Diabetic macular oedema treatment with intravitreal dexamethasone: case report

Overview

Diabetic macular edema (DME) is a multifactorial disease the pathogenesis of which is affected by a number of angiogenic, vascular and inflammatory processes with the subsequent development of characteristic changes in the macula. Vascular endothelial growth factor (VEGF) blockers – bevacizumab, ranibizumab and aflibercept – are effective in the treatment of DME and they are first-line drugs. However, the mechanism of action of VEGF blockers is focused on only one component of the complex pathology of DEM, and therefore approximately 50% of patients with DEM do not respond adequately to VEGF blockers. For these patients, intravitreal steroids that have different pathomechanisms may be an effective treatment alternative. Administration of steroids may reduce VEGF expression, suppress leukostasis, vascular leakage and reduce pro-inflammatory cytokine production. The evidence of this is the case report of a patient who stopped responding to treatment after several years of treatment with antiVEGF drugs (decrease in central visual acuity after the best correction and increase in swelling shown in OCT), but his anatomical and functional parameters improved after switching to intravitreally administered depot dexamethasone corticosteroid.

Keywords:

aflibercept – bevacizumab– (depot) corticosteroids – dexamethasone – diabetic macular edema – ranibizumab – VEGF-blockers