Combined Phacoemulsification and Intravitreal Dexamethasone Implant (Ozurdex®) in Diabetic Patients with Coexisting Cataract and Diabetic Macular Edema

Claudio Furino, Francesco Boscia, Alfredo Niro, Ermete Giancipoli, Maria Oliva Grassi, Giuseppe D'amico Ricci, Francesco Blasetti, Michele Reibaldi, Giovanni Alessio, Claudio Furino, Francesco Boscia, Alfredo Niro, Ermete Giancipoli, Maria Oliva Grassi, Giuseppe D'amico Ricci, Francesco Blasetti, Michele Reibaldi, Giovanni Alessio

Abstract

Purpose: To investigate the effectiveness and safety of combined phacoemulsification and dexamethasone intravitreal implant in patients with cataract and diabetic macular edema.

Methods: In this two-center, retrospective, single-group study, the charts of 16 consecutive patients who underwent combined phacoemulsification and intravitreal dexamethasone implant were retrospectively reviewed. These 16 patients, 7 men and 9 women, were observed at least 3 months of follow-up. Primary outcome was the change of the central retinal thickness (CRT); secondary outcome was the change of best-corrected visual acuity (BCVA). Any ocular complications were recorded.

Results: Mean CRT decreased significantly from 486 ± 152.4 μm at baseline to 365.5 ± 91 μm at 30 days (p = .005), to 326 ± 80 μm at 60 days (p = .0004), and to 362 ± 134 μm at 90 days (p = .001). Mean BCVA was 20/105 (logMAR, 0.72 ± 0.34) at baseline and improved significantly (p ≤ .007) at all postsurgery time points. One case of ocular hypertension was observed and successfully managed with topical therapy. No endophthalmitis or other ocular complications were observed.

Conclusion: Intravitreal slow-release dexamethasone implant combined with cataract surgery may be an effective approach on morphologic and functional outcomes for patients with cataract and diabetic macular edema for at least three months after surgery.

Figures

Figure 1
Figure 1
Boxplot of central retinal thickness (CRT) (μm) over 90 days. Mean CRT significantly decreased (p ≤ .005), mainly at 60 days after combined approach.
Figure 2
Figure 2
Boxplot of best-corrected visual acuity (BCVA) (logMAR) over 90 days. Mean BCVA increased significantly at all follow-up (p ≤ .007), mainly at 60 days after surgery.

