Comparison of Dexamethasone Implant and Anti-VEGF Agents in the Treatment of Naive Diabetic Macular Oedema: A Prospective Cohort Study
Introduction: Diabetic Retinopathy (DR) is one of the common microvascular complications of diabetes. In patients with DR, the most frequent cause of vision loss is Diabetic Macular oedema (DME). In the present era, anti-Vascular Endothelial Growth Factor (anti-VEGF) agents are the mainstay of t...
| Published in: | Journal of Clinical and Diagnostic Research |
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| Main Authors: | , , , , |
| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2023-11-01
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| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/18739/65352_CE[Ra1]_F(IS)_QC(KK_RDW_IS)_PF1(AKA_KM)_PFA(AKA_KM)_PN(KM).pdf |
| Summary: | Introduction: Diabetic Retinopathy (DR) is one of the common
microvascular complications of diabetes. In patients with DR, the
most frequent cause of vision loss is Diabetic Macular oedema
(DME). In the present era, anti-Vascular Endothelial Growth Factor
(anti-VEGF) agents are the mainstay of treatment for managing
DME. A majority of patients show a good response to multiple
doses of these agents administered by a pro re nata regimen
at regularly spaced fixed intervals. However, the tendency of
DME to become chronic and resistant to these agents, as well
as the burden of repeated injections, necessitates considering
alternative treatment options with similar or better efficacy. As
steroids can address these drawbacks of anti-VEGF treatment,
the present study compared the efficacy of anti-VEGF agents
with dexamethasone implant in the treatment of naïve DME.
Aim: To compare the effectiveness of dexamethasone implant
with anti-VEGF agents in the treatment of naïve DME.
Materials and Methods: A prospective cohort study was
conducted in the Department of Ophthalmology at Kalinga
Institute of Medical Sciences and Pradyumna Bal Memorial
Hospital, Bhubaneswar, Odisha, India from September 2020
to September 2022. A total of 100 eyes with DME, newly
diagnosed patients aged 18 years and above, without other
macular oedema-causing diseases, were included. A total of
50 eyes in each group were treated with an anti-VEGF agent
(Group A) or dexamethasone implant (Group B), and Best
Corrected Visual Acuity (BCVA) and Central Foveal Thickness
(CFT) were monitored for six months. For statistical analysis,
paired t-test and independent t-test were used for within-group
and inter-group analysis, respectively. A p-value <0.05 was
considered statistically significant.
Results: In both groups, post-treatment BCVA showed marked
improvement, but there was no significant difference in mean
BCVA between the groups (p=0.89) at six months. However, the
mean CFT showed significant improvement in Group B at six
months. In Group A, the mean CFT reduced from 441.87±54.48
μm to 257.83±25.73 μm, and in Group B, the mean CFT
reduced from 464±109.44 μm to 207±22.51 μm at six months
(p<0.0001). Adverse events like cataracts and glaucoma were
seen in patients treated with the dexamethasone implant and
were managed by cataract surgery and topical anti-glaucoma
medications, respectively.
Conclusion: Dexamethasone implant and anti-VEGF agents
are equally effective in improving visual acuity; however,
dexamethasone stands superior in reducing macular thickness.
Needing fewer injections while treating with a dexamethasone
implant improves compliance. The progression of cataract remains
a major side-effect with the dexamethasone implant, which is not
a concern when treating DME in pseudophakic eyes |
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| ISSN: | 2249-782X 0973-709X |