Intravitreal Dexamethasone Implant in Patients Who Did Not Complete Anti-VEGF Loading Dose During the COVID-19 Pandemic: a Retrospective Observational Study

Vincenzo Scorcia; Giuseppe Giannaccare; Valentina Gatti; Sabrina Vaccaro; Gabriele Piccoli; Annarita Villì; Mario Damiano Toro; Angeli Christy Yu; Claudio Iovino; Francesca Simonelli; Adriano Carnevali

doi:10.1007/s40123-021-00395-6

Intravitreal Dexamethasone Implant in Patients Who Did Not Complete Anti-VEGF Loading Dose During the COVID-19 Pandemic: a Retrospective Observational Study

Ophthalmol Ther. 2021 Dec;10(4):1015-1024. doi: 10.1007/s40123-021-00395-6. Epub 2021 Sep 5.

Affiliations

¹ Department of Ophthalmology, University of Magna Graecia of Cantazaro, Viale Europa, Loc. Germaneto, 88100, Catanzaro, Calabria, Italy.
² Department of Ophthalmology, University Hospital of Zurich, University of Zurich, 9081, Zurich, Switzerland.
³ Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
⁴ Multidisciplinary Department of Medical, Surgical and Dental Sciences, Eye Clinic, University of Campania Luigi Vanvitelli School of Medicine and Surgery, Naples, Italy.
⁵ Department of Ophthalmology, University of Magna Graecia of Cantazaro, Viale Europa, Loc. Germaneto, 88100, Catanzaro, Calabria, Italy. adrianocarnevali@live.it.

Abstract

Introduction: To compare the functional and anatomic outcomes between eyes in patients with diabetic macular edema (DME) who underwent a complete anti-vascular endothelial growth factor (VEGF) loading dose with aflibercept and those who were switched to dexamethasone intravitreal (DEX) implant after an incomplete anti-VEGF treatment regimen during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This was a retrospective and comparative study conducted on patients with DME. Main outcome measures were mean change in best corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 4.

Results: Forty-three eyes (23 eyes in the anti-VEGF group and 20 eyes in the DEX group) were included. Mean BCVA significantly improved from 37.7 ± 25.3 and 35.7 ± 22.0 letters at baseline to 45.4 (23.9) (mean adjusted BCVA improvement 7.6 ± 20.8 letters, p = 0.033) and 46.1 ± 26.0 (mean adjusted BCVA improvement 10.6 ± 15.9 letters, p = 0.049) at month 4 in the anti-VEGF and DEX groups, respectively, with no significant differences between study groups (mean adjusted BCVA difference 2.8 letters, 95% CI - 9.4 to 14.9 letters, p = 0.648). There were no statistically significant differences in the proportion of eyes that achieved a BCVA improvement of ≥ 5, ≥ 10, and ≥ 15 letters between groups. CRT was significantly reduced from baseline to month 4 in both DEX (mean adjusted CRT reduction 167.3 ± 148.2 µm, p = 0.012) and anti-VEGF groups (mean adjusted CRT reduction 109.9 ± 181.9 µm, p < 0.001), with no differences between them (mean adjusted CRT difference 56.1 µm, 95% CI - 46.0 to 158.2 µm, p = 0.273). Of 20 eyes in the DEX group, 16 (80.0%) and 9 (45.0%) eyes achieved a CRT reduction of ≥ 20% from baseline at 2 months and at 4 months, respectively.

Conclusions: Our results seem to suggest that DEX implant can significantly improve both functional and anatomic clinical outcomes in patients who were unable to complete anti-VEGF loading dose during the COVID-19 pandemic.

Keywords: COVID-19; Dexamethasone Intravitreal Implant; Diabetes; Diabetic Macular Edema; Diabetic Retinopathy; Vascular Endothelial Growth Factor Inhibitors.