Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema



To evaluate the efficacy and duration of action of an intravitreal (dexamethasone (Ozurdex)) implant in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema (DMO).


We retrospectively analysed the records for 18 eyes that had or had not been vitrectomised but required an intravitreal dexamethasone implant for DMO after a poor response to anti-vascular endothelial growth factor. Optical coherence tomography and visual acuity (VA) examinations were performed before and 1, 3 and 6 months after implantation. The six months following implantation constituted one treatment round; up to three rounds were studied.


Ten of 18 eyes had undergone vitrectomy. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were significantly improved by months 1–3 after implantation of the Ozurdex device in all rounds of treatment. The BCVA and CMT deteriorated gradually after month 3 through to month 6 post implantation. There were no statistically significant differences between the vitrectomised and non-vitrectomised groups at any time point. When the implantation interval was <6 weeks from the end of each treatment round, the improvement in BCVA and CMT was obvious even after 18 months of treatment.


Vitrectomy did not have a negative effect on the duration of action or efficacy of the Ozurdex implant in patients with persistent DMO. The implant started working from the first month after implantation regardless of whether vitrectomy had or had not been performed. The maximum functional and anatomic improvement was achieved in the first 3 months post implantation in all treatment rounds.

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  1. 1.

    Das A, McGuire PG, Rangasamy S. Diabetic macular edema: pathophysiology and novel therapeutic targets. Ophthalmology. 2015;122:1375–94.

  2. 2.

    Tomkins-Netzer O, Ismetova F, Bar A, Seguin-Greenstein S, Kramer M, Lightman S. Functional outcome of macular edema in different retinal disorders. Prog Retin Eye Res. 2015;48:119–36.

  3. 3.

    Bringmann A, Reichenbach A, Wiedemann P. Pathomechanisms of cystoid macular edema. Ophthalmic Res. 2004;36:241–9.

  4. 4.

    Romano V, Angi M, Scotti F, del Grosso R, Romano D, Semeraro F, et al. Inflammation and macular oedema after pars plana vitrectomy. Mediat Inflamm. 2013;2013:971758.

  5. 5.

    Lorenzi M. The polyol pathway as a mechanism for diabetic retinopathy: attractive, elusive, and resilient. Exp Diabetes Res. 2007;2007:61038.

  6. 6.

    Owen LA, Hartnett ME. Soluble mediators of diabetic macular edema: the diagnostic role of aqueous VEGF and cytokine levels in diabetic macular edema. Curr Diab Rep. 2013;13:476–80.

  7. 7.

    Funatsu H, Yamashita H, Ikeda T, Nakanishi Y, Kitano S, Hori S. Angiotensin II and vascular endothelial growth factor in the vitreous fluid of patients with diabetic macular edema and other retinal disorders. Am J Ophthalmol. 2002;133:537–43.

  8. 8.

    Funatsu H, Yamashita H, Ikeda T, Mimura T, Eguchi S, Hori S. Vitreous levels of interleukin-6 and vascular endothelial growth factor are related to diabetic macular edema. Ophthalmology. 2003;110:1690–6.

  9. 9.

    Boland EW. Nonspecific anti-inflammatory agents. Some notes on their practical application, especially in rheumatic disorders. Calif Med. 1964;100:145–55.

  10. 10.

    Bruno A, Cavallo-Perin P, Cassader M, Pagano G. Deflazacort vs prednisone. Effect on blood glucose control in insulin-treated diabetics. Arch Intern Med. 1987;147:679–80.

  11. 11.

    Stanbury RM, Graham EM. Systemic corticosteroid therapy—side effects and their management. Br J Ophthalmol. 1998;82:704–8.

  12. 12.

    Chen SD, Lochhead J, Patel CK, Frith P. Intravitreal triamcinolone acetonide for ischaemic macular oedema caused by branch retinal vein occlusion. Br J Ophthalmol. 2004;88:154–5.

  13. 13.

    Cheng CK, Berger AS, Pearson PA, Ashton P, Jaffe GJ. Intravitreal sustained-release dexamethasone device in the treatment of experimental uveitis. Invest Ophthalmol Vis Sci. 1995;36:442–53.

  14. 14.

    Diabetic Retinopathy Clinical Research N, Elman MJ, Qin H, Aiello LP, Beck, RW, Bressler NM, Ferris FL, et al. Intravitreal ranibizumab for diabetic macular edema with prompt versus deferred laser treatment: three-year randomized trial results. Ophthalmology. 2012;119:2312–8.

  15. 15.

    Bressler SB, Glassman AR, Almukhtar T, Bressler NM, Ferris FL, Googe JM Jr, et al. Five-year outcomes of ranibizumab with prompt or deferred laser versus laser or triamcinolone plus deferred ranibizumab for diabetic macular edema. Am J Ophthalmol. 2016;164:57–68.

  16. 16.

    Diabetic Retinopathy Clinical Research N, Elman MJ, Aiello LP, Beck RW, Bressler NM, Bressler SB, Edwards AR, et al. Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema. Ophthalmology. 2010;117:1064–77.e35.

  17. 17.

    Beer PM, Bakri SJ, Singh RJ, Liu W, Peters GB 3rd, Miller M. Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology. 2003;110:681–6.

