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EFFICACY OF COMBINED DEXAMETHASONE IMPLANT AND NAVIGATED SUBTHRESHOLD MICROPULSE YELLOW LASER IN DIABETIC MACULAR
Giovanni William Oliverio1, Alessandro Meduri, Irene Ingrande
1Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
Purpose:
To compare functional and anatomical outcomes of combining intravitreal dexamethasone implant (DEX-I) (Ozurdex) with navigated subthreshold yellow (577 nm) micropulse laser (subthreshold micropulse laser treatment [SMLT]) versus dexamethasone monotherapy in diabetic macular edema.
Methods:
In this prospective randomized study, 80 eyes with center-involving diabetic macular edema were allocated to two groups: 40 eyes received DEX-I followed 4 weeks later by navigated SMLT (DEX-I + SMLT), and 40 eyes received DEX-I alone (DEX-I). Best-corrected visual acuity (Early Treatment Diabetic Retinopathy Study - ETDRS letters), central subfield thickness, and ETDRS subfield thicknesses were measured at baseline and at 2, 4, 6, 9, and 12 months. Reinjection-free survival was analyzed over 12 months.
Results:
At 6 months, mean best-corrected visual acuity improvement was greater in the DEX-I + SMLT group than in the DEX-I monotherapy group (6.2 ± 5.1 vs. 4.1 ± 6.4 letters; P = 0.03), and this difference persisted at 12 months (5.8 ± 6.5 vs. 3.6 ± 6.8 letters; P = 0.05). Mean central subfield thickness was lower in the DEX-I + SMLT group at 6 months (295 ± 46 vs. 321 ± 58 µ m; P = 0.02) and remained lower at 12 months (315 ± 60 vs. 342 ± 70 µ m; P = 0.05). Median retreatment-free survival was longer in the combination group (11.2 vs. 8.3 months).
Conclusion:
Within the 12-month follow-up period, sequential navigated SMLT performed 4 weeks after dexamethasone implantation was associated with improvements in visual and anatomical outcomes and with a longer retreatment-free interval compared with dexamethasone monotherapy, without additional safety concerns.
