Adjuvant intravitreal dexamethasone implant for persistent CME
Reviewed by Sofia Rokerya

In this retrospective, cross-sectional study the authors investigate the efficiency of intravitreal dexamethasone implants (0.7mg) for cystoid macular oedema (CME) persisting, despite immunomodulatory treatment in patients with Behcets’ disease (BD). Twenty-seven eyes of 20 patients (12 males and eight females) who were under immunomodulatory therapy and had CME secondary to BD were included in this study. The study eyes received adjuvant intravitreal dexamethasone implant injections (0.7mg) for CME treatment. Five eyes of the study group received a second dexamethasone implant injection within an average of 16.8±3.54 months. The mean age of the patients in this study was 35.6±12.1 years and the mean follow-up time per eye was 24.35±9.86 months. Four (14.8%) of the eyes were pseudophakic and 23 (85.2%) were phakic at the time of injection. Twelve (60%) of the patients were using conventional therapy before the injection and eight (40%) were treated with biological agents. The overall average number of injections per eye was 1.18±0.32. BCVA increased from 0.85±0.72 to 0.45±0.52 logMAR. The data showed that best corrected visual acuity (BCVA) significantly improved after the implant injection and the peak mean visual gain per eye was reached within 1.81±1.41 months of the injection. At the sixth month follow-up, the mean peak visual acuity gain from baseline was 12.69±7.5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters per eye, and 48% of eyes (61% of patients) gained three lines or more. When assessed according to each eye, there was a statistically significant difference between pre-injection BCVA levels and post-injection BCVA levels assessed at one week and at one, two, three and six months (p=0.012, p<0.001, p<0.001, p=0.001, p<0.001), respectively. The mean central macular thickness (CMT) decreased from 406±190 to 243±101µm at the sixth month. Statistically significant anatomical and functional success was achieved with a single injection. The peak of visual acuity gain was reached within the first two months and a substantial proportion of the patients gained three or more lines. The BCVA gain was statistically significant at nine (p=0.013) and 12 months (p=0.017) post-injection. Likewise, the CMT reduction was significant at nine (p=0.036) and 12 months (p=0.028) post-injection. The study showed that intravitreal dexamethasone implants are a well-tolerated and effective adjuvant therapy in these cases. Anatomical and functional success was achieved at statistically significant levels. The peak mean visual gain was reached within the first two months of injection and a substantial proportion (48%) of eyes gained three lines or more of visual acuity. There was no complication other than transient IOP elevation in four eyes and cataract surgery in two eyes. Limitations: Retrospective nature and small cohort.

Efficacy of dexamethasone implants in uveitic macular edema in Behçet disease.
Yalcinbayir O, Caliskan E, Ucan Gunduz G, et al.
OPHTHALMOLOGICA
2019;241:190-4.