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Cataract surgery with combined versus deferred intravitreal dexamethasone implant for diabetic macular edema: long-term outcomes from a real-world setting

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Abstract

Aims

To compare the long-term functional and anatomical outcomes of cataract surgery with combined versus 1-month deferred intravitreal dexamethasone implant (DEX) in eyes with pre-existing diabetic macular edema (DME).

Methods

Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were retrospectively evaluated in both groups before treatments, then 1, 4, 12 and 24 months after DEX.

Results

Forty eyes were analyzed, 20 in each group. BCVA disclosed comparable trends, increasing from similar starting values (p = 0.9913) to akin scores 1 month after DEX (p = 0.4229). After 4 months, it similarly reduced without significant variations within each group throughout the whole observation period. CRT was similar at the time of surgery (p = 0.6134) and was reduced by DEX injection in both samples, with a superior beneficial effect in the combined group after 1 month (p = 0.0010). At 4 months, CRT further elevated and remained overall stable in the long term without differences. By 12 months, 19 (95%) eyes received further injections: 1 (5%) fluocinolone, 3 (15%) received other DEX and fluocinolone, 13 (65%) ≥ 1 DEX only and 2 (10%) anti-VEGFs. During the second year, 6 additional eyes (from the 13 receiving DEX) switched to fluocinolone, reaching a total of 10 (50%). Similar results were observed in the deferred group.

Conclusions

DEX implant performed at the time of surgery achieved the same long-term functional and anatomical outcomes compared to a 1-month injection deferral in treating eyes with pre-existing DME that should undergo cataract extraction.

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References

  1. Panozzo G, Staurenghi G, Dalla Mura G et al (2019) Prevalence of diabetes and diabetic macular edema in patients undergoing senile cataract surgery in Italy: the DIabetes and CATaract study. Eur J Ophthalmol. https://doi.org/10.1177/1120672119830578

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hayashi K, Igarashi C, Hirata A, Hayashi H (2009) Changes in diabetic macular oedema after phacoemulsification surgery. Eye (Lond) 23:389–396. https://doi.org/10.1038/sj.eye.6703022

    Article  CAS  Google Scholar 

  3. Sarao V, Veritti D, Maurutto E et al (2018) Pharmacotherapeutic management of macular edema in diabetic subjects undergoing cataract surgery. Expert Opin Pharmacother 19:1551–1563

    Article  CAS  Google Scholar 

  4. Chu CJ, Johnston RL, Buscombe C et al (2016) Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes. Ophthalmology 123:316–323. https://doi.org/10.1016/j.ophtha.2015.10.001

    Article  PubMed  Google Scholar 

  5. Denniston AK, Chakravarthy U, Zhu H et al (2017) The UK Diabetic Retinopathy Electronic Medical Record (UK DR EMR) Users Group, Report 2: real-world data for the impact of cataract surgery on diabetic macular oedema. Br J Ophthalmol 101:1673–1678. https://doi.org/10.1136/bjophthalmol-2016-309838

    Article  PubMed  Google Scholar 

  6. Dowler JG, Sehmi KS, Hykin PG, Hamilton AM (1999) The natural history of macular edema after cataract surgery in diabetes. Ophthalmology 106:663–668. https://doi.org/10.1016/S0161-6420(99)90148-3

    Article  CAS  PubMed  Google Scholar 

  7. Il KS, Hwang DJ, Seo JY, Park IW (2011) Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery. Korean J Ophthalmol 25:238–242. https://doi.org/10.3341/kjo.2011.25.4.238

    Article  Google Scholar 

  8. Chen C-H, Liu Y-C, Wu P-C (2009) The combination of intravitreal bevacizumab and phacoemulsification surgery in patients with cataract and coexisting diabetic macular edema. J Ocul Pharmacol Ther 25:83–89. https://doi.org/10.1089/jop.2008.0068

