Central Macular Thickness Reduced With Combined Phacoemulsification With Dexamethasone Implants

Anti–vascular endothelial growth factor (VEGF) injections may not be the only way to treat diabetic macular edema (DME), as combined phacoemulsification with intravitreal dexamethasone implant (DEX-1) led to superior reductions to central macular thickness (CMT) and comparable improvement to visual acuity with fewer treatments, according to a new study.1 This can offer new avenues for patients to treat their DME in ways that require less maintenance.

Those with diabetes are susceptible to DME, making it the leading cause of visual impairment in this group. Retinal vascular leakage and accumulation of fluid in the macula are the primary characteristics of the condition, and symptoms can include blurry vision, difficulty seeing colors, seeing straight lines as bent or curved, and difficulty seeing when there is a glare.2 Cataracts can also be a complication of diabetes, and patients with both cataracts and DME can have complications in their visual health.1 Anti-VEGF injections can be used to treat these conditions, but intravitreal corticosteroids like dexamethasone have also proven to be promising. DEX-I can deliver this corticosteroid treatment in a controlled manner. This study aimed to compare anti-VEGF injections with DEX-I when it comes to efficacy in treating patients with DME.

DEX-I was more effective and required fewer treatments compared with anti-VEGF treatment in DME. | Image credit: Miroslav110 - stock.adobe.com

The study was conducted at 2 tertiary care centers between January 2020 and January 2023. Participants were included if they had a visually significant cataract diagnosis and center-involving DME. Participants were excluded if they had intravitreal anti-VEGF therapy within 3 months of surgery, a history of ocular hypertension or glaucoma, intravitreal corticosteroid therapy within 6 months, or associated retinal conditions such as neovascular glaucoma or uveitis.

Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and CMT were all measured prior to the patients’ operations to insert the DEX-I. Those in the DEX-I group also received prednisolone eye drops, topical antibiotics, and nonsteroidal anti-inflammatory drops after their surgery. The primary outcome was change in BCVA and CMT 1 month and 3 months after their operation. Changes in IOP were a secondary outcome of the study.

There were 54 eyes in the DEX-I group and 47 eyes in the anti-VEGF group included in the study. The mean (SD) ages were 66.83 (7.27) years in the DEX-I group and 66.81 (6.79) years in the anti-VEGF group. The DEX-I group was 51.9% male, and the anti-VEGF group was 59.6% male.

Mean BCVA improved from 0.93 (0.43) logMAR to 0.38 (0.32) at 3 months in the DEX-I group and from 1.02 (0.44) logMAR to 0.49 (0.33) logMAR after 3 months in the anti-VEGF group. There were no statistically significant differences.

Baseline CMT was comparable between all eyes. Intergroup differences between the 2 groups were nonsignificant after surgery, but intra-group reductions were significant. CMT was significantly reduced in the DEX-I group compared with the CMT group after 3 months (330.02 μm); percentage CMT reduction was higher in the DEX-I group vs the anti-VEGF group (25.03% vs 14.07%).

IOP elevation was more common in the DEX-I group compared with the anti-VEGF group (14.8% vs 4.25%). All eyes normalized by the 3-month follow-up. All eyes in the anti-VEGF group had 3 doses, and some eyes required a fourth dose. There was 1 intraoperative complication in the DEX-I group.

There were some limitations to this study. Selection bias could be possible due to the retrospective design of the study, and follow-up was only 3 months and does not capture long-term outcomes.

“Combining intravitreal therapy with cataract surgery is an effective strategy for managing patients with coexisting cataract and DME,” the authors concluded. “While both anti-VEGF and DEX-I therapies provide significant visual improvement, DEX-I offers superior CMT reduction with fewer injections, making it a valuable option for patients with inflammatory DME or poor compliance.”

References

1. Kelkar A, Kelkar J, Dutta S, Bolisetty M, Jain H, Labhsetwar N. Management of coexisting cataract and diabetic macular edema: a comparative study of dexamethasone implant versus anti-VEGF agents injections. Int J Ophthalmol. 2026;19(1):56-62. doi:10.18240/ijo.2026.01.07
2. Diabetes-related macular edema. Cleveland Clinic. Updated February 14, 2023. Accessed January 12, 2026. https://my.clevelandclinic.org/health/diseases/24733-diabetes-related-macular-edema