Is there another option for treating diabetic macular edema, when medical treatments have failed?

This study looked at the treatment of diabetic macular edema (DME) which has not responded to medical treatment with vitrectomy and dexamethasone (Ozurdex) implant. This study showed that this treatment improved the vision of patients with DME.

DME is a condition affecting diabetic patients where fluid builds up at the back of the eye. It can cause serious visual impairment. DME is usually treated with a course of injections into the eye and sometimes laser treatment. Sometimes this treatment does not work and that is known as refractory DME. 

Refractory DME can be treated by doing a surgery called a vitrectomy. This involves removing the vitreous jelly from the eye. During a vitrectomy, a dexamethasone implant can be inserted into the eye. This implant releases small amounts of dexamethasone into the eye over a period of 3 months. Dexamethasone is a corticosteroid drug that helps to remove the fluid behind the eye and stop it from building up again. However, it is not clear how effective this treatment is in the long-term.

43 eyes from 39 patients were included in this study. All eyes had refractory DME which had not responded to medical treatment over a 6 month period. They were treated with a vitrectomy and a dexamethasone implant. Patients were followed up for 3 years to monitor the effects of treatment. 

After 3 years, treated eyes were able to read an average of 11 more letters on the vision chart. The average vision of eyes after 3 years was 0.294 logMAR, which is just above driving vision. The average number of medical treatments after surgery were reduced from 5.04 to 0.34 per year. 67% of eyes did not need any additional treatments in the 3 years after the procedure.

40% of patients experienced an increase in eye pressure after surgery. However, this side effect improved after using eye drops low lowering eye pressure.

This study showed that refractory DME can be treated effectively with vitrectomy and dexamethasone implant. 

This study was based on medical records, more studies are needed to confirm these findings. Also, the number of patients was small.