Page 109 - A Magyar Szemorvostársaság 2023. évi kongresszusa - Tudományos program és előadáskivonatok

Use of intravitreal dexamethasone implant in clinical practice
Barbara B. Tóth, László Szalay, Péter Balázs Kocsis, Attila Kovács
Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, Szemészeti Klinika,
Szeged

Introduction: The dexamethasone intravitreal implant can be used in three indications in
Hungary: diabetic macular edema (DMO), macular edema caused by retinal vein occlusion
(RVO) and uveitis. Indications other than these require OGYÉI permission. The implant does
not have OEP support, but NEAK support can be requested.

Aims: Our aim was to examine the effects of dexamethasone implants in different indications
at the clinical use, and to examine the general characteristics of the patients who received the
treatment.

Material and Methods: A retrospective analysis was performed based on the data of the
applications submitted for individual NEAK support at the University of Szeged, Department of
Ophthalmology between June 1. 2021 and January 31. 2023. General characteristics of the
patients, indication for use, response of the implant to the underlying disease based on the
best corrected visual acuity and central retinal thickness were evaluated. Duration of the
implant's effect and complications that developed during the treatment were observed.

Results: During the examined period, 121 eyes of 90 patients were treated with
dexamethasone implants. Most treatments were performed in the group of patients with DMO
indication, 223 implants were administered to 69 patients, 100 eyes during the follow-up
period. Other indication areas: CRVO: 2 patients/2 eyes, BRVO: 10 patients/10 eyes, AMD: 7
patients/7 eyes, and 1 patient each received this therapy in connection with macular edema
developed after uveitis and ERM surgery. Based on the treatments number, the DMO patient
group was suitable for statistical processing. Average age of DMO patients: 70 years (SD: 8.2),
74% had type 2 diabetes mellitus, 52% received insulin therapy. The average HbA1c of the
patients was 7.9% (SD: 1.6). The dexamethasone was the first drug used in 5 cases, the
second drug in 38 cases, and the third or the fourth in 57 cases. During the follow-up period of
19.8 months (SD: 11.8) 2.23 treatments/eye were performed. Treatment was effective based
on BCVA (p=0.076) changes and significant decrease of CRT (p=0.001) and CST (p=0.001).
Duration of the implant effect was 5.7 months (SD: 1.98). In 22 cases, elevated intraocular
pressure were measured, 17 eyes needed conservative therapy. Cataract surgeries were
performed in 13 cases because of the progression of lens opacity, pars plana vitrectomy was
performed in one case due to vitreous hemorrhage, and zonulolysis was detected in one case.

Conclusions: During the investigated period the dexamethasone implants were effective on
DMO patients based on the changes of visual acuity and central retinal thickness. The degree
of anatomical improvement was better than the functional improvement, can be explained by
the third-to-forth line use of dexamethasone implant therapy. The spectrum of the
complications was in accordance with literature data.