Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema. Issue 12 (21st April 2017)

• Record Type: Journal Article
• Authors: Cicinelli, Maria Vittoria; Cavalleri, Michele; Querques, Lea; Rabiolo, Alessandro; Bandello, Francesco; Querques, Giuseppe
• Is Part Of: British journal of ophthalmology. Volume 101:Issue 12(2017)
• Page Start: 1689
• Page End: 1693
• Publication Date: 2017-04-21
• Subjects: diabetic macular edema -- anti-VEGF -- dexamethasone -- ranibizumab; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2017-310242
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Purpose: To analyse the effects of intravitreal dexamethasone implant in patients suffering from diabetic macular oedema (DME) on the basis of their visual and functional response to antivascular endothelial growth factor (VEGF) loading dose, in order to early shift to corticosteroids in poorly responding patients. Design: Retrospective monocentric study. Methods: Data of patients with diabetes shifted to 0.7 mg dexamethasone implant after three injections of ranibizumab (RNB) and followed-up to 12 months were reviewed. Main outcome was the evaluation of short-term changes after dexamethasone implant injection, stratifying patients on the basis of best-corrected visual acuity (BCVA) and central macular thickness (CMT) after RNB loading dose. Secondary outcome was to investigate clinical gain maintenance at long-term follow-up. Results: Overall, 45 eyes of 45 patients (23 males, 51.1%), mean age 69.7±9 years, were included in the analysis. After 3 injections of RNB, 30 eyes (66.7%) had a poor visual response (−4.3±10.7 letters), while 15 eyes (33.3%) disclosed good visual outcome (+13.9±9.2 letters). Patients with poor visual response were associated with limited morphological improvement (p=0.04). After 1 month from dexamethasone, only poor responders showed relevant increase in BCVA (p=0.006) and reduction in CMT (p=0.002), in comparison to good visual response patients, featuring only minor clinical effects (p=0.3). The same trend was maintained up to 12 months, after a mean of 1.9±1.1 dexamethasone administrations. Conclusion: Visual and anatomical responses after RNB loading dose are significant predictors of both early term and long-term visual acuity improvement after switching to corticosteroids in patients with DME unresponsive to anti-VEGF.