Simultaneous Intravitreal Ranibizumab and Dexamethasone Implant Administration at the Same Setting in Eyes with Severe Diabetic Macular Edema

Aim: To share our experience in eyes with severe DME (exhibiting serous retinal detachment or large cysts) treated with simultaneous intravitreal ranibizumab and dexamethasone implant administration at the same setting as the first treatment step. Subjects and Results: Five eyes of three patients with DME who were either treatment naive or relatively undertreated were presented in this report. As optical coherence tomography exhibited serous retinal detachment or severe cystoid edema with large cysts, intravitreal ranibizumab and dexamethasone implant were simultaneously employed at the same setting as the first treatment step in those eyes. Panretinal photocoagulation was also commenced bilaterally a week after the start of injections when at least one eye had retinal neovascularization. Subsequent treatments of intravitreal ranibizumab and/or dexamethasone implant were administered. Patients were followed up for seven, eight and 13 months respectively. All five eyes achieved a relative anatomic stability and experienced visual improvement at the end of follow-up. Conclusion: In some cases with severe DME with or without proliferative diabetic retinopathy, simultaneous intravitreal ranibizumab and dexamethasone implant administration at the same setting may be a better option to initiate the treatment over mono ranibizumab treatment. A randomized study comparing the mono anti-VEGF therapy and mono dexamethasone implant administration with simultaneous treatment may outline the place of this type of therapy in the treatment armamentarium of severe DME.