Skip to main content

Advertisement

SpringerLink
Log in

Dexamethasone implant as an adjuvant therapy to ranibizumab loading dose in persistent diabetic macular edema

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

This study evaluates the effectiveness of a single-dose dexamethasone implant (DI) as an auxiliary therapy to continued intravitreal ranibizumab (IVR) treatment in patients with persistent diabetic macular edema (DME).

Methods

Twenty-five pseudophakic eyes of 25 patients with DME who underwent a single injection of DI as an adjuvant therapy following an IVR loading dose were examined retrospectively. All patients were treatment naive and had a poor response to a loading dose of three consecutive monthly IVR injections. IVR treatments were continued pro re nata after the DI. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 1, 3, 6 and 8 months post-DI treatment.

Results

After the IVR loading dose, the mean BCVA and CMT were 0.9 ± 0.6 LogMAR and 478.2 ± 107.8 µm, respectively. One month after the DI, the mean BCVA and CMT had improved to 0.6 ± 0.4 LogMAR (p = 0.005) and 313.8 ± 62.7 µm (p < 0.001), respectively. This improvement was maintained with mean 0.8 ± 0.8 IVR injections throughout the follow-up period. The final mean BCVA and CMT were 0.5 ± 0.5 LogMAR and 298.4 ± 71.5 µm. Subgroup analyses revealed that different DME types did not have any effect on CMT or BCVA improvement (p = 0.188, p = 0.136; respectively).

Conclusion

Adding DI results in rapid anatomical and visual improvement in patients who respond poorly to an IVR loading dose. Improvements may be maintained with additional IVR in follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Klein R, Klein BE, Moss SE, Davis MD, DeMets DL (1984) The Wisconsin epidemiologic study of diabetic retinopathy. IV. Diabetic macular edema. Ophthalmology 91:1464–1474

    Article  CAS  Google Scholar 

  2. Do DV, Schmidt-Erfurth U, Gonzalez VH et al (2011) The DA VINCI study: phase 2 primary results of VEGF Trap-Eye in patients with diabetic macular edema. Ophthalmology 118:1819–1826

    Article  Google Scholar 

  3. Cunningham ET Jr, Adamis AP, Altaweel M et al (2005) Macugen Diabetic Retinopathy Study Group. A phase II randomized double-masked trial of pegaptanib, an anti-vascular endothelial growth factor aptamer, for diabetic macular edema. Ophthalmology 112:1747–1757

    Article  Google Scholar 

  4. Cheung N, Wong IY, Wong TY (2014) Ocular anti-VEGF therapy for diabetic retinopathy: over-view of clinical efficacy and evolving applications. Diabetes Care 37:900–905

    Article  CAS  Google Scholar 

  5. Nguyen QD, Brown DM, Marcus DM et al (2012) RISE and RIDE Research Group. Ranibizumab for diabetic macular edema: results from 2 phase III randomized trials: RISE and RIDE. Ophthalmology. 119:789–801

    Article  Google Scholar 

  6. Ho AC, Scott IU, Kim SJ et al (2012) Anti-vascular endothelial growth factor pharmacotherapy for diabetic macular edema: a report by the American Academy of Ophthalmology. Ophthalmology 119:2179–2188

    Article  Google Scholar 

  7. Tamura H, Miyamoto K, Kiryu J et al (2005) Intravitreal injection of corticosteroid attenuates leukostasis and vascular leakage in experimental diabetic retina. Invest Ophthalmol Vis Sci 46:1440–1444

    Article  Google Scholar 

  8. Grover D, Li TJ, Chong CC (2008) Intravitreal steroids for macular edema in diabetes. Cochrane Database Syst Rev 1:CD005656

    Google Scholar 

  9. Elman MJ, Aiello LP, Beck RW et al (2010) Diabetic Retinopathy Clinical Research Network. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 117:1064–1077

    Article  Google Scholar 

  10. Smithen LM, Ober MD, Maranan L, Spaide RF (2004) Intravitreal triamcinolone acetonide and intraocular pressure. Am J Ophthalmol 138:740–743

    Article  CAS  Google Scholar 

  11. Pacella E, Vestri AR, Muscella R et al (2013) Preliminary results of an intravitreal dexamethasone implant (Ozurdex) in patients with persistent diabetic macular edema. Clin Ophthalmol 7:1423–1428

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  13. Ferris FL III, Maguire MG, Glassman AR, Ying GS, Martin DF (2016) Evaluating effects of switching anti-vascular endothelial growth factor drugs for age-related macular degeneration and diabetic macular edema. JAMA Ophthalmol 1:22. https://doi.org/10.1001/jamaophthalmol.2016.4820

    Article  Google Scholar 

  14. Chatziralli I, Santarelli M, Patrao N et al (2017) Identification of time point to best define ‘sub-optimal response’ following intravitreal ranibizumab therapy for diabetic macular edema based on real-life data. Eye (Lond) 31(11):1594–1599

    Article  CAS  Google Scholar 

  15. Maturi RK, Glassman AR, Liu D et al (2017) Diabetic Retinopathy Clinical Research Network. Effect of adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema: a DRCR Network Phase 2 randomized clinical trial. JAMA Ophthalmol Nov:11. https://doi.org/10.1001/jamaophthalmol.2017.4914

    Article  Google Scholar 

  16. Ying GS, Maguire MG, Daniel E et al (2015) Comparison of Age-Related Macular Degeneration Treatments Trials (CATT) Research Group. Association of baseline characteristics and early vision response with 2-year outcomes in the Comparison of AMD Treatments Trials (CATT). Ophthalmology 122(12):2523.e1–2531.e1

    Article  Google Scholar 

  17. Elman MJ, Aiello LP, Beck RW et al (2010) Diabetic Retinopathy Clinical Research Network. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology 117(6):1064.e35–1077.e35

    Article  Google Scholar 

  18. Cicinelli MV, Cavalleri M, Querques L, Rabiolo A, Bandello F, Querques G (2017) Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema. Br J Ophthalmol 101(12):1689–1693

    Article  Google Scholar 

Download references

Acknowledgements

The authors have no financial interest in any materials used in the study.

Author information

Authors and Affiliations

  1. Department of Opthalmology, Okmeydanı Research and Training Hospital, Darülaceze Cad. No:25 Şişli, 34367, Istanbul, Turkey

    Akin Cakir, Burak Erden, Selim Bolukbasi, Alper Halil Bayat, Seyma Gulcenur Ozturan & Mustafa Nuri Elcioglu

Authors
  1. Akin Cakir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Burak Erden
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Selim Bolukbasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alper Halil Bayat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Seyma Gulcenur Ozturan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mustafa Nuri Elcioglu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Akin Cakir.

Ethics declarations

Conflict of interest

None of the authors has any financial/conflicting interests to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cakir, A., Erden, B., Bolukbasi, S. et al. Dexamethasone implant as an adjuvant therapy to ranibizumab loading dose in persistent diabetic macular edema. Int Ophthalmol 39, 2179–2185 (2019). https://doi.org/10.1007/s10792-018-1053-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-018-1053-5

Keywords

Search

Navigation