patients (8 pseudophakic, 1 phakic) with chronic DME were included for this project. Patients underwent previously at least 6 intravitreal anti-VEGF injections before dexamethasone injection. Best corrected visual acuity (BCVA) as well as OCT-based central foveal thickness, Amsler-Test and visual field analysis were pre- and postoperatively analyzed. Metamorphopsies were additionally monitored by subjective grid distortion via a newly developed software. Intraocular pressure was monitored in all visits. Visits after one week, 1, 2 and 3 months were analyzed.
Patients showed in all cases a response to the dexamethasone treatment. Central foveal thickness dropped in all cases continously over time: mean preoperative CFT was 420±90 µm, three months after injection CFT showed a mean of 331±63 µm. The decrease ranged between 71 µm minimal and 297 µm three months after implantation. IOP increased continously from a mean of 15±4 mm Hg preoperatively to a mean of 20±4 mm Hg three months after injection. BCVA increased from 0.31± logMAR to 0.21 logMAR three months after implantation. Metamorphopsies decreased during central foveal recovery, but to a different extent, which could be monitored for the first time via software simulation. The pseudohakic patient was in parallel assessed for cataract development, which over the monitoring time did not occur.
Implantation of a dexamethose implant may represent an alternative therapy to anti-VEGF injections. IOP increases slightly, which suggests a careful monitoring in a small-meshed time interval. Metamorphopsy analysis via software simulation shows the visual recovery in a more detailed manner that VA assessment. In most cases, VA did not increase drastically and was not for all patients recognized during daily routine. But the reduction of distortion was in all cases recognized, since it had a much more disturbing character for each patient. Efficacy of this method implies, that inflammatory reactions, which are adressed on molecular level with dexamethasone, contribute to the return of macula edema during anti-VEGF therapy. Thus this study presents encouring results for anti-VEGF non-responsive patients.