J Korean Ophthalmol Soc > Volume 61(1); 2020 > Article
Journal of the Korean Ophthalmological Society 2020;61(1):51-58.
DOI: https://doi.org/10.3341/jkos.2020.61.1.51    Published online January 15, 2020.
Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab.
Doyeon Kim, Dong Geun Park, Gahyung Ryu, Min Sagong
Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea. msagong@ynu.ac.kr
당뇨황반부종에서 베바시주맙 치료 반응도에 따른 덱사메타손 삽입물의 효과 비교
김도연 · 박동근 · 류가형 · 사공민
영남대학교 의과대학 안과학교실
Correspondence:  Min Sagong,
Email: msagong@ynu.ac.kr
Received: 16 August 2019   • Revised: 30 September 2019   • Accepted: 30 December 2019
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.
Key Words: Bevacizumab;Dexamethasone;Diabetic macular edema;Intravitreal injection;Macular edema


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