Does Dexamethasone implant Combination with Aflibercept monotherapy have an effect on 1-year outcomes in treatment-naive Diabetic Macular Edema with Inflammatory Biomarkers?

Abstract

Abstract Purpose To compare the anatomical and functional outcomes of the combination of aflibercept and dexamethasone implant (CT) against aflibercept monotherapy (AM) in treatment-naive diabetic macular edema (DME) patients with serous macular detachment and hyperreflective foci. Methods This study included 82 eyes of 82 patients with treatment-naive DME who completed the follow-up period of 12 months. All patients had optical coherence tomography (OCT) biomarkers of an inflammatory DME phenotype. Patients were consecutively selected and classified into two groups. The CT group consisted of 39 eyes treated with aflibercept therapy and initially combined with a single-dose dexamethasone implant. The AM group consisted of 43 eyes treated with aflibercept alone. The primary outcome measures of the study were the mean reduction of the central macular thickness (CMT) and total macular volume parameters (TMV) and improvement in best-corrected visual acuity (BCVA). Results In both groups, the patient characteristics including age, gender, duration of diabetes, HbA1c levels, phakic percentage, and diabetic retinopathy status were similar (P > 0.05). The mean reduction in CMT and TMV was significantly higher in the CT group compared to the AM group (P < 0.001 and P = 0.002, respectively), while mean letter gains were not significantly higher (P = 0.240) at the end of the study. In the CT group, 8 eyes (20.5%) showed a transient IOP increase, and 18% of patients developed cataract. In subgroup analysis, the mean letter gain in pseudophakic eyes was significantly higher (12.5 in the CT vs. 9.3 in the AM group, P = 0.027). Conclusion The CT, where inflammation is prominent, can provide faster recovery. The pseudophakic eyes seem to be the ideal patient group for CT.