Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results

• DOI: 10.1007/s00592-019-01416-4
• Publication Date: 2019-09-21T04:01:15Z
• Authors: Catharina Busch; Samantha Fraser-Bell; Matias Iglicki; Marco Lupidi; Aude Couturier; Voraporn Chaikitm...; Ermete Giancipoli; Patricio J. Rodrí...; Pierre-Henry Gabr...; Inês Laíns; Ana Rita Santos; Zafer Cebeci; Atchara Amphornph...; Valentin Degenhardt; Jan-Darius Unterl...; Carlo Cagini; Valérie Mané-Tauty; Giuseppe D’Amico ...; Isaac Hindi; Kushal Agrawal; Jay Chhablani; Anat Loewenstein; Dinah Zur; Matus Rehak
• Keywords: Male; Vascular Endothelial Growth Factor A; intravitreal; Time Factors; implant; Drug Resistance; Visual Acuity; Angiogenesis Inhibitors; Drug Implant; Dexamethasone; Long- term outcome; 0302 clinical medicine; Retrospective Studie; diabetic; Dexamethasone implant; [SDV.MHEP.EM] Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism; Drug Implants; [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology; anti-vegf; Drug Substitution; Anti-VEGF therapy; Dexamethasone implant; Intravitreal therapy; Long-term outcome; Refractory diabetic macular edema;; [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism; Middle Aged; 3. Good health; Bevacizumab; Treatment Outcome; [SDV.MHEP.OS] Life Sciences [q-bio]/Human health and pathology/Sensory Organs; Intravitreal Injections; outcome; Female; Angiogenesis Inhibitor; Human; Refractory diabetic macular edema; Time Factor; 610; dexamethasone; Drug Administration Schedule; Macular Edema; 03 medical and health sciences; 615; Humans; [SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs; Anti-VEGF therapy; Aged; Retrospective Studies; long-term; therapy; Diabetic Retinopathy; Intravitreal Injection; Intravitreal therapy; macular; Long-term outcome; refractory; edema; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology; Anti-VEGF therapy; Dexamethasone implant; Intravitreal therapy; Long-term outcome; Refractory diabetic macular edema; Aged; Angiogenesis Inhibitors; Bevacizumab; Dexamethasone; Diabetic Retinopathy; Drug Administration Schedule; Drug Implants; Drug Resistance; Drug Substitution; Female; Humans; Intravitreal Injections; Macular Edema; Male; Middle Aged; Retrospective Studies; Time Factors; Treatment Outcome; Vascular Endothelial Growth Factor A; Visual Acuity

To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant.Multicenter, retrospective chart review comparing eyes with treatment-naïve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24 months.In 79% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24 months which were seen in the first year (from month 3: + 8.9 letters, - 214 µm). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24 months (from month 12: + 6.8 letters, p = 0.023; - 226 µm, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24 months (from month 3: + 2.8 letters, p = 0.254; - 24 µm, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12 months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3 months only (23.8 vs. 31.0%, p = 0.344).The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24 months maintained vision. A quarter of eyes, which had not improved vision at 12 months, exhibited a delayed response to treatment.