Background: To assess the safety of same-day bilateral intravitreal dexamethasone (DEX) implant administration in patients with bilateral diabetic macular edema (DME) and uveitic macular edema (UME).
Methods: This retrospective, single-center, consecutive case series included 190 eyes from 95 patients who received same-day, bilateral intravitreal DEX implants. A comprehensive ophthalmologic evaluation, including a slit-lamp examination, intraocular pressure (IOP) assessment using Goldmann applanation tonometry, fundus examination, and optical coherence tomography (OCT), was performed at baseline and during the follow-up. Central macular thickness (CMT) was recorded, and ocular adverse events (AEs) were reviewed. Elevated IOP was defined as an IOP value ≥ 25 mmHg at any visit.
Results: A total of 293 bilateral same-day DEX implant administrations (586 eyes) were performed, with a mean of 3.04 ± 3.02 implants per patient (median: 2; range: 1–17). Mean follow-up duration was 55.72 ± 38.86 months (median: 48; range: 1-156). Eighty patients (84.2%) had DME and 15 (15.8%) had UME. Prior ocular surgeries including phacoemulsification, pars plana vitrectomy and seton implant surgery were present in 85 eyes (44.7%). At baseline, 79 eyes (41.5%) were pseudophakic. Significant CMT improvement was observed in the right eye (from 529.73 ± 170.81 μm to 335.15 ± 136.04 μm) and the left eye (from 528.06 ± 149.79 μm to 357.89 ± 142.38 μm) at the last visit (p < 0.001 for both). Elevated IOP occurred in 7 eyes (3.6%) and was managed with topical therapy without the need for surgical intervention. Cataract progression necessitating surgery occurred in 41 eyes (21.6%). Vitreous hemorrhage was observed in 1 (0.5%) eye and retinal detachment developed in 3 (1.6%) eyes, while no cases of endophthalmitis were observed.
Conclusions: Same-day intravitreal DEX implantation appears to be a safe and effective therapeutic option for both DME and UME, with a low incidence of ocular AEs. This approach has the potential to reduce the treatment burden and may enhance patient compliance.
Trial registration: Retrospectively registered. The study followed the tenets of the Declaration of Helsinki, and it was approved by the local ethical committee (Non-Interventional Clinical Research Ethics Committee of Dokuz Eylül University, registration number: 2024/06 − 01).
Keywords: Cataract; DEX implant; Diabetic macular edema; Endophthalmitis; Retinal detachment; Uveitic macular edema.