    Article  CAS  PubMed  Google Scholar 

  9. Akinci A, Muftuoglu O, Altınsoy A, Ozkılıc E (2011) Phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in diabetic patients with clinically significant macular edema and cataract. Retina 31:755–758. https://doi.org/10.1097/IAE.0b013e3182006da1

    Article  CAS  PubMed  Google Scholar 

  10. Rauen PI, Ribeiro JAS, Almeida FPP et al (2012) Intravitreal injection of ranibizumab during cataract surgery in patients with diabetic macular edema. Retina 32:1799–1803. https://doi.org/10.1097/IAE.0b013e31824bebb8

    Article  CAS  PubMed  Google Scholar 

  11. Lam DSC, Chan CKM, Mohamed S et al (2005) Phacoemulsification with intravitreal triamcinolone in patients with cataract and coexisting diabetic macular oedema: a 6-month prospective pilot study. Eye (Lond) 19:885–890. https://doi.org/10.1038/sj.eye.6701686

    Article  CAS  Google Scholar 

  12. Habib MS, Cannon PS, Steel DHW (2005) The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabeticfoveal oedema and cataract. BMC Ophthalmol 5:15. https://doi.org/10.1186/1471-2415-5-15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Nunome T, Sugimoto M, Kondo M, Suto C (2018) Short-term results of intravitreal triamcinolone acetonide combined with cataract surgery for diabetic macular edema in japan: in the era of anti-vascular endothelial growth factor therapy. Ophthalmologica 240:73–80. https://doi.org/10.1159/000487548

    Article  CAS  PubMed  Google Scholar 

  14. Lim LL, Morrison JL, Constantinou M et al (2016) Diabetic macular edema at the time of cataract surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery—preliminary 6 month results. Clin Exp Ophthalmol 44:233–242. https://doi.org/10.1111/ceo.12720

    Article  PubMed  Google Scholar 

  15. Ozgur OR, Ozkurt Y, Kulekci Z, Evciman T (2016) The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema. Saudi J Ophthalmol Off J Saudi Ophthalmol Soc 30:33–38. https://doi.org/10.1016/j.sjopt.2015.10.004

    Article  Google Scholar 

  16. Murtha T, Cavallerano J (2007) The management of diabetic eye disease in the setting of cataract surgery. Curr Opin Ophthalmol 18:13–18. https://doi.org/10.1097/ICU.0b013e32801129fc

    Article  PubMed  Google Scholar 

  17. Fraser-Bell S, Kaines A, Hykin PG (2008) Update on treatments for diabetic macular edema. Curr Opin Ophthalmol 19:185–189

    Article  Google Scholar 

  18. Lattanzio R, Cicinelli MV, Bandello F (2017) Intravitreal steroids in diabetic macular edema. Dev Ophthalmol 60:78–90. https://doi.org/10.1159/000459691

    Article  PubMed  Google Scholar 

  19. Sacconi R, Giuffrè C, Corbelli E et al (2019) Emerging therapies in the management of macular edema: a review [version 1; peer review: 2 approved]. F1000 Research Ltd, London

    Google Scholar 

  20. Sacconi R, Parodi MB, Casati S et al (2017) Dexamethasone implants in diabetic macular edema patients with high visual acuity. Ophthalmic Res 58:125–130. https://doi.org/10.1159/000477256

    Article  CAS  PubMed  Google Scholar 

  21. Sacconi R, Corbelli E, Carnevali A et al (2018) Optical coherence tomography angiography in pseudophakic cystoid macular oedema compared to diabetic macular oedema: qualitative and quantitative evaluation of retinal vasculature. Br J Ophthalmol 102:1684–1690. https://doi.org/10.1136/bjophthalmol-2017-311240

    Article  PubMed  Google Scholar 

  22. Sze AM, Luk FO, Yip TP et al (2015) Use of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification. Eur J Ophthalmol 25:168–172. https://doi.org/10.5301/ejo.5000523

