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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  • Additional Information
    • Corporate Authors:
      International Retina Group
    • 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