Surgical tools working on a retina affected by macular edema.

Vision Breakthrough: Can a Vitrectomy with Dexamethasone Implant Restore Sight in Diabetic Macular Edema?

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"Exploring a Minimally Invasive Surgical Approach to Treating Persistent Diabetic Macular Edema."

Diabetic macular edema (DME) stands as a leading cause of vision loss among working-age adults in industrialized nations, affecting approximately 7% of individuals with diabetes in Germany alone. When DME progresses unchecked, it can lead to blindness, highlighting the critical importance of timely and effective intervention.

The current standard of care typically involves anti-VEGF (vascular endothelial growth factor) therapy, which aims to reduce both proliferation and edema. However, a notable subset of patients experiences limited or no response to this treatment, resulting in persistent macular edema and continued vision decline. This lack of response suggests that anti-VEGF therapy may not address all the pro-inflammatory cytokines implicated in DME.

In light of these challenges, innovative strategies have emerged, including the intravitreal application of dexamethasone implants. This approach targets multiple processes within the inflammatory cascade, aiding in the restoration of the blood-retina barrier. Corticosteroids, known for their ability to counteract various inflammatory mediators, present a promising alternative to anti-VEGF therapy by reducing retinal leukostasis and vascular endothelial ICAM expression, thereby suppressing leukocyte adhesion and transmigration.

Combining Vitrectomy and Dexamethasone: A New Hope for Refractory DME?

Surgical tools working on a retina affected by macular edema.

Another method to combat DME is vitrectomy. It has been suggested that vitrectomy enhances both retinal oxygen supply and overall anatomical and functional outcomes. Furthermore, removing the vitreous body may decrease the concentration of antigens and inflammatory mediators in the vitreous space, disrupting the chronic inflammatory environment. There is much evidence of vitrectomy's effects.

A study investigated the combined therapy of vitrectomy with simultaneous dexamethasone implant application to define and potentially adjust the appropriate treatment for persistent DME. The study examined the combined therapy involving vitrectomy and simultaneous application of a dexamethasone implant.

The study included patients with DME for at least 12 months, all of whom had undergone MIV25 vitrectomy with DEX implantation.
Researchers then evaluated best-corrected visual acuity (BCVA) and central retinal thickness post-surgery.
The study involved 18 eyes, with initial BCVA averaging 0.90 logMAR and central retinal thickness at 594 µm.
Post-intervention, central retinal thickness decreased until the third month, gradually increasing again by the sixth month but stabilizing by the twelfth month.
Five eyes required additional treatments five months post-operation.
Significantly, BCVA improved from one month post-treatment across all follow-up visits (p < 0.001).

The concurrent vitrectomy and application of a dexamethasone implant effectively antagonize the inflammatory cascade. Vitrectomy removes diffusion barriers for intravitreally administered drugs, enabling them to reach affected tissues more quickly. This advantage, coupled with the sustained release mechanism of the dexamethasone implant, ensures prolonged efficacy without diminishing the drug's impact.

Future Directions and Considerations

Despite these limitations, simultaneous vitrectomy and slow-release dexamethasone devices present a promising alternative for treating persistent DMÖ. This pilot study should be confirmed in a larger patient population.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1159/000447983, Alternate LINK

Title: Vitrektomie Mit Dexamethason-Implantat Bei Therapierefraktärem Diabetischem Makulaödem

Subject: General Medicine

Journal: Kompass Ophthalmologie

Publisher: S. Karger AG

Authors: Wafa Omri

Published: 2016-01-01

Everything You Need To Know

1

What exactly is diabetic macular edema (DME) and why is it such a serious concern?

Diabetic macular edema (DME) is a condition that results in vision loss among working-age adults. It occurs when the macula, a part of the retina, swells due to fluid accumulation. This swelling is a consequence of diabetes affecting blood vessels in the eye. If DME is left untreated, it can lead to blindness, which makes timely and effective intervention crucial to prevent vision loss and maintain quality of life.

2

What is anti-VEGF therapy, and how does it typically address diabetic macular edema (DME)?

Anti-VEGF therapy is a standard treatment for diabetic macular edema (DME). It works by targeting and reducing vascular endothelial growth factor (VEGF), a protein that promotes blood vessel growth and leakage. By inhibiting VEGF, this therapy aims to reduce both the proliferation of abnormal blood vessels and the edema (swelling) in the macula. However, in some patients, anti-VEGF therapy may not fully address all the inflammatory factors involved in DME, leading to a limited or no response.

3

What is a dexamethasone implant, and how does it work to treat diabetic macular edema (DME)?

A dexamethasone implant is a device containing dexamethasone, a type of corticosteroid, that is injected into the eye. It is designed to release the drug slowly over time. Dexamethasone helps to reduce inflammation by targeting multiple processes within the inflammatory cascade and aiding in the restoration of the blood-retina barrier. It works by counteracting various inflammatory mediators, reducing retinal leukostasis and vascular endothelial ICAM expression, and suppressing leukocyte adhesion and transmigration, offering a potential alternative for those not responding to anti-VEGF therapy.

4

What is a vitrectomy, and what role does it play in treating diabetic macular edema (DME)?

Vitrectomy is a surgical procedure that involves removing the vitreous body, the gel-like substance that fills the eye. In the context of diabetic macular edema (DME), vitrectomy can help by enhancing retinal oxygen supply and improving anatomical and functional outcomes. Removing the vitreous body may also reduce the concentration of antigens and inflammatory mediators in the vitreous space, thereby disrupting the chronic inflammatory environment and creating a better environment for drug delivery.

5

What does combining vitrectomy with a dexamethasone implant accomplish in treating diabetic macular edema (DME)?

Combining vitrectomy with a dexamethasone implant involves performing a vitrectomy to remove the vitreous body, followed by the injection of a dexamethasone implant into the eye. This combined approach aims to address diabetic macular edema (DME) by both removing inflammatory mediators and delivering a sustained release of the anti-inflammatory drug dexamethasone. The vitrectomy helps to remove diffusion barriers, allowing the drug to reach affected tissues more quickly, while the dexamethasone implant ensures prolonged efficacy by continuously releasing the drug.