@article {1466900,
	title = {Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results},
	journal = {Acta Diabetol},
	volume = {56},
	number = {12},
	year = {2019},
	month = {2019 Dec},
	pages = {1341-1350},
	abstract = {AIMS: To provide 2-year follow-up data on eyes with diabetic macular edema (DME) that were non-responsive after three initial anti-vascular endothelial growth factor (VEGF) injections, comparing functional and anatomical outcomes under continued anti-VEGF therapy versus dexamethasone (DEX) implant. METHODS: Multicenter, retrospective chart review comparing eyes with treatment-na{\"\i}ve DME and a suboptimal response to a loading phase of anti-VEGF therapy (3 injections given monthly) which were then treated with (a) further anti-VEGF (n = 72) or (b) initially switched to DEX implant (n = 38). Main outcome measures were change in visual acuity (VA) and central subfield thickness (CST) from the end of the loading phase to 24\&nbsp;months. RESULTS: In 79\% of the 12-month study population (87/110 eyes), 24-month data were available. One quarter of eyes in each group switched treatments during the second year. Eyes that were switched early to DEX implant maintained the functional and anatomical improvements at 24\&nbsp;months which were seen in the first year (from month 3: + 8.9 letters, - 214\&nbsp;{\textmu}m). Eyes that were switched from anti-VEGF therapy to steroids in the second year improved VA and reduced CST at 24\&nbsp;months (from month 12: + 6.8 letters, p = 0.023; - 226\&nbsp;{\textmu}m, p = 0.004). In eyes continued on anti-VEGF therapy, VA and CST were stable at 24\&nbsp;months (from month 3: + 2.8 letters, p = 0.254; - 24\&nbsp;{\textmu}m, p = 0.243). Eyes that were non-responsive to anti-VEGF therapy for 12\&nbsp;months had similar chances to experience a VA gain from further therapy as eyes that were non-responsive for 3\&nbsp;months only (23.8 vs. 31.0\%, p = 0.344). CONCLUSIONS: The beneficial effect of an early switch to DEX implant in DME non-responders seen at month 12 was maintained during the second year. A later switch from anti-VEGF to steroids still provided significant improvement. Eyes continued on anti-VEGF over a period of 24\&nbsp;months maintained vision. A quarter of eyes, which had not improved vision at 12\&nbsp;months, exhibited a delayed response to treatment.},
	issn = {1432-5233},
	doi = {10.1007/s00592-019-01416-4},
	author = {Busch, Catharina and Fraser-Bell, Samantha and Iglicki, Matias and Lupidi, Marco and Couturier, Aude and Chaikitmongkol, Voraporn and Giancipoli, Ermete and Rodr{\'\i}guez-Vald{\'e}s, Patricio J and Gabrielle, Pierre-Henry and La{\'\i}ns, In{\^e}s and Santos, Ana Rita and Cebeci, Zafer and Amphornphruet, Atchara and Degenhardt, Valentin and Unterlauft, Jan-Darius and Cagini, Carlo and Man{\'e}-Tauty, Val{\'e}rie and Ricci, Giuseppe D{\textquoteright}Amico and Hindi, Isaac and Agrawal, Kushal and Chhablani, Jay and Loewenstein, Anat and Zur, Dinah and Rehak, Matus and International Retina Group}
}
