Skip to main content

Comparison of early dexamethasone retreatment versus standard dexamethasone regimen combined with PRN ranibizumab in diabetic macular edema

International Ophthalmology volume 37, pages 185–196 (2017)Cite this article

Abstract

The purpose of the study is to evaluate the efficacy and safety of as-needed dexamethasone (DEX) retreatment compared with standard DEX retreatment combined with PRN ranibizumab injections among patients with persistent diabetic macular edema (DME). Twenty-eight patients with persistent macular edema having recurrence earlier than 6 months after initial DEX implantation were included in this retrospective study. Group I consisted of 13 patients retreated using monthly PRN ranibizumab injections combined with standard 6-monthly DEX implantation; Group II consisted of 15 patients retreated with DEX implantation earlier than 6 months on an “as-needed” basis. There was no significant difference between the groups with regarding to age, gender, HbA1C levels, duration of diabetes, duration of macular edema, baseline central macular thickness (CMT), best-corrected visual acuity (BCVA), and intraocular pressure (IOP) values (p > 0.05). The mean follow-up time of the whole study population was 10.13 ± 1.75 months (range 9–15). The mean CMT values were significantly decreased in both groups compared to baseline values except for the 6th-month CMT in Group I (p < 0.05). The mean logMAR BCVA values were not statistically different between groups during the follow-up compared to baseline BCVA values (p > 0.05). However, a significant change in mean BCVA from baseline was seen at 4th, 6th, and 9th months in Group II (p ≤ 0.05). The mean number of total intravitreal treatments was 3.50 ± 0.77 in Group I and 2.53 ± 0.51 in Group II (p = 0.001). During the follow-up period, one patient in Group I and five patients in Group II had increased IOP (≥25 mmHg). Early DEX retreatment improved vision with superior anatomical improvement at 6th month and with fewer intravitreal treatments in eyes with DME. However, improvement in visual acuity is similar with standard DEX retreatment combined with PRN ranibizumab group.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Frank RN (2004) Diabetic retinopathy. N Engl J Med 350:48–58

    CAS  Article  PubMed  Google Scholar 

  2. Bressler SB, Qin H, Beck RW et al (2012) Factors associated with changes in visual acuity and central subfield thickness at 1 year after treatment for diabetic macular edema with ranibizumab. Arch Ophthalmol 130:1153–1161

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Hooper P, Boucher MC, Colleaux K et al (2014) Contemporary management of diabetic retinopathy in Canada: from guidelines to algorithm guidance. Ophthalmologica 231:2–15

    Article  PubMed  Google Scholar 

  4. Diabetic Retinopathy Clinical Research N, Beck RW, Edwards AR et al (2009) Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol 127:245–251

    Article  Google Scholar 

  5. Haller JA, Kuppermann BD, Blumenkranz MS et al (2010) Randomized controlled trial of an intravitreous dexamethasone drug delivery system in patients with diabetic macular edema. Arch Ophthalmol 128:289–296

    CAS  Article  PubMed  Google Scholar 

  6. Fischer S, Renz D, Schaper W, Karliczek GF (2001) In vitro effects of dexamethasone on hypoxia-induced hyperpermeability and expression of vascular endothelial growth factor. Eur J Pharmacol 411:231–243

    CAS  Article  PubMed  Google Scholar 

  7. Haller JA, Bandello F, Belfort R Jr et al (2010) Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 117:1134–1146

    Article  PubMed  Google Scholar 

  8. Boyer DS, Yoon YH, Belfort R Jr et al (2014) Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 121:1904–1914

    Article  PubMed  Google Scholar 

  9. Totan Y, Guler E, Guragac FB (2015) Dexamethasone intravitreal implant for chronic diabetic macular edema resistant to intravitreal bevacizumab treatment. Curr Eye Res 22:1–7

    Article  Google Scholar 

  10. Dutra Medeiros M, Postorino M, Navarro R et al (2014) Dexamethasone intravitreal implant for treatment of patients with persistent diabetic macular edema. Ophthalmologica 231(3):141–146

    CAS  Article  PubMed  Google Scholar 

  11. Panozzo G, Gusson E, Panozzo G, Dalla Mura G (2015) Dexamethasone intravitreal implant for diabetic macular edema: indications for a PRN regimen of treatment. Eur J Ophthalmol 25:347–351

