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Pars plana vitrectomy with internal limiting membrane peeling versus intravitreal dexamethasone implant for diabetic macular edema resistant to anti-VEGF treatment

Author: Murat Arici (Turkey)

Co-authors: Seren Pehlivanoglu, Halil Ozgur Artunay

Purpose

To compare the anatomical and functional outcomes of severe diabetic macular edema (DME) resistant to anti-VEGF treatment managed by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling or intravitreal dexamethasone implant

Setting/Venue

All intravitreal injections and surgeries applied to the patients were performed in Beyoglu Eye Hospital.

Methods

We retrospectively reviewed 50 eyes with DME. Patients who showed persistent DME after receiving at least six doses of anti-VEGF agents for DME treatment were included. Patients treated with either PPV with ILM peeling (vitrectomy group, 24 eyes) or nonsurgical treatment with intravitreal dexamethasone (nonsurgical group, 26 eyes). One dose of intravitreal dexamethasone implant injection was applied to nonsurgical group eye and patients were followed up for six months. The response to therapy was assessed monthly by measuring intraocular pressure (IOP), the best-corrected visual acuity (BCVA), and central foveal thickness (CRT). Results were compared between the two groups

Results

After treatment, CRT decreased steadily in both group but fluctuated in the vitrectomy group . Compared with eyes in the surgical group, eyes treated with intravitreal dexamethasone implant had better visual improvement (P < 0.05 at 6 month and the final visit) and greater decrease in CRT (P < 0.05 at 6 month and the final visit) after adjustment for baseline BCVA In the vitrectomy group, 41% eyes require further injections for treating DME after the operation. 10% of eyes developed a transient increase in intraocular pressure (IOP 25 mmHg) in non surgical, intravitreal dexamethasone group. During the follow-up period, endophthalmitis, significant cataract or regmatogenous retinal detachment were not detected

Conlusions

Both PPV with ILM peeling and intravitreal dexamethaosne implant resulted in rapid resolution of macula edema in patients who showed persistent DME after receiving at least six doses of anti-VEGF agent but after treatment, CRT fluctuated in the vitrectomy group. Intravitreal dexamethasone implant injection is associated with significant CRT reduction and minimally invasive for up to six months without causing any complications. Intravitreal dexamethasone implant should be considered as an effective and safe treatment option in the management of DME patients resistant to anti-VEGF injections

Financial Disclosure

no financial disclosure

Comments

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