  18. 18.

    Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121:1904–14.

  19. 19.

    Campochiaro PA, Brown DM, Pearson A, Ciulla T, Boyer D, Holz FG, et al. Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology. 2011;118:626–35.e2.

  20. 20.

    Haller JA, Bandello F, Belfort R Jr, Blumenkranz MS, Gillies M, Heier J, et al. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117:1134–46.e3.

  21. 21.

    Thakur A, Kadam R, Kompella UB. Trabecular meshwork and lens partitioning of corticosteroids: implications for elevated intraocular pressure and cataracts. Arch Ophthalmol. 2011;129:914–20.

  22. 22.

    Lee SS, Ghosn C, Yu Z, Zacharias LC, Kao H, Lanni C, et al. Vitreous VEGF clearance is increased after vitrectomy. Invest Ophthalmol Vis Sci. 2010;51:2135–8.

  23. 23.

    Chin HS, Park TS, Moon YS, Oh JH. Difference in clearance of intravitreal triamcinolone acetonide between vitrectomized and nonvitrectomized eyes. Retina. 2005;25:556–60.

  24. 24.

    Schindler RH, Chandler D, Thresher R, Machemer R. The clearance of intravitreal triamcinolone acetonide. Am J Ophthalmol. 1982;93:415–7.

  25. 25.

    Doft BH, Weiskopf J, Nilsson-Ehle I, Wingard LB Jr Amphotericin clearance in vitrectomized versus nonvitrectomized eyes. Ophthalmology. 1985;92:1601–5.

  26. 26.

    Jarus G, Blumenkranz M, Hernandez E, Sossi N. Clearance of intravitreal fluorouracil. Normal and aphakic vitrectomized eyes. Ophthalmology. 1985;92:91–6.

  27. 27.

    Boyer DS, Faber D, Gupta, S, Patel SS, Tabandeh H, Li XY, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina. 2011;31:915–23.

  28. 28.

    Scaramuzzi M, Querques G, Spina CL, Lattanzio R, Bandello F,, et al. Repeated intravitreal dexamethasone implant (Ozurdex) for diabetic macular edema. Retina. 2015;35:1216–22.

  29. 29.

    Medeiros MD, Alkabes M, Navarro R, Garcia-Arumi J, Mateo C, Corcostegui B. Dexamethasone intravitreal implant in vitrectomized versus nonvitrectomized eyes for treatment of patients with persistent diabetic macular edema. J Ocul Pharmacol Ther. 2014;30:709–16.

  30. 30.

    Bressler SB, Melia M, Glassman AR, Almukhtar T, Jampol LM, Shami M, et al. Ranibizumab plus prompt or deferred laser for diabetic macular edema in eyes with vitrectomy before anti-vascular endothelial growth factor therapy. Retina. 2015;35:2516–28.

  31. 31.

    Ramu J, Yang Y, Menon G, Bailey C, Narendran N, Bunce C, et al. A randomized clinical trial comparing fixed vs pro-re-nata dosing of Ozurdex in refractory diabetic macular oedema (OZDRY study). Eye. 2015;29:1603–12.

  32. 32.

    Arikan Yorgun M, Toklu Y, Mutlu M. Comparison of early dexamethasone retreatment versus standard dexamethasone regimen combined with PRN ranibizumab in diabetic macular edema. Int Ophthalmol. 2017;1:185–96.

  33. 33.

    Reibaldi M, Russo A, Zagari M, Toro M, Grande De V, Cifalino V, et al. Resolution of persistent cystoid macular edema due to central retinal vein occlusion in a vitrectomized eye following intravitreal implant of dexamethasone 0.7 mg. Case Rep Ophthalmol. 2012;3:30–4.

  34. 34.

    Adan A, Pelegrin L, Rey A, Llorenc V, Mesquida M, Molins, B, et al. Dexamethasone intravitreal implant for treatment of uveitic persistent cystoid macular edema in vitrectomized patients. Retina. 2013;33:1435–40.

  35. 35.

    Chang-Lin JE, Burke JA, Peng Q, Lin T, Orilla WC, Ghosn CR, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes. Invest Ophthalmol Vis Sci. 2011;52:4605–9.

  36. 36.

    Christoforidis JB, Williams MM, Wang J, Jiang A, Pratt C, Abdel-Rasoul M, et al. Anatomic and pharmacokinetic properties of intravitreal bevacizumab and ranibizumab after vitrectomy and lensectomy. Retina. 2013;33:946–52.

  37. 37.

    Ahn SJ, Ahn J, Park S, Kim H, Hwang DJ, Park JH, et al. Intraocular pharmacokinetics of ranibizumab in vitrectomized versus nonvitrectomized eyes. Invest Ophthalmol Vis Sci. 2014;55:567–73.

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We would like to acknowledge the help and support provided by our department staff members, Zambia Mirthianou, Sofia Sidiropoulou and Chrisoula Vlaxou; we greatly appreciate all the assistance provided.

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Correspondence to George Pappas.

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Bastakis, G.G., Dimopoulos, D., Stavrakakis, A. et al. Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema. Eye 33, 411–418 (2019). https://doi.org/10.1038/s41433-018-0219-8

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