@article {1328876, title = {Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema}, journal = {Acta Diabetol}, volume = {55}, number = {8}, year = {2018}, month = {2018 Aug}, pages = {789-796}, abstract = {AIMS: To compare functional and anatomical outcomes of continued anti-vascular endothelial growth factor (VEGF) therapy versus dexamethasone (DEX) implant in eyes with refractory diabetic macular edema (DME) after three initial anti-VEGF injections in a real-world setting. METHODS: To be included in this retrospective multicenter, case-control study, eyes were required: (1) to present with early refractory DME, as defined by visual acuity (VA) gain <= 5 letters or reduction in central subfield thickness (CST) <= 20\%, after a loading phase of anti-VEGF therapy (three monthly injections) and (2) to treat further with (a) anti-VEGF therapy or (b) DEX implant. Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) at 12\ months. Due to imbalanced baseline characteristics, a matched anti-VEGF group was formed by only keeping eyes with similar baseline characteristics as those in the DEX group. RESULTS: A total of 110 eyes from 105 patients were included (anti-VEGF group: 72 eyes, DEX group: 38 eyes). Mean change in VA at 12\ months was - 0.4 {\textpm} 10.8 letters (anti-VEGF group), and + 6.1 {\textpm} 10.6 letters (DEX group) (P = 0.004). Over the same period, mean change in CST was + 18.3 {\textpm} 145.9\ {\textmu}m (anti-VEGF group) and - 92.8 {\textpm} 173.6\ {\textmu}m (DEX group) (P \< 0.001). Eyes in the DEX group were more likely to gain >= 10 letters (OR 3.71, 95\% CI 1.19-11.61, P = 0.024) at month 12. CONCLUSIONS: In a real-world setting, eyes with DME considered refractory to anti-VEGF therapy after three monthly injections which were switched to DEX implant and had better visual and anatomical outcomes at 12\ months than those that continued treatment with anti-VEGF therapy.}, issn = {1432-5233}, doi = {10.1007/s00592-018-1151-x}, author = {Busch, Catharina and Zur, Dinah and Fraser-Bell, Samantha and La{\'\i}ns, In{\^e}s and Santos, Ana Rita and Lupidi, Marco and Cagini, Carlo and Gabrielle, Pierre-Henry and Couturier, Aude and Man{\'e}-Tauty, Val{\'e}rie and Giancipoli, Ermete and Ricci, Giuseppe D{\textquoteright}Amico and Cebeci, Zafer and Rodr{\'\i}guez-Vald{\'e}s, Patricio J and Chaikitmongkol, Voraporn and Amphornphruet, Atchara and Hindi, Isaac and Agrawal, Kushal and Chhablani, Jay and Loewenstein, Anat and Iglicki, Matias and Rehak, Matus and International Retina Group} }