Título / Title

CASE REPORT: MANAGEMENT OF CHRONIC DIABETIC MACULAR EDEMA

Introdução / Purpose

We report a case of a 68-year-old diabetic patient presented to the retinal outpatient clinic complaining of visual loss. She had undergone anti-VEGF IVI in both eyes previously. At admission her best-corrected visual acuity (BCVA) was 20/60 for both eyes.

Material e Método / Methods

This is a retrospective case review study.

Resultados / Results

The OCT revealed macular edema for both eyes; foveal thickness OD 633µm and OS 234µm. In OD the edema was thicker and had signs of an important inflammatory component, such as macrocyst. Due to this characteristic it was opted for a biodegradable dexamethasone implant (Ozurdex®) in OD and new cycle of ranibizumab in OS. After treatment, the patient presented BCVA OD 20/60+1 and OS 20/200. A new cycle of ranibizumab was performed in OS, and, once again, got worse (BCVA <20/400). After a new cycle of ranibizumab in OS, BCVA improved to 20/60. Another cycle of ranibizumab in OS was indicated, then, BCVA OD 20/20 and OS 20/100. Although anti-VEGF IVI is the gold standard treatment to diabetic macular edema (DME), it is believed that the non-response may be related to specific characteristics of the macular edema's pathophysiology that may vary from patient to patient.

Discussão e Conclusões / Conclusion

With a greater understanding of the inflammatory component of DME, steroid implants have gained a prominent role in anatomical improvement of DME, as well as exposing patients to a smaller number of procedures when compared to repeated anti-VEGF IVI. Corticosteroids can decrease inflammation and control the effects of breaking the blood-retinal barrier, in addition to their anti-angiogenic properties possibly related to the downregulation phenomenon of VEGF. Some studies have considered evaluating the benefit of an early switch of ranibizumab injections to biodegradable dexamethasone implant. Although both early and late switches have similar results in terms of functional and anatomical improvement, early switch ensures the patient's well-being earlier when compared to those who undergo a late change.

Palavras Chave

diabetic macular edema, anti-VEGF, dexamethasone implant, ranibizumab

Area

CLINICAL RETINA