Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema

© 2018, Springer-Verlag Italia S.r.l., part of Springer Nature. Aims: To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEG...

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Main Authors: Catharina Busch, Dinah Zur, Samantha Fraser-Bell, Inês Laíns, Ana Rita Santos, Marco Lupidi, Carlo Cagini, Pierre Henry Gabrielle, Aude Couturier, Valérie Mané-Tauty, Ermete Giancipoli, Giuseppe D.Amico Ricci, Zafer Cebeci, Patricio J. Rodríguez-Valdés, Voraporn Chaikitmongkol, Atchara Amphornphruet, Isaac Hindi, Kushal Agrawal, Jay Chhablani, Anat Loewenstein, Matias Iglicki, Matus Rehak
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Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/58215
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spelling th-cmuir.6653943832-582152018-09-05T04:34:18Z Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema Catharina Busch Dinah Zur Samantha Fraser-Bell Inês Laíns Ana Rita Santos Marco Lupidi Carlo Cagini Pierre Henry Gabrielle Aude Couturier Valérie Mané-Tauty Ermete Giancipoli Giuseppe D.Amico Ricci Zafer Cebeci Patricio J. Rodríguez-Valdés Voraporn Chaikitmongkol Atchara Amphornphruet Isaac Hindi Kushal Agrawal Jay Chhablani Anat Loewenstein Matias Iglicki Matus Rehak Biochemistry, Genetics and Molecular Biology Medicine © 2018, Springer-Verlag Italia S.r.l., part of Springer Nature. Aims: To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting. Methods: To be included in this retrospective multicenter, case–control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ≤ 5 letters or reduction in central subfield thickness (CST) ≤ 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group. Results: A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was − 0.4 ± 10.8 letters (anti-VEGF group), and + 6.1 ± 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 ± 145.9 µm (anti-VEGF group) and − 92.8 ± 173.6 µm (DEX group) (P < 0.001). Eyes in the DEX group were more likely to gain ≥ 10 letters (OR 3.71, 95% CI 1.19–11.61, P = 0.024) at month 12. Conclusions: In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy. 2018-09-05T04:21:15Z 2018-09-05T04:21:15Z 2018-08-01 Journal 14325233 09405429 2-s2.0-85046451948 10.1007/s00592-018-1151-x https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85046451948&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/58215
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Biochemistry, Genetics and Molecular Biology
Medicine
spellingShingle Biochemistry, Genetics and Molecular Biology
Medicine
Catharina Busch
Dinah Zur
Samantha Fraser-Bell
Inês Laíns
Ana Rita Santos
Marco Lupidi
Carlo Cagini
Pierre Henry Gabrielle
Aude Couturier
Valérie Mané-Tauty
Ermete Giancipoli
Giuseppe D.Amico Ricci
Zafer Cebeci
Patricio J. Rodríguez-Valdés
Voraporn Chaikitmongkol
Atchara Amphornphruet
Isaac Hindi
Kushal Agrawal
Jay Chhablani
Anat Loewenstein
Matias Iglicki
Matus Rehak
Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
description © 2018, Springer-Verlag Italia S.r.l., part of Springer Nature. Aims: To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting. Methods: To be included in this retrospective multicenter, case–control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain ≤ 5 letters or reduction in central subfield thickness (CST) ≤ 20%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12 months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group. Results: A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12 months was − 0.4 ± 10.8 letters (anti-VEGF group), and + 6.1 ± 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 ± 145.9 µm (anti-VEGF group) and − 92.8 ± 173.6 µm (DEX group) (P < 0.001). Eyes in the DEX group were more likely to gain ≥ 10 letters (OR 3.71, 95% CI 1.19–11.61, P = 0.024) at month 12. Conclusions: In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12 months than those that continued treatment with anti-VEGF therapy.
format Journal
author Catharina Busch
Dinah Zur
Samantha Fraser-Bell
Inês Laíns
Ana Rita Santos
Marco Lupidi
Carlo Cagini
Pierre Henry Gabrielle
Aude Couturier
Valérie Mané-Tauty
Ermete Giancipoli
Giuseppe D.Amico Ricci
Zafer Cebeci
Patricio J. Rodríguez-Valdés
Voraporn Chaikitmongkol
Atchara Amphornphruet
Isaac Hindi
Kushal Agrawal
Jay Chhablani
Anat Loewenstein
Matias Iglicki
Matus Rehak
author_facet Catharina Busch
Dinah Zur
Samantha Fraser-Bell
Inês Laíns
Ana Rita Santos
Marco Lupidi
Carlo Cagini
Pierre Henry Gabrielle
Aude Couturier
Valérie Mané-Tauty
Ermete Giancipoli
Giuseppe D.Amico Ricci
Zafer Cebeci
Patricio J. Rodríguez-Valdés
Voraporn Chaikitmongkol
Atchara Amphornphruet
Isaac Hindi
Kushal Agrawal
Jay Chhablani
Anat Loewenstein
Matias Iglicki
Matus Rehak
author_sort Catharina Busch
title Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
title_short Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
title_full Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
title_fullStr Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
title_full_unstemmed Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
title_sort shall we stay, or shall we switch? continued anti-vegf therapy versus early switch to dexamethasone implant in refractory diabetic macular edema
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85046451948&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/58215
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