Long-Term Outcomes Of Combined Phacoemulsification And Intravitreal Dexamethasone Implant In Diabetic Macular Edema
Published 2026 - 44th Congress of the ESCRS
Reference: PP21.02 | Type: Poster | DOI: 10.82333/0a1w-y607
Authors: Dr Maaz Khan* 1 , Dr Imran Karim Janmohamed 1 , Dr Havena Harahn 1 , Mr Saleh Sahbi 2 , Dr Barnaby Carr 1 , Dr Hamza Nawaz 3 , Mr Goncalo Almeida 1
1Ophthalmology,1. Maidstone General Hospital,Maidstone,United Kingdom, 2Medical School,Kings College London,London,United Kingdom, 3Ophthalmology,Hammersmith Hospital,London,United Kingdom
Purpose
To evaluate long-term visual, anatomical, and safety outcomes following combined phacoemulsification with intravitreal dexamethasone implant in a cohort of patients with diabetic macular edema (DME).
Setting
Single-center retrospective interventional case series.
162 eyes of 126 patients with DME and visually significant cataract who underwent combined phacoemulsification and dexamethasone implant between January 2019 and December 2024. 68 eyes were treatment-naïve, while 94 had received previous treatment with anti-vascular endothelial growth factor (anti-VEGF) or macular laser photocoagulation.
Methods
All patients underwent uncomplicated phacoemulsification with intraocular lens implantation followed by immediate intravitreal dexamethasone implant insertion. Outcome measures were assessed at baseline and multiple postoperative timepoints through 5 years. Retreatment with intravitreal dexamethasone or anti-VEGF agents was administered at physician discretion. Linear mixed-effects models evaluated longitudinal changes, and Kaplan-Meier analysis assessed retreatment-free survival.
Results
Mean follow-up was 30.8 + 16.9 months. Significant early visual improvements were observed, with adjusted mean gains of 6.6 letters at 1 month (p<0.001), 4.3 letters at 3 months (p=0.007), and 3.1 letters at 6 months (p=0.047). At final follow-up, 35 eyes (21.6%) achieved ≥15-letter gain. CMT showed maximal reduction at 1 month (adjusted mean -60.1 μm, p<0.001), with statistically significant reductions persisting through 3 years. 84 eyes (51.9%) required at least one retreatment, with a median of 1 retreatment (interquartile range 0-2) per eye. Median time to retreatment was 9.1 months. Retreatment-free survival was 29.2 months. Topical therapy was required to manage raised IOP in 20 eyes (12.3%); no eyes required surgical intervention.
Conclusions
Combined phacoemulsification with intravitreal dexamethasone implant provides significant early functional improvements and sustained anatomical benefits through 3 years in patients with diabetic macular edema, with acceptable safety profile and approximately half of eyes remaining retreatment-free beyond 2 years.