Combined Phacoemulsification and Intravitreal anti-vascular endothelial growth factor(VEGF) versus Dexamethasone Implant  in Diabetics with Coexisting Cataract and Centre-involving Diabetic Macular  Edema

Abstract Purpose: To compare the anatomical and functional outcome in groups who underwent combined phacoemulsification with intravitreal anti-vascular endothelial growth factor (VEGF) versus combined phacoemulsification with intravitreal dexamethasone implant who had centre-involving diabetic macular edema (CI-DME) with significant cataract.Methods: Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were retrospectively evaluated in both groups at baseline,1 month, 3 months and 6 months follow up period. Results: Fifty six eyes were analysed, 36 in phacoemulsification with anti-VEGF group and 20 in phacoemulsification with dexamethasone implant group. BCVA showed improvement from baseline of log MAR 0.54 ± 0.58 to 0.49 ± 0.57 at 1month in combined phacoemulsification with anti-VEGF group. Phacoemulsification with intravitreal dexamethasone implant showed baseline BCVA of 0.43 ± 0.34 and 0.55 ± 0.44 at 6 months follow up with not much of visual improvement due to the chronicity of the DME. Mean CST groups of less than 300μm, 300-600μm and more than 600μm disclosed comparable trends in both Anti-VEGF (p=0.005) and Dexamethasone group (p=0.018) from the baseline to the 6 month follow up period. 300-600μm CST group showed no such statistical significance in either group whereas in the ≥ 600μm mean CST group, there was significant statistical difference only in the dexamethasone group with p value of 0.043. Conclusions: This study demonstrates that individuals with CI-DME with lower baseline CST values undergoing combined phacoemulsification with either intravitreal Anti-VEGF or dexamethasone implant shows similar anatomical and functional success at six months. Eyes with higher baseline CST had better anatomical response to dexamethasone implant.