    Article  PubMed  Google Scholar 

  12. Scaramuzzi M, Querques G, Spina CL, Lattanzio R, Bandello F (2015) Repeated intravitreal dexamethasone implant (Ozurdex) for diabetic macular edema. Retina 35(6):1216–1222

    CAS  Article  PubMed  Google Scholar 

  13. Yorgun MA, Toklu Y, Mutlu M, Uysal BS, Cakmak HB (2015) Efficacy of single-dose dexamethasone implantation in patients with persistent diabetic macular edema. Int Ophthalmol 7:1–9

    Google Scholar 

  14. Boyer DS, Faber D, Gupta S et al (2011) Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina 31:915–923

    CAS  Article  PubMed  Google Scholar 

  15. Nguyen QD, Shah SM, Khwaja AA et al (2010) Two-year outcomes of the ranibizumab for edema of the mAcula in diabetes (READ-2) study. Ophthalmology 117:2146–2151

    Article  PubMed  Google Scholar 

  16. Maturi RK, Bleau L, Saunders J, Mubasher M, Stewart MW (2015) A 12-month, single-masked, randomized controlled study of eyes with persistent diabetic macular edema after multiple anti-vegf injections to assess the efficacy of the dexamethasone-delayed delivery system as an adjunct to bevacizumab compared with continued bevacizumab monotherapy. Retina 35:1604–1614

    CAS  Article  PubMed  Google Scholar 

  17. Mathew R, Pearce E, Muniraju R, Abdel-Hay A, Sivaprasad S (2014) Monthly OCT monitoring of Ozurdex for macular oedema related to retinal vascular diseases: re-treatment strategy (OCTOME Report 1). Eye 28:318–326

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. Sadda SR, Wu Z, Walsh AC et al (2006) Errors in retinal thickness measurements obtained by optical coherence tomography. Ophthalmology 113:285–293

    Article  PubMed  Google Scholar 

  19. Zucchiatti I, Lattanzio R, Querques G et al (2012) Intravitreal dexamethasone implant in patients with persistent diabetic macular edema. Ophthalmologica 228:117–122

    CAS  Article  PubMed  Google Scholar 

  20. Diabetic Retinopathy Clinical Research N, Browning DJ, Glassman AR et al (2007) Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology 114:525–536

    Article  Google Scholar 

  21. Blumenkranz MS, Haller JA, Kuppermann BD et al (2010) Correlation of visual acuity and macular thickness measured by optical coherence tomography in patients with persistent macular edema. Retina 30:1090–1094

    Article  PubMed  Google Scholar 

  22. Das A, McGuire PG, Rangasamy S (2015) Diabetic macular edema: pathophysiology and novel therapeutic targets. Ophthalmology 122:1375–1394

    Article  PubMed  Google Scholar 

  23. Adamis AP, Berman AJ (2008) Immunological mechanisms in the pathogenesis of diabetic retinopathy. Semin Immunopathol 30:65–84

    CAS  Article  PubMed  Google Scholar 

  24. Querques L, Querques G, Lattanzio R, Gigante SR, Del Turco C, Corradetti G et al (2013) Repeated intravitreal dexamethasone implant (Ozurdex(R)) for retinal vein occlusion. Ophthalmologica 229:21–25

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Ophthalmology, Ankara Atatürk Education and Research Hospital, Yıldırım Beyazıt University, Ankara, Turkey

    Mücella Arıkan Yorgun, Yasin Toklu & Melek Mutlu

Authors
  1. Mücella Arıkan Yorgun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasin Toklu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Melek Mutlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mücella Arıkan Yorgun.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Arıkan Yorgun, M., Toklu, Y. & Mutlu, M. Comparison of early dexamethasone retreatment versus standard dexamethasone regimen combined with PRN ranibizumab in diabetic macular edema. Int Ophthalmol 37, 185–196 (2017). https://doi.org/10.1007/s10792-016-0251-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-016-0251-2

Keywords

  • Dexamethasone
  • Diabetes mellitus
  • Persistent diabetic macular edema
  • Ranibizumab