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Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema
  1. Maria Vittoria Cicinelli,
  2. Michele Cavalleri,
  3. Lea Querques,
  4. Alessandro Rabiolo,
  5. Francesco Bandello,
  6. Giuseppe Querques
  1. Department of Ophthalmology, University Vita-Salute, San Raffaele Hospital, Milan, Italy
  1. Correspondence to Professor Giuseppe Querques, Department of Ophthalmology, Ospedale San Raffaele, Milano, 20132, Italy; giuseppe.querques{at}


Purpose To analyse the effects of intravitreal dexamethasone implant in patients suffering from diabetic macular oedema (DME) on the basis of their visual and functional response to antivascular endothelial growth factor (VEGF) loading dose, in order to early shift to corticosteroids in poorly responding patients.

Design Retrospective monocentric study.

Methods Data of patients with diabetes shifted to 0.7 mg dexamethasone implant after three injections of ranibizumab (RNB) and followed-up to 12 months were reviewed. Main outcome was the evaluation of short-term changes after dexamethasone implant injection, stratifying patients on the basis of best-corrected visual acuity (BCVA) and central macular thickness (CMT) after RNB loading dose. Secondary outcome was to investigate clinical gain maintenance at long-term follow-up.

Results Overall, 45 eyes of 45 patients (23 males, 51.1%), mean age 69.7±9 years, were included in the analysis. After 3 injections of RNB, 30 eyes (66.7%) had a poor visual response (−4.3±10.7 letters), while 15 eyes (33.3%) disclosed good visual outcome (+13.9±9.2 letters). Patients with poor visual response were associated with limited morphological improvement (p=0.04). After 1 month from dexamethasone, only poor responders showed relevant increase in BCVA (p=0.006) and reduction in CMT (p=0.002), in comparison to good visual response patients, featuring only minor clinical effects (p=0.3). The same trend was maintained up to 12 months, after a mean of 1.9±1.1 dexamethasone administrations.

Conclusion Visual and anatomical responses after RNB loading dose are significant predictors of both early term and long-term visual acuity improvement after switching to corticosteroids in patients with DME unresponsive to anti-VEGF.

  • diabetic macular edema
  • anti-VEGF
  • dexamethasone
  • ranibizumab

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  • Contributors All the authors contributed to the conception or design of the work, the acquisition, analysis and interpretation of data, drafting the work, revising it critically for important intellectual content and gave final approval of the version to be published.

  • Competing interests MVC, MC, LQ, AR: none; GQ consultant for Alimera Sciences (Alpharetta, Georgia, USA), Allergan (Irvine, California, USA), Heidelberg (Germany), Novartis (Basel, Switzerland), Bayer Shering-Pharma (Berlin, Germany), Zeiss (Dublin, USA). Francesco Bandello consultant for Alcon (Fort Worth, Texas, USA), Alimera Sciences, Allergan, Farmila-Thea (Clermont-Ferrand, France), Bausch & Lomb (Rochester, New York, USA), Genentech (San Francisco, California, USA), Hoffmann-La-Roche (Basel, Switzerland), Novagali Pharma (Évry, France), Novartis Bayer Shering-Pharma, Sanofi-Aventis (Paris, France), Thrombogenics (Heverlee, Belgium), Zeiss, Pfizer (New York, USA), Santen (Osaka, Japan), Sifi (Aci Sant’Antonio, Italy).

  • Ethics approval San Raffaele Hospital Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.