Real-life experience of Dexamethasone implant under a proactive treatment regimen: The ProDEX Study

PURPOSE To assess the effectiveness of switching intravitreal dexamethasone implants (DEX-implant) from pro re nata (PRN) treatment regimen to a proactive regimen in patients with macular edema of diverse etiologies. DESIGN An observational, retrospective, uncontrolled, multicenter, national case series. PARTICIPANTS Eighty-one eyes from 68 patients treated between October 2015 and June 2023 were included. METHODS This study included consecutive eyes treated with DEX-implant who were switched from a PRN regimen to a proactive regimen, for diabetic macular edema (DME), retinal vein occlusion (RVO), non-infectious uveitis macular edema (UME; including post-surgical macular edema), and radiation maculopathy (RM). MAIN OUTCOME MEASURES The main outcome measures were change in the best-corrected visual acuity (BCVA), central macular thickness (CMT), and intra ocular pressure (IOP) at each visit. RESULTS According to the etiology, DME represented 49.4% of eyes, UME 24.3%, RVO 21.0%, and RM 6.2%. The mean (SD) duration of follow-up under the PRN and proactive regimens was 20.6 (13.3) and 14.2 (10.3) months, respectively. Switching from a PRN to a proactive regimen significantly improved mean (SD) BCVA by 3.7 (12.9) ETDRS letters (p=0.01) with a mean (SD) decrease in CMT of 108.0 (151.4) μm (p<0.001). The proportion of visits with significant anatomical recurrence (>50μm) also decreased from 40.1% to 6.0% after switching to a proactive regimen (p<0.001). The number of DEX-implant injections significantly increased during the proactive treatment period (p<0.001), but the change in the number of visits was not significantly different (p=0.2). The proactive treatment period was not associated with a significant increase in IOP (p=0.6). CONCLUSION Switching to a proactive regimen in patients already treated with DEX-implant appears to significantly improve BCVA and CMT while maintaining stable IOP.