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Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab
당뇨황반부종에서 베바시주맙 치료 반응도에 따른 덱사메타손 삽입물의 효과 비교
JKOS 2020 Jan;61(1):51-8
Published online January 15, 2020;  https://doi.org/10.3341/jkos.2020.61.1.51
Copyright © 2020 The Korean Ophthalmological Society.
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Doyeon Kim, MD, Dong-Geun Park, MD, Gahyung Ryu, MD, Min Sagong, MD, PhD
김도연 · 박동근 · 류가형 · 사공민

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
영남대학교 의과대학 안과학교실
Received August 16, 2019; Revised September 30, 2019; Accepted December 30, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: To compare the efficacy of intravitreal dexamethasone implants according to previous response to bevacizumab treatment in patients with diabetic macular edema (DME).
Methods: Forty-nine eyes of 49 patients who received intravitreal dexamethasone implants for DME were reviewed retrospectively. Of these patients, 13 were treatment-naïve and 36 had previously received intravitreal injections of bevacizumab. Of the 36 previously treated patients, 24 comprised a refractory group showing no response to previous injections, and 12 comprised a responder group showing a response to previous treatments. The best-corrected visual acuity, central macular thickness (CMT), and retreatment percentages were assessed monthly for 6 months.
Results: After the intravitreal dexamethasone implants, visual acuity improved significantly over 6 months in the treatment-naïve group, while in the responder group, a significant improvement in visual acuity was seen at the 2-month follow-up. In the refractory group, there was no significant improvement in visual acuity during the follow-up period. The CMT showed a significant decrease in all three groups, and there was no significant difference in the CMT among the three groups at any time point. Five patients in the treatment-naive group (38.5%), 19 patients in the refractory group (79.2%), and nine patients in the responder group (75.0%) needed retreatment for recurrent macular edema, and there was a significant difference among the three groups in the rate of recurrence (p = 0.034).
Conclusions: In DME patients, intravitreal dexamethasone implants were associated with a significant anatomical improvement irrespective of previous bevacizumab treatment response. However, the treatment-naïve and responder groups showed improvements in visual acuity, whereas the refractory group showed limited improvement.
Keywords : Bevacizumab, Dexamethasone, Diabetic macular edema, Intravitreal injection, Macular edema

 

February 2020, 61 (2)