Dexamethasone implant in vitreoretinal surgery for diabetic retinal detachment: A retrospective comparative study

PURPOSE: To evaluate the effect of simultaneous intraoperative dexamethasone implant on visual and anatomical outcomes in eyes undergoing pars plana vitrectomy (PPV) with silicone oil for diabetic retinal detachment (DRD). DESIGN: Retrospective comparative case series. METHODS SETTING: Tertiary eye care center. STUDY POPULATION: Sixty eyes of 60 patients with DRD. INTERVENTION/OBSERVATION PROCEDURES: Medical records of 60 eyes of 60 patients undergoing PPV with silicone oil for diabetic tractional retinal detachment or combined tractional-rhegmatogenous retinal detachment were retrospectively reviewed. Thirty eyes underwent standard PPV with silicone oil tamponade, while 30 eyes underwent PPV with simultaneous intraoperative dexamethasone implant. Silicone oil removal was performed at 2-3 months. All patients were followed for at least 6 months. MAIN OUTCOME MEASURES: The main outcome measures were best-corrected visual acuity (BCVA) and central macular thickness (CMT). Secondary outcomes included postoperative macular edema (ME), epiretinal membrane (ERM) formation, need for rescue dexamethasone therapy, anatomical success, and requirement for secondary internal limiting membrane peeling. RESULTS: At 6 months, BCVA was 0.62 ± 0.14 logMAR in Group A versus 0.48 ± 0.12 logMAR in Group B ( P < 0.01). Mean CMT was 314 ± 35 μm versus 272 ± 28 μm, respectively ( P < 0.05). ME occurred in 30% of eyes in Group A versus 10% in Group B. Rescue dexamethasone was required in 16.7% of Group A and none in Group B. ERM formation was observed in 23.3% versus 6.7% ( P = 0.07), and secondary ILM peeling was required in 10% versus 0% in Groups A and B, respectively. Retinal reattachment rates at 6 months were comparable (93.3% vs 96.7%). CONCLUSION: Intraoperative dexamethasone implantation may improve postoperative visual and anatomical outcomes and warrant further evaluation in prospective randomized studies.