COMBINATION OF DEXAMETHASONE IMPLANT AND ANTI-VEGF IN THE MANAGEMENT OF DIABETIC MACULAR EDEMA: A SYSTEMATIC REVIEW
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Dexamethasone implant, Anti-VEGF therapy, Diabetic Macular Edema
Abstract
Background: Anti Vascular Endothelial Growth Factor (anti-VEGF) and dexamethasone implant (DEX) are suggested as the first and second-line therapy for Diabetic Macular Edema (DME). However, persistent DME were found after six months of routine anti-VEGF injection. Intravitreal steroids have the advantage to control the inflammatory component of DME. Combining intravitreal anti-VEGF and DEX may reduce macular edema more effectively and more quickly theoretically. Hence, we aim to review the efficacy of adding DEX to anti-VEGF in treating DME.
Methods: Literatures were obtained using comprehensive searching on PubMed and Proquest using the keywords “Dexamethasone implant”, “anti-VEGF therapy”, and “Diabetic Macular Edema” including their synonyms between 2018 to 2023. Non-English studies, animal studies, review articles, case studies, and editorial letters were excluded. This result was presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines.
Results: A total of 3 studies with 265 eyes were included. All of the studies had Central Foveal Thickness (CFT) and Best Corrected Visual Acuity (BCVA) as the main outcomes. Improved CFT was seen in all of the studies (all p<0.05) with ∆CFT (200,40 μm in 6 months and 413 μm in 12 months). Most studies showed improved visual acuity after 8 months of injections which were shown by ∆BCVA (8,84 letters in 6 months and 21,6 letters in 12 months) and increased intraocular pressure as an adverse effect of steroids.
Conclusion: Combination of DEX and anti-VEGF showed improvement in CFT and BCVA. Further studies are required due to the controversial intravitreal steroids’ ocular adverse effect.
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References
Stewart M, Browning D, Lee C. Diabetic macular edema: Evidence-based management. Indian Journal of Ophthalmology. 2018;66(12):1736.
Gundogan F, Yolcu U, Akay F, Ilhan A, Ozge G, Uzun S. Diabetic macular edema: A short review. Pakistan Journal of Medical Sciences. 1969;32(2). doi:10.12669/pjms.322.8496
Bhagat N, Grigorian RA, Tutela A, Zarbin MA. Diabetic macular edema: Pathogenesis and treatment. Survey of Ophthalmology. 2009;54(1):1–32. doi:10.1016/j.survophthal.2008.10.001
Urbančič M. Visual outcomes in patients with diabetic macular edema treated with dexamethasone implant in routine clinical practice. Acta Clinica Croatica. 2021;60(4):602–8.
Kaya M, Kocak N, Ozturk T, Bolluk V, Ayhan Z, Kaynak S. Intravitreal ranibizumab and dexamethasone implant injections as primary treatment of diabetic macular edema: Simultaneously double protocol. Eye. 2020;35(3):777–85.
Nicolò M, Musetti D, Marenco M, Cotti L, Bonetto M, Giacomini M, et al. Real-life management of diabetic macular edema with Dexamethasone Intravitreal Implant: A retrospective analysis of long-term clinical outcomes. Journal of Ophthalmology. 2020;2020:1–7.
Singer MA, Dugel PU, Fine HF, Capone A, Maltman J. Real-world assessment of Dexamethasone Intravitreal implant in DME: Findings of the prospective, Multicenter Reinforce Study. Ophthalmic Surgery, Lasers and Imaging Retina. 2018;49(6):425–35.
Maturi RK, Glassman AR, Liu D, Beck RW, Bhavsar AR, Bressler NM, et al. Effect of adding dexamethasone to continued ranibizumab treatment in patients with persistent diabetic macular edema. JAMA Ophthalmology. 2017Nov11;136(1):29–38.
Kaya M, Atas F, Kocak N, Ozturk T, Ayhan Z, Kaynak S. Intravitreal ranibizumab and dexamethasone implant injections as primary treatment of diabetic macular edema: The Month 24 results from simultaneously double protocol. Current Eye Research. 2023Jan12;:1–8.
Boyer DS, Yoon YH, Belfort R, Jr., Bandello F, Maturi RK, Augustin AJ, Li XY, Cui H, Hashad Y, Whitcup SM. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121(10):1904–1914.
Authors
Copyright (c) 2024 Ursula Natasya Pradnya Paramita, Tania Tania, Clarissa Clarissa, Salma Salsabila
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