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Early response to dexamethasone implant predicts visual outcomes in DME

07 Nov 2017

In diabetic macular oedema (DME), visual outcomes following intravitreal dexamethasone implant therapy may be predicted by early treatment response, according to a study. Specifically, eyes with optimal early responses demonstrate better outcomes compared with eyes having suboptimal early visual acuity gains.

With the aim of determining whether early visual acuity response to dexamethasone implant in DME was associated with long-term outcome, researchers reviewed the clinical data of 102 eyes with DME treated with intravitreal dexamethasone implant. Eyes with vitroretinal interface abnormalities or that underwent vitrectomy were excluded.

Eyes were grouped into three according to the change in best-corrected visual acuity (BCVA) at 3 months: logMAR equivalence of <5-letter, 5 to 9-letter or ≥10-letter gain. Assessments included visual acuity outcomes and the association between early (3 months) and overall change in BCVA.

Of the eyes, 44.1 percent showed <5-letter, 18.6 percent had 5 to 9-letter and 37.3 percent had ≥10-letter BCVA improvements at 3 months. Significantly more eyes in the robust (≥10-letter) early response group achieved ≥10-letter gains at study conclusion than in the suboptimal (<5-letter) early response group (29 vs 6.7 percent; p=0.009).

Regression analysis found that change in BCVA at 3 months positively correlated with overall change in BCVA (p=0.002).

Researchers pointed out that an adjustment to therapy or alternative options such as pars plana vitrectomy with inner limiting membrane peeling may be considered for DME patients with poor early response, which is associated with worse outcomes compared with robust early response.

Further work must be done to clarify which alterations to the treatment regimen will most benefit DME patients with poor early response, as well as to characterize and understand the underlying factors that lead some patients to respond more favourably to particular treatments so that therapies can be tailored individually, researchers said.

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