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Diabetic eyes: Steroids or anti-growth factors?

Title of Article: The Efficacy and Safety of Dexamethasone Intravitreal Implant for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis of Randomized Controlled Trials


What are the key takeaway points from this article?:

Diabetic macular edema (DME), a common and serious complication of diabetic retinopathy, occurs when fluid accumulates within the extracellular space of the macula. Retinal vein occlusion secondary to macular edema (RVO-ME) can occur if there is an obstruction of the outflow channel of the eye, such as retinal vein thrombosis. Both DME and RVO-ME are common complications of fundus disease that, from recurrent episodes, can lead to vision loss and blindness. This meta-analysis of 13 randomized control trials evaluated the efficacy and safety of dexamethasone intravitreal implant (DEX) as a treatment for DME and RVO-ME. DEX treatment of RVO-ME was more effective than anti-VEGF treatment for improvement in best corrected visual acuity (BCVA) and central retinal thickness (CRT). For DEX treatment of DME, there was significantly greater CRT reduction and no difference in BCVA improvement when compared to anti-VEGF therapy. However, DEX was shown to significantly increase the risk of cataract from RVO-ME and DME and the incidence of high intraocular pressure compared to anti-VEGF therapy.


In conclusion, the authors state the DEX has greater efficacy than anti-VEGF therapy and recommends DEX to reduce the number of injections and follow-up treatments needed to manage DME. They recommend DEX for patients with refractory DME that have a poor response to anti-VEFG drugs and a high number of relapses. However, the safety profile of DEX should be considered as there is an increased risk of cataract development and high intraocular pressure. Clinicians must take this into consideration when choosing a therapeutic modality for DME and RVO-ME, though the majority of the cataracts from these studies did not require surgical intervention and the majority with increased intraocular pressures could be managed by observation or medication alone.


Publication Date: Aug 9, 2022


Reference:

Xiaodong L, Xuejun X. The Efficacy and Safety of Dexamethasone Intravitreal Implant for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis of Randomized Controlled Trials. J Ophthalmol. 2022 Aug 9;2022:4007002. doi: 10.1155/2022/4007002. PMID: 35982771; PMCID: PMC9381227.


Summary by: Neil Kamra



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