Retinal angiographic alteration in diabetic macular edema after dexamethasone implantation: a case report

Chia-Yi Lee,1,2,* Cheng-Chao Ching,1,* Chi-Chin Sun,3,4 Hung-Chi Chen,5–7 Hung-Yu Lin1,8–111Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua, Taiwan; 2Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan, Taiwan; 3Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan; 4Department of Chinese Medicine, Chang Gung University, Taoyuan City, Taiwan; 5Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; 6Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan; 7Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan; 8Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 9Department of Optometry, Chung Shan Medical University, Taichung, Taiwan; 10Department of Optometry, Yuanpei University of Medical Technology, Hsinchu, Taiwan; 11Department of Exercise and Health Promotion, Chung Chou University of Science and Technology, Changhua, Taiwan*These authors contributed equally to this workAbstract: Here we reported a rare case of the implantation of a dexamethasone intravitreal implant (DEX) in which decreased retinal vessel density (VD) was found by optical coherence tomography angiography (OCTA). A 74-year-old male with diabetes mellitus presented with bilateral macular edema. The best-corrected visual acuity (BCVA) was 0.6 in the right eye. Diabetic macular edema (DME) was diagnosed. A DEX for the right eye was planned, and the preoperative evaluation showed a superficial VD of 48.74 percent, a deep VD of 53.12 percent, and a foveal avascular zone (FAZ) 0.165 mm2 in size by OCTA. The BCVA in the right eye recovered to 0.8, and a notably lower superficial VD of 45.97 percent and a deep VD of 45.40 percent were observed with an enlarged FAZ of 0.294 mm2 one month postoperatively. Moreover, BCVA in the right eye was maintained at 0.8, while further reductions in both superficial (40.07 percent) and deep (40.91 percent) VD were noted with a FAZ measured at 0.305 mm2 two months postoperatively. In conclusion, retinal superficial and deep VD decreased, while the FAZ increased, after the implantation of the DEX in a patient with DME.Keywords: dexamethasone, Ozurdex, optical coherence tomography angiography, diabetic macular edema, retina