Efficacy of dexamethasone intravitreal implants in macular oedema excluding venous occlusions : results about 80 patients

Purpose The dexamethasone intravitreal implant has shown efficacy in the treatment of macular edema (ME) of non-infectious uveitis and retinal venous occlusions. The aim was to evaluate the efficacy of this implant in the treatment of other diffuse macular edemas with an inflammatory mechanism. Methods Retrospective cohort study over 2 years : from January 2012 to December 2013, including all patients who received at least one injection of intravitreal dexamethasone implant, excluding venous occlusions and non-infectious uveitis. The primary endpoint was the change in visual acuity. Results 80 patients were included. The indications of treatment were : diabetic ME when anti-VEGF were ineffective (53%), ME after retinal detachment(RD)(22%), ME of Irvine Gass syndrome(16%), ME after endophtalmitis(4%), macular telangiectasia(4%), ME of retinitis pigmentosa(1%). The mean ETDRS visual acuity was 53.7 letters before injection, 62.3 letters after injection (p<0.001). The average gain in visual acuity was 6.7 letters [4.5;8.8](p<0.001) in patients treated for diabetic ME, 9.6 letters[6.1;13.1] (p<0.001) for ME after RD, and 15.2 letters[10.2;20.2] (p<0.001) for Irvine Gass syndrome. The mean duration of efficiency was 4.6 months, with a median of 3.8 months. Conclusion The intravitreal implant of dexamethasone appears to be an effective second-line treatment even in patients with diabetic ME after failure of anti-VEGF. It is also effective and well tolerated in patients with ME after RD, and Irvine Gass syndrome.