Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul 4:12:1205-1211.
doi: 10.2147/OPTH.S163681. eCollection 2018.

Macular edema resolution assessment with implantable dexamethasone in diabetic retinopathy (MERIT): a pilot study

Jay Chhablani  1 , Mahima Jhingan  1 , Abhilash Goud  1 , Kiran Kumar Vupparaboina  1 , Taraprasad Das  1
Affiliations

Macular edema resolution assessment with implantable dexamethasone in diabetic retinopathy (MERIT): a pilot study

Jay Chhablani et al. Clin Ophthalmol. .

Abstract

Purpose: This study aimed to evaluate the effect of dexamethasone implantation on the hard exudates (HEX) in patients with diabetic macular edema (DME).

Study design: This was a nonrandomized open-label single-center prospective trial.

Methods: This study included 15 eyes of 11 subjects with DME. Key inclusion criteria were naïve eyes with DME with HEX within 3 mm of fovea with center-involving DME; central macular thickness (CMT) >250 μm at baseline; best-corrected visual acuity (BCVA) between 20/400 and 20/40. Key exclusion criteria were previous intraocular surgery and history of panretinal photocoagulation (PRP) in past 4 months. The primary outcome measure was change in total HEX area at the macula (in mm2) measured by semiautomated algorithm. Secondary outcome measures were change in visual acuity, low-contrast visual acuity (LCVA), retinal sensitivity (RS) on macular microperimetry, and CMT.

Results: The total HEX area reduced from 1.5 mm2 (±1.46 mm2) at baseline to 0.89 mm2 (±1.062 mm2) at the final visit (p=0.185). The CMT improved significantly (p=0.03) from 488.67 μm (±240.66 μm) to 326.93 μm (±135.84 μm) at the final visit. Mean BCVA remained stable (p=0.95) (50.93±16.65 at baseline and 50.6±18.95 at final visit). The mean LCVA and RS showed insignificant improvement (p=0.31 and p=0.28, respectively).

Conclusion: Our pilot study demonstrated an improving trend in reduction of total HEX area and other anatomical outcomes, with limited functional outcomes. Larger randomized studies with a larger sample size with a control group are warranted to establish management protocols for DME with significant subfoveal HEX.

Keywords: Ozurdex; dexamethasone implant; diabetic macular edema; hard exudates.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Representative case of phakic eye. Notes: (A) A 56-year-old male presented with moderate NPDR and center-involving macular edema with plenty of HEX. He underwent 2 intravitreal dexamethasone implantations at baseline and at Month 4. (B) His visual acuity improved from 20/200 to 20/100 at Month 8, with reduction in HEX. Quantitative analysis of HEX showed a reduction from (C) 1.9 mm2 to (D) 1.75 mm2. Spectral domain optical coherence tomography showed a reduction in subfoveal HEX (arrow) and reduction in central macular thickness as can be seen at (E) baseline and (F) Month 8. Retinal sensitivity map shows improvement from (G) baseline to (H) Month 8. Abbreviations: HEX, hard exudates; NPDR, nonproliferative diabetic retinopathy.
See this image and copyright information in PMC

References

    1. Singh A, Stewart JM. Pathophysiology of diabetic macular edema. Int Ophthalmol Clin. 2009;49(2):1–11. - PubMed
    1. Yang CM. Surgical treatment for severe diabetic macular edema with massive hard exudates. Retina. 2000;20(2):121–125. - PubMed
    1. Avci R, Kaderli B. Intravitreal triamcinolone injection for chronic diabetic macular oedema with severe hard exudates. Graefes Arch Clin Exp Ophthalmol. 2006;244(1):28–35. - PubMed
    1. Avci R, Kaderli B, Akalp FD. Intravitreal triamcinolone injection for chronic diffuse diabetic macular oedema. Clin Exp Ophthalmol. 2006;34(1):27–32. - PubMed
    1. Ciardella AP, Klancnik J, Schiff W, Barile G, Langton K, Chang S. Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study. Br J Ophthalmol. 2004;88(9):1131–1136. - PMC - PubMed