Mid-term safety and effectiveness of macular peeling one month after intravitreal dexamethasone implant for tractional diabetic macular edema

Abstract

Macular peeling combined or followed by intravitreal dexamethasone implant (DEX-i) was recommended as an efficacy approach for tractional diabetic macular edema (tDME). Knowing the synergistic effect of cataract surgery and DEX-i one month earlier in eyes with DME, we compared Epiretinal Membrane/Inner Limiting Membrane (ERM/ILM) peeling preceded by DEX-i one month before versus ERM/ILM peeling alone for the treatment of tDME. A retrospective study on patients affected by tDME who underwent ERM/ILM peeling one month after DEX-i (n = 11; Group A) or ERM/ILM peeling alone (n = 10; Group B) was performed. Longitudinal comparison of best-correct visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) between the time of surgery (T₀) and each time point (months 1,3,5,6) within and among the groups were assessed. To evaluate the repeated measurements of BCVA, CRT, and IOP, a linear mixed-effects model was used. In Group A, DEX-i significantly improved mean BCVA and CRT (P < 0.001) just after 1 month (T₀). After ERM/ILM peeling, mean BCVA and CRT significantly improved from month 1 in Group A and month 3 in Group B. Mixed model revealed a significant difference in BCVA (P ≤ 0.0001) and CRT (P ≤ 0.02) at different time-points among the groups with better results in Group A. Neither complications nor uncontrolled IOP increase was detected. ERM/ILM peeling confirmed its effectiveness in treating tDME. DEX-i performed one month before surgery seemed to be a safe approach and ensured a greater and faster recovery considering functional and tomographic parameters.

Figure 1

Optical coherence tomography scan showing tractional diabetic macular edema (tDME) with cystoid and retinal detachment pattern, and epiretinal membrane. A representative case.

Figure 2

Mean Best corrected visual acuity (BCVA) in Groups (A and B) over the study follow-up. DEX-i, intravitreal dexamethasone implant; ERM/ILM, Epiretinal Membrane/Inner Limiting Membrane; *P < 0.01 as compared to T₀ within each group.

Figure 3

Mean Central retinal thickness (CRT) in Groups (A and B) over the study follow-up. DEX-i, intravitreal dexamethasone implant; ERM/ILM, Epiretinal Membrane/Inner Limiting Membrane; *P < 0.001 as compared to T₀ within each group.

Figure 4

Mean Intraocular pressure (IOP) in Groups (A and B) over the study follow-up. DEX-i, intravitreal dexamethasone implant; ERM/ILM, Epiretinal Membrane/Inner Limiting Membrane.