Efficacy Of Intravitreal Dexamethasone Implant In Different Patterns Of Diabetic Macular Edema

Objective:This study evaluated and analyzed the effect of different types of macular edema on this treatment by injecting dexamethasone sustained-release into the vitreous cavity.Methods:In this retrospective study,we collected 69 DME patients diagnosed by fluorescence fundus angiograph(FFA)and optical coherence tomography(OCT)in the Second Affiliated Hospital of Nanchang University from October 2019 to October2021.69 eyes were treated with dexamethasone sustained-release(Ozurdex)injection into the vitreous cavity.The average age was 57.58±9.14 years(range 29-82 years),of which 40(57.97%)were male and 29(42.07%)were female.Different types of diabetic macular edema patients were divided into three groups by optical coherence tomography in the macular region,including 21 patients(30.43%)in the DRT group(group A),23 patients(33.33%)in the CME group(group B),and 25 people(36.23%)in the SRD group(Group C),all three groups received DEX treatment for the first time.The best corrected visual acuity(BCVA),intraocular pressure(IOP),central retinal thickness(CRT),serous retinal detachment height(SRDh),and hyperreflection Point number(HRS),and incidence of ocular and systemic adverse events related to treatment were recorded on the day of treatment and 1,3,and 6months after treatment.Functional success was defined as a visual acuity gain of at least 0.1 Log MAR units,and anatomical success was defined as a foveal thickness<300 μm by Optical coherence tomography.Finally,we need to analyze the efficacy of treatments between different groups,as well as the impact of changes in biomarkers within different groups.And further guide treatment and monitor treatment response.Results:There was no statistically significant difference in demographics among the three groups(P>0.05),There were significant differences in baseline CRT: the SRD group had the thickest CRT,and the DRT group had the thinnest CRT(P=0.000).After adjustment,there was no significant difference in CRT between groups A and B(P=0.459).During the follow-up,the BCVA at each time point in the three groups was improved compared with that before treatment,and the difference was statistically significant(P<0.05).There was no significant difference in BCVA among the three groups at 1 month,3 months and 6 months of follow-up after treatment(P=0.253、P=0.619、P=0.581).After treatment,CRT at each time point in the three groups was significantly lower than that before treatment,and the difference was statistically significant(P<0.05).There were significant differences in CRT between the three groups at the initial diagnosis,1 month,3 months and 6 months after treatment.After Bonferroni correction,there was no significant difference in CRT between groups A and B at each follow-up time point(P=0.329、P=0.814、P=0.689),The decrease of CRT in group A and C,group B and C at the same follow-up time point was statistically significant(P<0.05).At each follow-up time after treatment,the regression of macular edema was better in group C patients.After treatment,SRDh in group C decreased significantly at three follow-up time points compared with before treatment,and the difference was statistically significant.At 3 months,SRDh dropped to 0 in 16(24%)eyes.At 6 months,1(4%)eye had recurrent SRD and 4(16%)eyes had persistent SRD.After treatment,the number of HRS in the three groups decreased significantly,and the difference was statistically significant(P<0.05).At the 6-month follow-up,there was no significant difference in the number of HRS among the three groups(P=0.266).BCVA changes were positively correlated with CRT(r=0.403,P=0.001)and HRS number(r=0.292,P=0.015).Adverse event:During the follow-up,the incidence of intraocular hypertension was 1 case(4.76%)in the DRT group,2 cases(8.70%)in the CME group,1 case(4.00%)in the SRD group.In the CME group,1 case(4.35%)of vitreous hemorrhage occurred after the follow-up,and underwent surgical treatment in our hospital.In the SRD group,2 cases(8.00%)underwent cataract surgery.No other adverse reactions such as endophthalmitis were found during the entire follow-up.Conclusion:The study found that implanted dexamethasone sustained-release formulations are effective in the treatment of different types of diabetic macular edema,especially for the treatment of SRD type macular edema,the effect is the best.