REPEATED INTRAVITREAL DEXAMETHASONE IMPLANT (OZURDEX) FOR DIABETIC MACULAR EDEMA

Purpose: To evaluate the effects of repeated intravitreal dexamethasone implant. Methods: We reviewed the charts of 12 patients with diabetic macular edema, who received at least 2 intravitreal Ozurdex (0.7 mg) on an "as needed" basis. Main outcome measures included changes in best-corrected visual acuity, central macular thickness, retreatment interval, and incidence of side effects. Results: A total of 15 eyes of 12 patients (6 men, 6 women; mean age 62 +/- 12 years) were included. Retreatment was judged necessary after mean of 7.8 +/- 4.1 months from the first Ozurdex (median, 6 months) (15 of 15 eyes), mean of 4.8 +/- 0.9 months from the second Ozurdex (median, 5 months) (7 of 15 eyes), mean of 5.3 +/- 1.5 months from the third Ozurdex (median, 5 months) (3 of 15 eyes), and mean of 5.6 +/- 2 months from the fourth Ozurdex (median, 5 months) (3 of 15 eyes). Mean baseline best-corrected visual acuity was 0.67 +/- 0.33 logMAR in the overall diabetic macular edema population; it significantly improved to 0.53 +/- 0.31 logMAR after mean of 40.9 +/- 18.2 days from the first Ozurdex (peaking efficacy) (P < 0.001), to 0.53 +/- 0.29 logMAR after mean of 34.4 +/- 9.0 days from the second Ozurdex (peaking efficacy) (P < 0.003), and stabilized to 0.62 +/- 0.26 logMAR after mean of 29.8 +/- 12.1 days from the third Ozurdex (peaking efficacy) (P = 0.05), to 0.5 +/- 0.26 logMAR after mean of 36.3 +/- 3.2 days from the fourth Ozurdex (peaking efficacy) (P = 0.2), and to 0.50 +/- 0.26 logMAR after mean of 37.0 +/- 2.6 days from the fifth Ozurdex (peaking efficacy) (P = 0.2). Mean baseline central macular thickness significantly decreased from 546 +/- 139 mu m to 292 +/- 43 mu m at 39.4 +/- 17.9 days from the first Ozurdex (peaking efficacy) (P < 0.001), to 297 +/- 47 mu m at 33 +/- 9.4 days from the second Ozurdex (peaking efficacy) (P < 0.001), to 293 +/- 22 mu m at 29.8 +/- 12.1 days from the third Ozurdex (peaking efficacy) (P = 0.01), and stabilized to 309 +/- 35 mu m at 36.3 +/- 3.2 days from the fourth Ozurdex (peaking efficacy) (P = 0.1), and to 295 +/- 7 mu m at 37.0 +/- 2.6 days from the fifth Ozurdex (peaking efficacy) (P = 0.1). No serious adverse events were observed; three eyes developed a transient intraocular pressure increase, and cataract was extracted in one eye. Conclusion: Repeated intravitreal Ozurdex on an "as needed" basis with a variable retreatment interval may produce long-term clinically meaningful benefits in the treatment of diabetic macular edema, without other significant side effects than expected after intraocular corticosteroid treatment.