References

    1. Obrosova I. G., Chung S. S., Kador P. F. Diabetic cataracts: mechanisms and management. Diabetes/Metabolism Research and Reviews. 2010;26(3):172–180. doi: 10.1002/dmrr.1075.
    1. Haddad N. M., Sun J. K., Abujaber S., Schlossman D. K., Silva P. S. Cataract surgery and in diabetic its complications patients. Seminars in Ophthalmology. 2014;29(5-6):329–337. doi: 10.3109/08820538.2014.959197.
    1. Kim S. J., Equi R., Bressler N. M. Analysis of macular edema after cataract surgery in patients with diabetes using optical coherence tomography. Ophthalmology. 2007;114(5):881–889. doi: 10.1016/j.ophtha.2006.08.053.
    1. Suto C., Hori S., Kato S. Management of type 2 diabetics requiring panretinal photocoagulation and cataract surgery. Journal of Cataract and Refractive Surgery. 2008;34(6):1001–1006. doi: 10.1016/j.jcrs.2008.02.019.
    1. Yau J. W., Rogers S. L., Kawasaki R., et al. Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care. 2012;35(3):556–564. doi: 10.2337/dc11-1909.
    1. Rauen P. I., Ribeiro J. A. S., Almeida F. P. P., Scott I. U., Messias A., Jorge R. Intravitreal injection of ranibizumab during cataract surgery in patients with diabetic macular edema. Retina. 2012;32(9):1799–1803. doi: 10.1097/IAE.0b013e31824bebb8.
    1. Lanzagorta-Aresti A., Palacios-Pozo E., Menezo Rozalen J. L., Navea-Tejerina A. Prevention of vision loss after cataract surgery in diabetic macular edema with intravitreal bevacizumab: a pilot study. Retina. 2009;29(4):530–535. doi: 10.1097/IAE.0b013e31819c6302.
    1. Takamura Y., Kubo E., Akagi Y. Analysis of the effect of intravitreal bevacizumab injection on diabetic macular edema after cataract surgery. Ophthalmology. 2009;116(6):1151–1157. doi: 10.1016/j.ophtha.2009.01.014.
    1. Akinci A., Batman C., Ozkilic E., Altinsoy A. Phacoemulsification with intravitreal bevacizumab injection in diabetic patients with macular edema and cataract. Retina. 2009;29(10):1432–1435. doi: 10.1097/IAE.0b013e3181b77422.
    1. Chen C. H., Liu Y. C., Wu P. C. The combination of intravitreal bevacizumab and phacoemulsification surgery in patients with cataract and coexisting diabetic macular edema. Journal of Ocular Pharmacology and Therapeutics. 2009;25(1):83–89. doi: 10.1089/jop.2008.0068.
    1. Habib M. S., Cannon P. S., Steel D. H. The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabetic foveal oedema and cataract. BMC Ophthalmology. 2005;5:p. 15. doi: 10.1186/1471-2415-5-15.
    1. Akinci A., Muftuoglu O., Altınsoy A., Ozkılıc E. Phacoemulsification with intravitreal bevacizumab and triamcinolone acetonide injection in diabetic patients with clinically significant macular edema and cataract. Retina. 2011;31(4):755–758. doi: 10.1097/IAE.0b013e3182006da1.
    1. Lim L. L., Morrison J. L., Constantinou M., et al. Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery - preliminary 6 month results. Clinical and Experimental Ophthalmology. 2016;44(4):233–242. doi: 10.1111/ceo.12720.
    1. Agarwal A., Gupta V., Ram J., Gupta A. Dexamethasone intravitreal implant during phacoemulsification. Ophthalmology. 2013;120(1):p. 211. doi: 10.1016/j.ophtha.2012.08.002. 211.e1-5.
    1. Panozzo G. A., Gusson E., Panozzo G., Dalla M. G. Dexamethasone intravitreal implant at the time of cataract surgery in eyes with diabetic macular edema. European Journal of Ophthalmology. 2017;27(4):433–437. doi: 10.5301/ejo.5000920.
    1. Sze A. M., Luk F. O., Yip T. P., Lee G. K., Chan C. K. Use of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification. European Journal of Ophthalmology. 2015;25(2):168–172. doi: 10.5301/ejo.5000523.
    1. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Archives of Ophthalmology. 1985;103(12):1796–1806. doi: 10.1001/archopht.1985.01050120030015.
    1. Koleva-Georgieva D. Optical coherence tomography findings in diabetic macular edema. In: Ola M. S., editor. Diabetic Retinopathy. Vienna, Austria: InTech; 2012.
    1. Shah A. S., Chen S. H. Cataract surgery and diabetes. Current Opinion in Ophthalmology. 2010;21(1):4–9. doi: 10.1097/ICU.0b013e328333e9c1.
    1. Squirrell D., Bhola R., Bush J., Winder S., Talbot J. F. A prospective, case controlled study of the natural history of diabetic retinopathy and maculopathy after uncomplicated phacoemulsification cataract surgery in patients with type 2 diabetes. The British Journal of Ophthalmology. 2002;86(5):565–571. doi: 10.1136/bjo.86.5.565.
    1. Somaiya M. D., Burns J. D., Mintz R., Warren R. E., Uchida T., Godley B. F. Factors affecting visual outcomes after small-incision phacoemulsification in diabetic patients. Journal of Cataract and Refractive Surgery. 2002;28(8):1364–1371. doi: 10.1016/S0886-3350(02)01319-6.
    1. Gillies M. C., Lim L. L., Campain A., et al. A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology. 2014;121(12):2473–2481. doi: 10.1016/j.ophtha.2014.07.002.
    1. Furino C., Boscia F., Recchimurzo N., Sborgia C., Alessio G. Intravitreal dexamethasone implant for macular edema following uncomplicated phacoemulsification. European Journal of Ophthalmology. 2014;24(3):387–391. doi: 10.5301/ejo.5000375.
    1. Furino C., Boscia F., Recchimurzo N., Sborgia C., Alessio G. Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker. Retina. 2014;34(8):1612–1616. doi: 10.1097/IAE.0000000000000105.
    1. Chang-Lin J. E., Attar M., Acheampong A. A., et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant. Investigative Ophthalmology & Visual Science. 2011;52(1):80–86. doi: 10.1167/iovs.10-5285.
    1. Feltgen N., Neubauer A., Jurklies B., et al. Multicenter study of the European Assessment Group for Lysin in Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. EAGLE study report no.1. Graefe's Archive for Clinical and Experimental Ophthalmology. 2006;244(8):950–956. doi: 10.1007/s00417-005-0140-2.
    1. Blumenkranz M. S., Haller J. A., Kuppermann B. D., et al. Correlation of visual acuity and macular thickness measured by optical coherence tomography in patients with persistent macular edema. Retina. 2010;30(7):1090–1094. doi: 10.1097/IAE.0b013e3181dcfaf3.
    1. Diabetic Retinopathy Clinical Research Network, Browning D. J., Glassman A. R., et al. Relationship between optical coherence tomography-measured central retinal thickness and visual acuity in diabetic macular edema. Ophthalmology. 2007;114(3):525–536. doi: 10.1016/j.ophtha.2006.06.052.
    1. Bresnick G. H. Diabetic maculopathy: a critical review highlighting diffuse macular edema. Ophthalmology. 1983;90(11):1301–1317. doi: 10.1016/S0161-6420(83)34388-8.
    1. Nelson M. L., Martidis A. Managing cystoids macular edema after cataract surgery. Current Opinion in Ophthalmology. 2003;14:39–43. doi: 10.1097/00055735-200302000-00007.
    1. Massin P., Audren F., Haouchine B., et al. Intravitreal triamcinolone acetonide for diabetic diffuse macular edema. Ophthalmology. 2004;111(2):218–225. doi: 10.1016/j.ophtha.2003.05.037.

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