Purpose: To compare functional and anatomical outcomes of combining intravitreal dexamethasone implant (Ozurdex®) with navigated subthreshold yellow (577 nm) micropulse laser (SMLT) versus dexamethasone monotherapy in diabetic macular edema (DME). Methods: In this prospective randomized study, 80 eyes with center-involving DME were allocated to two groups: 40 eyes received dexamethasone implant followed four weeks later by navigated SMLT (DEX-I + SMLT), and 40 eyes received dexamethasone implant alone (DEX-I). Best-corrected visual acuity (BCVA, ETDRS letters), central subfield thickness (CST), and ETDRS subfield thicknesses were measured at baseline and at 2, 4, 6, 9 and 12 months. Reinjection-free survival was analyzed over 12 months. Results: At 6 months, mean BCVA improvement was greater in the DEX-I + SMLT group than in the DEX-I monotherapy group (6.2 ± 5.1 vs 4.1 ± 6.4 letters; p = 0.03), and this difference persisted at 12 months (5.8 ± 6.5 vs 3.6 ± 6.8 letters; p = 0.05). Mean CST was lower in the DEX-I + SMLT group at 6 months (295 ± 46 vs 321 ± 58 µm; p = 0.02) and remained lower at 12 months (315 ± 60 vs 342 ± 70 µm; p = 0.05). Median retreatment-free survival was longer in the combination group (11.2 vs 8.3 months). Conclusion: Within the 12-month follow-up period, sequential navigated SMLT performed four weeks after dexamethasone implantation was associated with improvements in visual and anatomical outcomes and with a longer retreatment-free interval compared with dexamethasone monotherapy, without additional safety concerns.
Oliverio et al. (Tue,) studied this question.