Steroids may be preferable to anti-VEGF for DME in certain cases
Two-year study results highlight some advantages of steroid treatment for DME.
Take-home message: Two-year study results highlight some advantages of steroid treatment for DME.
Reviewed by Mark Gillies, MBBS, PhD
Sydney-Steroids may offer an alternative to anti-vascular endothelial growth factor (VEGF) therapy in pseudophakic eyes with diabetic macular edema (DME), said Mark Gillies, MBBS, PhD.
A study comparing the two treatments show similar gains in visual acuity, but with fewer treatments required for the steroid over the course of 2 years, said Dr. Gillies, professor of ophthalmology, Save Sight Institute, University of Sydney.
On the other hand, steroid-treated eyes had more cataracts.
“We routinely here treat pseudophakic eyes with steroids,” he said. “For phakic eyes we use anti-VEGFs as first-line treatment."
Dr. Gillies and his colleagues published the 2-year results of the
"The Save Sight Institute has pioneered the study of steroids in DME," he said.
When faculty there realized that drug companies were not planning head-to-head trials comparing steroids with anti-VEGF treatment, it took the initiative in 2010.
With funding from the Australian government, with support from Allergan, the center recruited 88 study eyes with center-affecting DME. Researchers randomly assigned 42 to bevacizumab as needed up to once eveyr 4 weeks, and 46 to slow-release dexamethasone implants (Ozurdex, Allergan) as needed up to once every 16 weeks.
The two groups were well matched, with mean visual acuity at baseline 56.3 logMAR letters in the bevacizumab group and 55.5 in the dexamethasone group. Central macular thickness was 503 µm in the bevacizumab group and 474 µm in the dexamethasone group. Both groups were about one-third female and had a mean age of 62 years.
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