    Article  PubMed  Google Scholar 

  23. Agarwal A, Gupta V, Ram J, Gupta A (2013) Dexamethasone intravitreal implant during phacoemulsification. Ophthalmology 120(211):211.e1–5. https://doi.org/10.1016/j.ophtha.2012.08.002

    Article  Google Scholar 

  24. Furino C, Boscia F, Niro A et al (2017) Combined phacoemulsification and intravitreal dexamethasone implant (Ozurdex®) in diabetic patients with coexisting cataract and diabetic macular edema. J Ophthalmol 2017:4896036. https://doi.org/10.1155/2017/4896036

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Panozzo GA, Gusson E, Panozzo G, Dalla Mura G (2017) Dexamethasone intravitreal implant at the time of cataract surgery in eyes with diabetic macular edema. Eur J Ophthalmol 27:433–437. https://doi.org/10.5301/ejo.5000920

    Article  PubMed  Google Scholar 

  26. Panozzo G, Cicinelli MV, Augustin AJ et al (2020) An optical coherence tomography-based grading of diabetic maculopathy proposed by an international expert panel: the European School for Advanced Studies in Ophthalmology classification. Eur J Ophthalmol 30:8–18. https://doi.org/10.1177/1120672119880394

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    Eleonora Corbelli, Francesco Fasce, Lorenzo Iuliano, Riccardo Sacconi, Rosangela Lattanzio, Francesco Bandello & Giuseppe Querques

Authors
  1. Eleonora Corbelli
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  2. Francesco Fasce
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  3. Lorenzo Iuliano
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  4. Riccardo Sacconi
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  5. Rosangela Lattanzio
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  6. Francesco Bandello
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  7. Giuseppe Querques
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Correspondence to Giuseppe Querques.

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Conflict of interest

Dr. Corbelli, Dr. Fasce, Dr. Iuliano, Dr. Sacconi and Dr. Lattanzio have nothing to disclose. Dr. Bandello reports personal fees from Alcon (Fort Worth, Texas, USA), personal fees from Alimera Sciences (Alpharetta, Georgia, USA), personal fees from Allergan Inc. (Irvine, California, USA), personal fees from Farmila-Thea (Clermont-Ferrand, France), personal fees from Bayer Schering Pharma (Berlin, Germany), personal fees from Bausch And Lomb (Rochester, New York, USA), personal fees from Genentech (San Francisco, California, USA), personal fees from Hoffmann-La-Roche (Basel, Switzerland), personal fees from Novagali Pharma (Évry, France), personal fees from Novartis (Basel, Switzerland), personal fees from Sanofi-Aventis (Paris, France), personal fees from ThromboGenics (Heverlee, Belgium), personal fees from Zeiss (Dublin, USA), outside the submitted work. Dr. Querques reports personal fees from Alimera Sciences (Alpharetta, Georgia, USA), personal fees from Allergan Inc. (Irvine, California, USA), personal fees from Amgen (Thousand Oaks, USA), personal fees from Heidelberg (Germany), personal fees from KBH (Chengdu, China), personal fees from LEH Pharma (London, UK), personal fees from Lumithera (Poulsbo, USA), personal fees from Novartis (Basel, Switzerland), personal fees from Bayer Schering Pharma (Berlin, Germany), personal fees from Sandoz (Berlin, Germany), personal fees from Sifi (Catania, Italy), personal fees from Soof-Fidia (Albano, Italy), personal fees from Zeiss (Dublin, USA), outside the submitted work.

Ethical standard

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and its later amendments.

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Informed consent was obtained from all patients for being included in the study.

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This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques.

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Corbelli, E., Fasce, F., Iuliano, L. et al. Cataract surgery with combined versus deferred intravitreal dexamethasone implant for diabetic macular edema: long-term outcomes from a real-world setting. Acta Diabetol 57, 1193–1201 (2020). https://doi.org/10.1007/s00592-020-01509-5

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