Letting the Good Times Roll in Retina

American Academy of Ophthalmology 2013

Carl D. Regillo, MD; Allen C. Ho, MD; Sunir J. Garg, MD


December 04, 2013

Editorial Collaboration

Medscape &

In This Article

Steroid Implant for Diabetic Macular Edema

Dr. Regillo: What about diabetic macular edema (DME)? Sunir, what do you think?

Dr. Garg: There is a lot of excitement in DME. New data[9] came out looking at Ozurdex®, which is a slow-release steroid implant for the treatment of DME, which is the leading cause of vision loss in patients with diabetes.

They found that for many patients, 4 injections are all that are required over 2 years to get meaningful visual improvement. That improvement was sustained for that period of time. For working-age adults who otherwise would have to come in monthly for treatment, I can see them once every quarter or so, give them an injection, keep them functioning and seeing well, and more important, avoid them having to take time off from work.

Dr. Regillo: We have had steroids for a while. How is the safety profile? How did it look in this phase 3 study?

Dr. Garg: It was very impressive. Unlike with some of the other steroids that we use, the pressure rise or the glaucoma issue here is not such a big concern anymore. The probability of people needing to have surgery after this was very low. Most of the time, if the pressure increased, it was easily treated with some drops.

Cataracts are a bit more of an issue. Many of the patients who receive this will develop a cataract and need to have surgery within 2 years. But for a lot of the patients who are older, who already have some cataract anyway, having cataract surgery a few months or a year sooner than you otherwise would might not be such a big deal.

Dr. Regillo: What do you think is the likelihood of Ozurdex being US Food and Drug Administration (FDA)-approved and available for us to use for DME in the near future?

Dr. Garg: It's pretty good. The data are under review by the FDA. Hopefully it will be up for a vote in April, and hopefully we will have it available to our patients by the summer of next year.

Dr. Regillo: The other potentially new FDA-approved treatment is aflibercept. Allen, what about the studies there?

Dr. Ho: The studies there are surprisingly consistent to what we saw in RISE and RIDE with ranibizumab. Ranibizumab works, [aflibercept] works. Diana Do[10] gave an excellent presentation to show that we will have something else in our toolbox for patients with DME down the line. We really need the steroids there as well. That is an important statement, and the results from the MEAD trial were important. I hope that goes through.

Dr. Regillo: I certainly welcome additional options to treat our patients with DME. Another anti-VEGF agent -- a good steroid that seems to have a good safety profile -- is very exciting.