Dexamethasone intravitreal implant for diabetic macular edema during pregnancy

PURPOSE: To describe the management of diabetic macular edema during pregnancy with the use of a dexamethasone slow-release intravitreal implant.

DESIGN: Retrospective, observational, consecutive case series.

METHODS: The study included 5 pregnant women who presented with diabetic macular edema during pregnancy in the period from 2011 to 2014. Review of charts and photographs comprised best-corrected visual acuity (BCVA), foveal center field thickness assessed by optical coherence tomography, blood pressure, glycated hemoglobin, medications and changes in such parameters after implant injection.

RESULTS: Diabetic macular edema involving the foveal center was observed between gestational weeks 9 and 23 in 10 eyes in 5 patients. Dexamethasone intravitreal implant injection was given 10 times in 9 eyes with a mean pre-injection center field retinal thickness of 535 μm (range 239-727 μm) and a mean pre-injection best-corrected visual acuity (BCVA) of 63 approxETDRS (approximated Early Treatment Diabetic Retinopathy Study) letters (range 50-77 letters). One eye was unavailable for follow-up. In 7 of 8 eyes injection was followed, within 3 weeks, by a greater than 145 μm reduction in foveal center field thickness and in 6 of 8 eyes by an increase in BCVA of 5 or more approxETDRS letters. A mild transient rise in intraocular pressure occurred in 3 out of 8 eyes.

CONCLUSION: Diabetic macular edema involving the foveal center that presented during pregnancy responded promptly to intravitreal dexamethasone therapy by foveal thickness reduction and visual acuity improvement without clinically significant intraocular pressure increases.