Cataract surgery with combined versus deferred intravitreal dexamethasone implant for diabetic macular edema: long-term
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ORIGINAL ARTICLE
Cataract surgery with combined versus deferred intravitreal dexamethasone implant for diabetic macular edema: long‑term outcomes from a real‑world setting Eleonora Corbelli1 · Francesco Fasce1 · Lorenzo Iuliano1 · Riccardo Sacconi1 · Rosangela Lattanzio1 · Francesco Bandello1 · Giuseppe Querques1 Received: 12 January 2020 / Accepted: 19 February 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Abstract Aims To compare the long-term functional and anatomical outcomes of cataract surgery with combined versus 1-month deferred intravitreal dexamethasone implant (DEX) in eyes with pre-existing diabetic macular edema (DME). Methods Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were retrospectively evaluated in both groups before treatments, then 1, 4, 12 and 24 months after DEX. Results Forty eyes were analyzed, 20 in each group. BCVA disclosed comparable trends, increasing from similar starting values (p = 0.9913) to akin scores 1 month after DEX (p = 0.4229). After 4 months, it similarly reduced without significant variations within each group throughout the whole observation period. CRT was similar at the time of surgery (p = 0.6134) and was reduced by DEX injection in both samples, with a superior beneficial effect in the combined group after 1 month (p = 0.0010). At 4 months, CRT further elevated and remained overall stable in the long term without differences. By 12 months, 19 (95%) eyes received further injections: 1 (5%) fluocinolone, 3 (15%) received other DEX and fluocinolone, 13 (65%) ≥ 1 DEX only and 2 (10%) anti-VEGFs. During the second year, 6 additional eyes (from the 13 receiving DEX) switched to fluocinolone, reaching a total of 10 (50%). Similar results were observed in the deferred group. Conclusions DEX implant performed at the time of surgery achieved the same long-term functional and anatomical outcomes compared to a 1-month injection deferral in treating eyes with pre-existing DME that should undergo cataract extraction. Keywords Diabetic macular edema · Cataract · Dexamethasone · Inflammation
Introduction Given the increasing global prevalence of diabetes together with the longer life expectancy and aging of the population, cataract surgery in diabetic individuals is going to overall be increasingly frequent [1]. In the diabetic eye two different entities, with distinct pathogenesis and natural histories, may contribute to macular edema after surgery: the onset of postcataract macular This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques. * Giuseppe Querques [email protected] 1
Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
edema (PCME) and the worsening of pre-existing diabetic macular edema (DME) [2, 3]. Diabetic patients have an increased and independent risk of developing PCME, even after uncomplicated surgeries, higher in the presence of any diabetic retinopathy (DR) [4, 5]. On the othe
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