Differential response to intravitreal dexamethasone implant in naive and previously treated diabetic macular edema eyes

Background To identify different response patterns to intravitreal dexamethasone implants (IDI) in naive and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting. Methods 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and >= 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naive and PT DME eyes over 24 months. Results Mean number of injections was significantly lower in naive vs PT DME eyes (1.40 +/- 0.9 vs 1.82 +/- 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naive vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving >= 4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 +/- 4.0 vs 10.0 +/- 5.5, p = 0.75, 13.2 +/- 4.0 vs 16.0 +/- 3.5, p = 0.21 and 21.7 +/- 3.8 vs 19.7 +/- 5.8, p = 0.55). VA scores were consistently better in naive vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates. Conclusion Naive DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.