J Vis Exp. 2026 Apr 30;(230). doi: 10.3791/70675.
ABSTRACT
Diabetic macular edema (DME) is a leading cause of blindness involving vascular endothelial growth factor (VEGF) leakage and inflammation. This retrospective, single-center cohort study evaluated the efficacy and safety of intravitreal anti-VEGF monotherapy versus combination therapy with anti-VEGF plus dexamethasone implant in DME. A total of 200 patients (one eye per patient) treated between January 2021 and December 2024 were included, with 100 receiving anti-VEGF monotherapy and 100 receiving combination therapy. Best-corrected visual acuity (BCVA), central macular thickness (CMT), adverse events, and quality of life (NEI-VFQ-25) were assessed at baseline and at 1, 3, and 6 months. At 1 and 3 months, the combination therapy group showed faster improvement in BCVA (0.53±0.14 vs. 0.61±0.14 at 1 month; 0.46±0.13 vs. 0.53±0.12 at 3 months) and CMT (342±52 µm vs. 380±55 µm at 1 month; 315±48 µm vs. 345±50 µm at 3 months) compared with the monotherapy group (all P < 0.05), along with a higher rapid response rate (68.0% vs. 42.0%, P < 0.001). However, these differences were no longer significant at 6 months. The combination therapy group had higher rates of elevated intraocular pressure (18% vs. 6%, P < 0.05) and cataract progression (12% vs. 3%, P < 0.05). In conclusion, combination therapy was associated with faster early improvement in visual acuity and macular edema resolution within the first 3 months, but this early advantage was not sustained at 6 months and was accompanied by increased risks of elevated intraocular pressure and cataract progression.
PMID:42149793 | DOI:10.3791/70675