Berhuni Mustafa, Yılmaz İbrahim Edhem, Gizem Gürbostan Soysal, Özcan Zeynep Özer, Doğan Levent
Cesk Slov Oftalmol. 2025;81(Ahead of Print):1-6. doi: 10.31348/2025/4.
To investigate the efficacy and safety of intravitreal Dexamethasone implant (DEX-I) therapy in the treatment of diabetic macular edema (DME) refractory to intravitreal bevacizumab (IVB).
This retrospective and cross-sectional study included 37 eyes of 37 patients who received 3 loading doses of IVB injections for DME with no response and underwent DEX-I implant. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurements and central foveal thickness (CFT) measured by spectral domain optical coherence tomography (SD-OCT) were recorded and compared before DEX-I, at the first week, first, second, third and sixth months. Duration of DME, glycated hemoglobin (HbA1c) levels, DME types and lens status (phakic, pseudophakic) were also recorded.
The mean age of the patients was 61.14 ±8.69 years (59.5% male, 40.5% female). 35.1% of the patients had cystoid macular edema, 64.9% had diffuse macular edema and 73 % were phakic and 27% were pseudophakic. BCVA, CFT and IOP values before DEX-I injection were 0.78 ±0.16 LogMAR, 493.73 ±107.6 µm and 13.05 ±2.59 mmHg, respectively. At 6 months after DEX-I, BCVA, CFT and IOP values were 0.64 ±0.11 LogMAR, 397.35 ±59.72 µm and 16.3 ±2.51 mmHg, respectively. In all follow-ups, there was a significant improvement in BCVA, a significant decrease in CFT and a significant increase in IOP compared to pre-injection. Ocular hypertension was observed in 0.8 % of patients and progression of cataract progression in 1% of patients after treatment.
DEX-I therapy is an effective and safe treatment option for DME refractory to IVB treatment.
探讨玻璃体内注射地塞米松植入物（DEX-I）治疗对玻璃体内注射贝伐单抗（IVB）难治的糖尿病性黄斑水肿（DME）的疗效和安全性。
这项回顾性横断面研究纳入了37例患者的37只眼，这些患者接受了3次负荷剂量的IVB注射治疗DME但无反应，随后接受了DEX-I植入。记录并比较了在DEX-I植入前、第1周、第1、2、3和6个月时的最佳矫正视力（BCVA）、眼压（IOP）测量值以及通过光谱域光学相干断层扫描（SD-OCT）测量的中心凹厚度（CFT）。还记录了DME的病程、糖化血红蛋白（HbA1c）水平、DME类型和晶状体状态（有晶状体、人工晶状体）。
患者的平均年龄为61.14±8.69岁（男性占59.5%，女性占40.5%）。35.1%的患者患有黄斑囊样水肿，64.9%患有弥漫性黄斑水肿，73%为有晶状体眼，27%为人工晶状体眼。DEX-I注射前的BCVA、CFT和IOP值分别为0.78±0.16 LogMAR、493.73±107.6 µm和13.05±2.59 mmHg。DEX-I注射后6个月，BCVA、CFT和IOP值分别为0.64±0.11 LogMAR、397.35±59.72 µm和16.3±2.51 mmHg。在所有随访中，与注射前相比，BCVA有显著改善，CFT显著降低，IOP显著升高。治疗后，0.8%的患者出现高眼压，1%的患者白内障进展。
DEX-I治疗是对IVB治疗难治的DME的一种有效且安全的治疗选择。
