• Written By: Rahul Khurana, MD

    This prospective study is the first to provide direct evidence that the dexamethasone implant can achieve similar rates of vision improvement compared with bevacizumab for diabetic macular edema (DME) with superior anatomic outcomes and fewer injections.

    However, more patients receiving steroids lost vision, mainly due to cataract. As a result, the authors recommend the dexamethasone implant as a second-line treatment for DME in phakic eyes and as first-line treatment for pseudophakic eyes or for patients who are averse to frequent intraocular injections or have difficulty attending regularly.

    The authors randomized 61 patients with center-involving DME to injections with bevacizumab every 4 weeks or dexamethasone implant every 16 weeks, both prn.

    About 40% of both groups achieved the prospectively identified primary outcome of a 10-letter gain at 12 months.

    But the reduced treatment burden associated with the dexamethasone implant offers a distinct advantage over bevacizumab, 2.7 vs. 8.6 treatments over the course of 1 year.

    Anatomic outcomes were also significantly better in the dexamethasone implant-treated group, with mean central macular thickness decreasing by 187 μm in the dexamethasone group, compared with 122 μm in the bevacizumab group.

    When do you use steroids for the treatment of diabetic macular edema?