Diabetic macular edema (DME) is a significant complication of diabetes, often leading to vision loss. A recent review paper published in the journal MDPI provides evidence-based recommendations on using intravitreal dexamethasone implants (DEX) for treating DME. DEX is a corticosteroid implant that reduces inflammation and fluid accumulation in the retina.
The paper was authored by an international team of researchers working with the Sbarro Health Research Organization (SHRO) under the leadership of Antonio Giordano, M.D., Ph.D., Founder and Director of SHRO. The authors suggest considering DEX as a first-line strategy in certain situations. For instance, patients with signs of inflammation or have had eye surgery.
DME occurs when fluid accumulates in the macula - the central part of the retina responsible for sharp and detailed vision. Despite significant advancements in therapeutic management, DME remains a clinical challenge due to the increasing global prevalence of diabetes.
The authors also recommend DEX for patients with recent cardiovascular events like heart attacks or strokes. These patients may have an increased risk of bleeding or thrombosis from anti-VEGF injections. Pregnant women needing urgent treatment to prevent vision loss and patients scheduled for cataract surgery or with poor compliance with frequent injections might also benefit from DEX.
Other aspects analyzed for DME treatment with DEX include when to start, switch, or stop DEX therapy based on factors like visual acuity, retinal thickness, intraocular pressure, and more.
The review explores whether combining DEX with laser photocoagulation could enhance the effect or reduce side effects of either therapy. It also addresses how to manage the association between glaucoma and DEX therapy since corticosteroids can increase eye pressure and damage the optic nerve. Additionally, it discusses the use of DEX implants in patients with DME undergoing cataract surgery. Because DME likely increases after surgery, the injection of a DEX implant preop or at the same time is highly recommended as it was shown to prevent DME or keep it from worsening.
“The use of dexamethasone implants in treating diabetic macular edema presents an opportunity for personalized treatment strategies based on individual patient characteristics and responses to therapy,” says Giordano. “As our understanding of DME continues to evolve, so too will our therapeutic approaches, ultimately leading to improved patient outcomes.” (TD/Newswise)