Intravitreal implant with laser yields better visual results than laser alone in diffuse DME

FORT LAUDERDALE, Fla. — A dexamethasone intravitreal implant with laser photocoagulation led to better visual results than laser monotherapy in diffuse diabetic macular edema, according to a speaker here.

"There was a greater improvement in best corrected visual acuity in patients treated with combination therapy vs. laser alone. Over 12 months, the retinal thickness and leakage area decreased more," David Callanan, MD, said at the Association for Research in Vision and Ophthalmology meeting.

The double-masked study randomized 126 diffuse DME patients to receive Ozurdex (dexamethasone intravitreal implant, Allergan) followed by laser at 1 month; 127 patients received laser monotherapy. All patients had central retinal thickness of at least 275 µm and best corrected visual acuity between 34 and 70 letters.

After 12 months, 28% of patients in the combination therapy group and 24% of patients in the laser group had at least a 10-letter improvement in BCVA, Dr. Callanan said.

Patients in the combination therapy group had significantly higher increases in BCVA at 1, 4, 6, 7 and 9 months. They also showed significantly greater mean reductions in diffuse leakage area at 4, 6 , 9 and 12 months.

Increased IOP was the only adverse event, and it occurred more frequently in the combination therapy group (20%) than in the monotherapy group (2%; P < .001). However, most patients did not require medication, and no patient required surgery to lower IOP.

Researchers also found that cataracts may have worsened in the combination group, Dr. Callanan said.

Further study is needed with earlier re-treatment to determine the best course of combination therapy for DME patients.

Disclosure: Dr. Callanan receives financial support from Allergan, and he is a consultant to Bausch + Lomb.