Safety profile of same-day bilateral intravitreal dexamethasone implantation for diabetic and uveitic macular edema: a single-center experience

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). 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. 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. 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. 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).