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Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema.
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- Author(s): Busch C;Busch C; Zur D; Zur D; Zur D; Fraser-Bell S; Fraser-Bell S; Laíns I; Laíns I; Laíns I; Laíns I; Santos AR; Santos AR; Santos AR; Lupidi M; Lupidi M; Cagini C; Cagini C; Gabrielle PH; Gabrielle PH; Gabrielle PH; Couturier A; Couturier A; Mané-Tauty V; Mané-Tauty V; Giancipoli E; Giancipoli E; Giancipoli E; Ricci GD; Ricci GD; Ricci GD; Cebeci Z; Cebeci Z; Rodríguez-Valdés PJ; Rodríguez-Valdés PJ; Chaikitmongkol V; Chaikitmongkol V; Amphornphruet A; Amphornphruet A; Hindi I; Hindi I; Hindi I; Agrawal K; Agrawal K; Chhablani J; Chhablani J; Loewenstein A; Loewenstein A; Loewenstein A; Loewenstein A; Iglicki M; Iglicki M; Rehak M; Rehak M
- Source:
Acta diabetologica [Acta Diabetol] 2018 Aug; Vol. 55 (8), pp. 789-796. Date of Electronic Publication: 2018 May 05.- Publication Type:
Journal Article; Multicenter Study- Language:
English - Source:
- Additional Information
- Corporate Authors:
- Source: Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE
- Publication Information: Publication: Berlin : Springer Verlag
Original Publication: Berlin : Springer International, c1991- - Subject Terms: Drug Substitution*; Angiogenesis Inhibitors/*administration & dosage ; Dexamethasone/*administration & dosage ; Diabetic Retinopathy/*drug therapy ; Macular Edema/*drug therapy ; Vascular Endothelial Growth Factor A/*antagonists & inhibitors; Aged ; Case-Control Studies ; Drug Administration Schedule ; Drug Implants ; Drug Resistance/drug effects ; Female ; Glucocorticoids ; Humans ; Intravitreal Injections ; Male ; Middle Aged ; Retrospective Studies ; Treatment Failure ; Visual Acuity/drug effects
- Abstract: Aims: To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting.
Methods: To be included in this retrospective multicenter, case-control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ≤ 5 letters or reduction in central subfield thickness (CST) ≤ 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group.
Results: A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was - 0.4 ± 10.8 letters (anti-VEGF group), and + 6.1 ± 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 ± 145.9 µm (anti-VEGF group) and - 92.8 ± 173.6 µm (DEX group) (P < 0.001). Eyes in the DEX group were more likely to gain ≥ 10 letters (OR 3.71, 95% CI 1.19-11.61, P = 0.024) at month 12.
Conclusions: In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy. - Contributed Indexing: Keywords: Anti-VEGF therapy; Dexamethasone implant; Intravitreal therapy; Long-term outcome; Refractory diabetic macular edema
- Accession Number: 0 (Angiogenesis Inhibitors)
0 (Drug Implants)
0 (Glucocorticoids)
0 (Vascular Endothelial Growth Factor A)
7S5I7G3JQL (Dexamethasone) - Publication Date: Date Created: 20180507 Date Completed: 20180920 Latest Revision: 20181004
- Publication Date: 20221213
- Accession Number: 10.1007/s00592-018-1151-x
- Accession Number: 29730822
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