Intravitreal Dexamethasone Implant in Anti-Vascular Endothelial Growth Factor Pretreated Diabetic Macular Edema-A Swiss Cohort Study

被引：0

作者：

Turgut, Ferhat ^{[1
,2
,3
,4
]}

Somfai, Gabor M. ^{[1
,2
,3
]}

Tappeiner, Christoph ^{[5
,6
,7
]}

Hatz, Katja ^{[8
,9
]}

Mantel, Irmela ^{[10
]}

Ambresin, Aude ^{[11
]}

Donati, Guy ^{[12
]}

Guignard, Viviane ^{[1
,2
]}

Nagyova, Dana ^{[13
]}

Pfister, Isabel B. ^{[14
]}

Schild, Christine ^{[14
]}

Garweg, Justus G. ^{[14
,15
]}

机构：

[1] Stadtspital Zurich, Dept Ophthalmol, CH-8063 Zurich, Switzerland

[2] Spross Res Inst, CH-8055 Zurich, Switzerland

[3] Semmelweis Univ, Dept Ophthalmol, H-1428 Budapest, Hungary

[4] Gutblick Res, CH-8808 Pfaffikon, Switzerland

[5] Pallas Kliniken, Dept Ophthalmol, CH-4600 Olten, Switzerland

[6] Univ Duisburg Essen, Univ Hosp Essen, Dept Ophthalmol, D-45147 Essen, Germany

[7] Univ Bern, Med Fac, CH-3012 Bern, Switzerland

[8] Vista Augenklin Binningen, CH-4102 Binningen, Switzerland

[9] Univ Basel, Med Fac, CH-4001 Basel, Switzerland

[10] Univ Eye Hosp Jules Gonin, CH-1004 Lausanne, Switzerland

[11] Swiss Visio Montchoisi, CH-1006 Lausanne, Switzerland

[12] Clin Colline, Ctr Ophtalmol Colline, CH-1205 Geneva, Switzerland

[13] Pallas Klin, CH-8600 Dubendorf, Switzerland

[14] Berner Augenklin, Swiss Eye Inst & Clin Vitreoretinal Dis, CH-3007 Bern, Switzerland

[15] Univ Bern, Dept Ophthalmol, Inselspital, CH-3012 Bern, Switzerland

来源：

PHARMACEUTICALS | 2024年 / 17卷 / 09期

关键词：

diabetic macular edema; intravitreal dexamethasone implant; anti-VEGF; RANIBIZUMAB; BEVACIZUMAB; AFLIBERCEPT;

D O I：

10.3390/ph17091235

中图分类号：

R914 [药物化学];

学科分类号：

100701 ;

摘要：

Background/Objectives: Diabetic macular edema (DME) is a significant cause of visual impairment, often treated with anti-vascular endothelial growth factor (anti-VEGF) agents. However, some patients do not respond adequately to this treatment. This study aims to evaluate the contribution of the intravitreal dexamethasone (DEX) implant as a second-line treatment in DME patients with insufficient response to anti-VEGF therapy or with high treatment burden. Methods: This retrospective multicenter cohort study was conducted across seven clinical sites in Switzerland. The study included eyes with active DME that had been pretreated with anti-VEGF for at least six months before receiving DEX therapy. Data were extracted from electronic patient records, focusing on best-corrected visual acuity (BCVA), central subfield thickness (CST), and injection frequency. Results: A total of 95 eyes from 89 patients (38.8% females, mean age 65.6 +/- 9.1 years, follow-up time 80.6 +/- 38.5 [13.5-166.7] months) were analyzed. Prior to the first DEX implant, eyes had undergone an average of 16.0 +/- 13.3 anti-VEGF injections over 32.5 +/- 22.4 months. Post-DEX treatment, 22.1% of eyes received DEX monotherapy, 44.2% received a combination of DEX and anti-VEGF, 25.3% continued with anti-VEGF monotherapy, and 8.4% received no further treatment. The number of anti-VEGF injections decreased significantly from 6.4 +/- 3.1 in the year before DEX to 1.6 +/- 2.4 in the year after DEX (p < 0.001). BCVA remained stable (0.4 +/- 0.3 logMAR at baseline, 0.4 +/- 0.5 logMAR at 24 months, p = 0.2), while CST improved from 477.7 +/- 141.0 to 320.4 +/- 125.5 mu m (p < 0.001), and the presence of retinal fluid decreased from 98.0% to 61.1% (p = 0.021). During follow-up, 26.3% of eyes required glaucoma medication, 4.2% underwent glaucoma surgery, and 1.1% needed cataract surgery. Conclusions: In real-world clinical settings, the addition of DEX to anti-VEGF therapy in DME patients significantly reduces treatment burden and retinal fluid while maintaining visual function. Treatment decisions should balance anatomical and functional outcomes, considering individual patient needs.

引用

页数：15

共 30 条

[1] The impact of compliance among patients with diabetic macular oedema treated with intravitreal aflibercept: a 48-month follow-up study [J].