Long-term results of refractory diabetic macular edema in patients treated with intravitreal phacoemulsification plus dexamethasone implant: case series

Author: Carolina Arruabarrena (Spain)

Co-authors: Carlos Vera, Beatriz Son

Purpose

Objective: To examine the long-term outcomes of patients with refractory diabetic macular edema (DME) that underwent phacoemulsification plus dexamethasone (DEX) intravitreal implant (Ozurdex; Allergan, Inc., Irvine, CA).

Setting/Venue

Setting: Principe of Asturias University Hospital, Alcalá de Henares, Madrid, Spain. It covers an area of 250,000 people.

Methods

Methods: Design: Retrospective observational case series. Participants: A total of 16 eyes of 13 patients with long-term refractory DME (10 eyes had received anti-VEGF and 6 eyes also dexamethasone) who underwent cataract surgery were studied. Each patient was treated with a 0.7 mg DEX intravitreal implant and underwent phacoemulsification with intraocular lens placement within 4 months. And were treated with intravitreal anti-VEGF or corticosteroids in standard practice after that. The primary outcome measure was the change in central macular thickness (CMT) measured by optical coherence tomography (OCT) measured before the operation and 6, 12, and 24 months after the operation. Demographic data, pre-and post-treatment, and BCVA were also recorded.

Results

Results: A total of sixteen eyes (13 patients) were included. Five of them were women. The mean age was 66.12 ±7,93 years (range from 59 to 79 years). All eyes had a nuclear or cortical significant cataract (C3 or NO3 LOCS III classification). The preoperative CMT changed from a mean of 389.22 µm to a mean CMT of 318.1 µm at 6 months postoperatively and 267.03 µm at 24 months postoperatively. Median baseline logMAR BCVA was 1.32 (Snellen 20/400) and improved to 0.41 (Snellen 20/50) at 4 months of follow-up. Only one patient achieved permanent resolution of the DME 24 months after the operation.

Conlusions

Conclusions: Intravitreal dexamethasone implant has been shown to prevent recurrence or worsening of macular edema in diabetic patients with a history of DME undergoing phacoemulsification. The mean CMT decreased in the subset of eyes that received the DEX implant by a mean of 71.12 μm at 6 months of follow-up and 122.19 μm at 24 months of follow-up, although only one patient resolved the DME.

Financial Disclosure

The authors have no financial relations.