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World J Diabetes. Aug 15, 2021; 12(8): 1220-1232
Published online Aug 15, 2021. doi: 10.4239/wjd.v12.i8.1220
Place of intravitreal dexamethasone implant in the treatment armamentarium of diabetic macular edema
Omer Karti, Ali Osman Saatci
Omer Karti, Department of Ophthalmology, İzmir Democracy University, İzmir 35330, Turkey
Ali Osman Saatci, Department of Ophthalmology, Dokuz Eylul University, İzmir 35330, Turkey
Author contributions: Karti O and Saatci AO contributed to the conception of the paper, literature review, critical revision, and approval of the final version.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ali Osman Saatci, MD, Professor, Department of Ophthalmology, Dokuz Eylul University, İnciraltı Mahallesi Mithatpaşa cad. No. 1606 Balçova, İzmir 35330, Turkey. osman.saatci@yahoo.com
Received: December 27, 2020
Peer-review started: December 27, 2020
First decision: April 20, 2021
Revised: April 25, 2021
Accepted: July 7, 2021
Article in press: July 7, 2021
Published online: August 15, 2021
Processing time: 224 Days and 23.3 Hours
Abstract

Diabetic macular edema (DME) is a very important and well-known cause of visual loss in diabetics. Blood–retina barrier disruption and consequent intraretinal fluid accumulation may lead to retinal thickening at the posterior pole namely DME. Even though it is not clearly understood, current evidence suggests that chronic low-grade inflammation characterized with various cytokines has a major role in the occurrence of DME. Clinical trials are continuously shaping our treatment approaches for the eyes with DME. Today, vascular endothelial growth factor (VEGF) inhibitor and steroid administrations are the main alternatives in DME treatment. Dexamethasone (DEX) implant (Ozurdex®; Allergan, Inc., Irvine, CA, United States) was approved by the United States Food & Drug Administration in 2014 for DME treatment. The implant is made up of a biodegradable solid copolymer that is broken down by releasing its active ingredient into the vitreous cavity over time. Biphasic release feature of this sustained-release drug delivery system ensures its efficacy for up to 6 mo with an acceptable and manageable safety profile. DEX implant provides a favorable anatomical and functional outcome in DME as shown in several randomized-controlled studies but has a relatively higher ocular side-effect profile such as increased risk of cataract formation and raised intraocular pressure when compared to the gold standard anti-VEGF agents. Thus, DEX implant becomes the second-line treatment option demonstrating inadequate clinical response to anti-VEGF therapy. However, it can be preferred as the first-line treatment in vitrectomized and pseudophakic eyes. Even in some selected conditions DEX implant is favored over anti-VEGF agents where the use of VEGF-inhibitors is either inappropriate or contraindicated such as the patients with a recent history of a major cardiovascular or cerebrovascular event, pregnancy and noncompliant to frequent visits. This mini-review briefly overviews the efficacy, safety profile and complications of DEX implant and summarizes the outcome of DEX implant administration in major clinical studies on DME treatment.

Keywords: Dexamethasone implant; Diabetic macular edema; Diabetic retinopathy; Drug-delivery system; Glaucoma; Pharmacotherapy

Core Tip: Administration of dexamethasone (DEX) implant is among the main therapeutic alternatives for treating the diabetic macular edema (DME). Though DEX implant provides a long-standing anatomic and visual improvement, implant induced cataract progression and intraocular pressure elevation limit its clinical use as the first-line treatment but DEX implant can sometimes be the preferred option in previously vitrectomized eyes, pseudophakic eyes, and in some specific conditions where the use of vascular endothelial growth factor inhibitors is either contraindicated or suboptimal. In this mini-review, we overviewed the randomized-controlled trials, real-life clinical experiences, and meta-analyses on DEX implant treatment in DME.