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. 2021 Apr 30:8:649979.
doi: 10.3389/fmed.2021.649979. eCollection 2021.

Short-Term Outcomes of Refractory Diabetic Macular Edema Switch From Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real World Experience

Ning-Yi Hsia  1 , Chun-Ju Lin  1   2   3 , Huan-Sheng Chen  4 , Cheng-Hsien Chang  1   2   3 , Henry Bair  1   5 , Chun-Ting Lai  1 , Jane-Ming Lin  1   3 , Wen-Lu Chen  1   3 , Peng-Tai Tien  1   6 , Wen-Chuan Wu  1 , Yi-Yu Tsai  1   2   3
Affiliations

Short-Term Outcomes of Refractory Diabetic Macular Edema Switch From Ranibizumab to Dexamethasone Implant and the Influential Factors: A Retrospective Real World Experience

Ning-Yi Hsia et al. Front Med (Lausanne). .

Abstract

Introduction: To evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implants in refractory diabetic macular edema (DME) treated by intravitreal ranibizumab. Materials and Methods: We retrospectively analyzed DME patients who received DEX implant treatment after being refractory to at least 3 monthly intravitreal ranibizumab injections. The main outcomes were best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). Results: Twenty-nine eyes of 26 patients who had previously received an average of 8.1 ± 4.4 ranibizumab injections were included. Patients received between one and three DEX implants during 12.4 ± 7.4 months of follow-up. The mean final CRT significantly decreased from 384.4 ± 114.4 μm at baseline to 323.9 ± 77.7 μm (p = 0.0249). The mean final BCVA was 51.4 ± 21.3 letters, which was not significant compared to baseline (44.9 ± 30.2 letters, p = 0.1149). Mean IOP did not increase significantly. All patients tolerated the treatment well without serious adverse events. Higher baseline CRT and worse BCVA correlated with better therapeutic responses. Conclusion: Switching to DEX implant is feasible and safe for treating patients of DME refractory to intravitreal ranibizumab in real world. Further larger-scale or multicenter studies would be conducted to explore different DEX treatment strategies for DME, such as first-line or early switch therapy, for better BCVA improvement.

Keywords: diabetic macular edema; intravitreal dexamethasone implant; intravitreal ranibizumab; ozurdex; refractory diabetic macular edema.

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Conflict of interest statement

H-SC is employed by company NephroCare Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Mean baseline and final CRT after the respective treatments. The mean final CRT after DEX implant treatment was significantly lower than the CRT (p = 0.0249) at baseline and 1 month after the last ranibizumab injection (p = 0.0265). (B) Mean best CRT (the lowest CRT value recorded during follow-up) at baseline and after the respective treatments. The mean best CRT after DEX implant treatment was significantly lower than the CRT (p < 0.0001) before treatment. *p < 0.05; **p < 0.001 compared to before-treatment data (Generalized linear mixed model).
Figure 2
Figure 2
(A) Mean BCVA at baseline and after the respective treatments. There was no significant improvement in BCVA 1 month after the last ranibizumab and after DEX implant treatment. (B) Mean maximal BCVA (the highest letter score recorded during follow-up) at baseline and after respective treatments. The mean maximal BCVA after DEX implant treatment was significantly higher than baseline BCVA (p = 0.0022). *p < 0.05 compared to before-treatment data (Generalized linear mixed model).
Figure 3
Figure 3
Correlation between changes in CRT and baseline CRT.
Figure 4
Figure 4
Correlation between changes in BCVA and baseline BCVA.
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