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Progression of diabetic retinopathy severity after treatment with dexamethasone implant: a 24-month cohort study the ‘DR-Pro-DEX Study’

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Abstract

Purpose

Intravitreal anti-vascular endothelial growth factor agents have been shown to reduce diabetic retinopathy (DR) progression; data on the effects of intravitreal corticosteroids on modifying disease severity are limited. This study evaluates the long-term effect of intravitreal dexamethasone implant (DEX) on the severity and progression of non-proliferative DR (NPDR).

Methods

This was a retrospective cohort study. Sixty eyes from 60 consecutive patients with NPDR and diabetic macular edema (DME) treated with dexamethasone implant (DEX group) and 49 eyes from consecutive 49 patients without DME requiring observation only. Fundus angiography images from baseline and after 24 months were graded by two masked assessors into mild, moderate and severe NPDR and PDR, according to the ETDRS classification. Patients were followed up 1–3 and 4–6 months after each DEX implant. Re-treatment with DEX implant was on a pro re nata basis. Records were reviewed for performance of panretinal photocoagulation. Main outcome was as follows: change of DR ≥ 1 grade and progression to proliferative diabetic retinopathy (PDR).

Results

Three eyes (5%) in the DEX group and 43 (87.8%) eyes in the control group progressed to PDR (P < 0.0001). Twenty-five eyes (41.7%) in the DEX group but none in the control group demonstrated an improvement in DR severity (P < 0.0001).

Conclusion

This study provides the first long-term evidence that DEX implant has the potential to not only delay progression of DR and PDR development, but may also improve DR severity over 24 months. Better understanding of the effects of corticosteroids will help guide its use in the treatment pathway of DR.

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Funding

Anat Loewenstein is a consultant for Allergan. Matias Iglicki, Dinah Zur, Catharina Busch and Mali Okada receive travel support by Allergan.

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Author notes

  1. Matias Iglicki and Dinah Zur have contributed equally to this work.

Authors and Affiliations

  1. Retina Private Office, University of Buenos Aires, 525 Aguirre St., 3rd floor, Apt. A, Zip code 1414, Buenos Aires, Argentina

    Matias Iglicki

  2. Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Dinah Zur & Anat Loewenstein

  3. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Dinah Zur & Anat Loewenstein

  4. Department of Ophthalmology, University of Leipzig, Leipzig, Germany

    Catharina Busch

  5. Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia

    Mali Okada

  6. Incumbent, Sydney A. Fox Chair in Ophthalmology, Tel Aviv University, Tel Aviv, Israel

    Anat Loewenstein

Authors
  1. Matias Iglicki
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  2. Dinah Zur
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  3. Catharina Busch
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  4. Mali Okada
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Correspondence to Matias Iglicki.

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The authors declare that they have no conflict of interest.

Ethical approval

Institutional review board approval was obtained through the individual IRBs at the participating institutes for a retrospective consecutive chart review. The research adhered to the tenets of the Declaration of Helsinki.

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Iglicki, M., Zur, D., Busch, C. et al. Progression of diabetic retinopathy severity after treatment with dexamethasone implant: a 24-month cohort study the ‘DR-Pro-DEX Study’. Acta Diabetol 55, 541–547 (2018). https://doi.org/10.1007/s00592-018-1117-z

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  • DOI: https://doi.org/10.1007/s00592-018-1117-z

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