Diabetic Macular Edema Treated With Ozurdex (DMEO)

Study Overview
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Brief Summary
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To measure various pro-permeability factors in the aqueous humor of patients with persistent/recurrent diabetic macular edema

Detailed Description
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Patients with Diabetic Macular Edema (DME) are increasingly being treated with molecules targeting vascular endothelial factor (VEGF). One potential advantage of a dexamethasone implant over specific VEGF antagonists is that steroids suppress production of multiple pro-permeability factors. Our primary objective is to measure the pro-permeability factors in the aqueous humor of patients with persistent/recurrent macular edema despite prior treatment with anti-VEGF agents at baseline and at 1, 2, 3, and 4 months after intraocular injection of a dexamethasone implant.

Official Title
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Diabetic Macular Edema Treated With Ozurdex (DMEO)

Conditions
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Diabetic Macular Edema

Intervention / Treatment
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* Drug: Dexamethasone Implant
* Drug: Anti-VEGF injection


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • Signed informed consent and authorization of use and disclosure of protected health information Age more than or equal to 18 years Diagnosis of diabetic macular edema Intraretinal or subretinal fluid in the macula determined by Spectralis OCT Best corrected visual acuity score in the study eye of 20/30 to 20/400 inclusive (Snellen equivalents using the ETDRS protocol at a distance of 4 meters) In the opinion of the investigator, decreased vision in the study eye is due to foveal thickening from DME and not from other obvious causes of decreased vision Persistent or recurrent edema despite prolonged treatment with an anti-VEFG agent Exclusion Criteria: • Scatter laser photocoagulation or macular photocoagulation within 3 months of study entry in the study eye Intraocular surgery in the study eye within 3 months of study entry Use of intraocular or periocular injection of steroids in the study eye (e.g., triamcinolone) within 4 months of study entry Previous use of an anti-VEGF drug within 1 month of study entry Yttrium-Aluminum-Garnet (YAG) laser capsulotomy within 1 month of study entry Any condition that the investigator believes would pose a significant hazard to the subject if investigational therapy were initiated. Inability to comply with study or follow up procedures History of glaucoma. (Patients who have undergone filtration surgery may be included) Patients with active or suspected ocular or periocular infection, including most viral diseases of the cornea and conjunctiva, including active epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections, and fungal diseases. Aphakic eyes with rupture of the posterior lens capsule. Eyes with ACIOL and rupture of the posterior lens capsule. Patients with hypersensitivity to dexamethasone or to any other components of the product

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1 (dexamethasone implant/anti-VEGF)<br>Patients in group 1 received an injection of an dexamethasone implant at baseline followed by PRN anti-VEGF injections after crossover at week 16. | Drug: Dexamethasone Implant<br>* Patients will receive a single injection of a dexmethasone implant<br>Drug: Anti-VEGF injection<br>* Patients will receive PRN injections of an anti-VEGF agent<br>|
| Experimental: Group 2 (anti-VEGF/dexamethasone implant)<br>Patients in group 2 received prn anti-VEGF injections followed by injection of a dexamethasone implant after crossover at week 16. | Drug: Dexamethasone Implant<br>* Patients will receive a single injection of a dexmethasone implant<br>Drug: Anti-VEGF injection<br>* Patients will receive PRN injections of an anti-VEGF agent<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Correlation Between Change in Level of Propermeability Factors With Change in Edema After Treatment With a Dexamethasone Implant or Anti-VEGF Agent | Changes in propermeability factor levels were correlated with changes in edema using the person correlation coefficient (this was calculated using data from all time points). | 1, 2, 3, and 4 months after injection of a dexamethasone implant or anti-VEGF agent |