A Collaborative Retrospective Study on the Efficacy and Safety of Intravitreal Dexamethasone Implant (Ozurdex) in Patients with Diabetic Macular Edema: The European DME Registry Study

A. Rosenblatt, P. Udaondo, J. Cunha-Vaz, S. Sivaprasad, F. Bandello, P. Lanzetta, L. Kodjikian, M. Goldstein, Z. Habot-Wilner, A. Loewenstein, J.J. Escobar, G. Menon, B. Corcostegui, U. Eriksson, A. Boixadera, L. Sararols, S. Guigou, M. Varano, J. Figueira, A. PollackP. Massin, P. Carpineto, N. Recchimurzo, F. Matonti, K. Kinnunen, F. Coscas, E. Midena, J. Nascimento, F. Armada, N. Sorkin, ARTES Study Group

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To evaluate the efficacy, effect profile, and safety of dexamethasone implant on diabetic macular edema (DME) in a real-life setting, further comparing results by DME duration, previous treatment status, and diabetic control. Design: A multicenter, retrospective cohort of 340 DME eyes of 287 patients from 25 clinical sites from 8 countries. Methods: Data were analyzed in 2 perspectives: per injection, in which all measurements were grouped and baseline was defined as the day of injection, and thus the pharmacodynamics of single injections could be assessed; and injection series, defined as 2 or more injections with 3 to 6 months between injections analyzing the outcome 3 to 6 months after the last injection. Main Outcome Measures: Primary outcome was improvement of 15 or more letters in best-corrected visual acuity (BCVA) from baseline. Secondary outcomes included improvement of 10 letters or more in BCVA, change in central macular thickness (CMT), and time to maximum improvement and safety. Results: Overall, 762 injections were administered to 340 eyes of 287 patients. Injection series analysis included 171 series in 171 eyes of 150 patients, for a total of 444 injections, with a mean follow-up of 1.7±0.8 years. Of the 762 injections analyzed per injection, 22.7% achieved a 15-letter or more improvement, and 37.8% achieved a 10-letter or more improvement. Mean time to peak improvement was 81.9±39.7 days. Mean maximum change in CMT was –174±171 μm. Overall, 7.6% lost 15 or more letters. More eyes with early DME gained 10 or more letters and fewer eyes lost 10 or more letters compared with eyes with late DME (47.4% vs. 33.9% [P = 0.001] and 8.2% vs. 13.5% [P = 0.029], respectively). Patients with controlled diabetes showed greater CMT reduction (P = 0.0002). A higher percentage of treatment-naive patients gained 10 or 15 letter or more in BCVA (P = 0.001 and P = 0.006, respectively). Intraocular pressure elevation of more than 25 mmHg was found following 7.9% of injections; no endophthalmitis was reported. Conclusions: Dexamethasone implant is an effective and safe treatment for DME. Peak improvement was achieved 3 months after injection and dissipated thereafter. Clinicians and providers may consider shortening treatment intervals. © 2019 American Academy of Ophthalmology
Original languageEnglish
Pages (from-to)377-393
Number of pages17
JournalOphthalmology
Volume127
Issue number3
DOIs
Publication statusPublished - 2020

Keywords

  • dexamethasone
  • hemoglobin A1c
  • glucocorticoid
  • aged
  • best corrected visual acuity
  • cataract
  • central macular thickness
  • clinical assessment
  • clinical evaluation
  • cohort analysis
  • comparative study
  • Conference Paper
  • controlled study
  • diabetes control
  • diabetic macular edema
  • disease duration
  • drug effect
  • drug efficacy
  • drug safety
  • endophthalmitis
  • female
  • follow up
  • human
  • intraocular pressure
  • major clinical study
  • male
  • multicenter study
  • outcome assessment
  • pharmacodynamics
  • priority journal
  • retina detachment
  • retrospective study
  • time to treatment
  • treatment indication
  • visual acuity
  • vitreous hemorrhage
  • adult
  • clinical trial
  • diabetic retinopathy
  • drug implant
  • intravitreal drug administration
  • macular edema
  • middle aged
  • Adult
  • Aged
  • Dexamethasone
  • Diabetic Retinopathy
  • Drug Implants
  • Female
  • Glucocorticoids
  • Humans
  • Intravitreal Injections
  • Macular Edema
  • Male
  • Middle Aged
  • Retrospective Studies
  • Visual Acuity

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