Summary: In eyes with proliferative diabetic retinopathy and tractional retinal detachment undergoing vitrectomy with silicone oil tamponade, adding an intravitreal dexamethasone implant reduced preretinal reproliferation and macular epiretinal membrane and improved 12-month visual acuity versus surgery alone.
PICO Summary
| Element | Detail |
|---|---|
| Population | 30 patients (34 eyes) with proliferative diabetic retinopathy and retinal detachment undergoing vitrectomy with silicone oil tamponade. |
| Intervention | Intravitreal dexamethasone (Ozurdex) implant after vitrectomy, before silicone oil tamponade. |
| Comparison | Vitrectomy with silicone oil tamponade alone. |
| Outcome | Less preretinal proliferation progression (23.5% vs 88.2%; p<0.001), fewer macular epiretinal membranes (11.8% vs 41.2%; p=0.024), better 12-month BCVA (0.61 vs 1.02 logMAR; p=0.024), lower central retinal thickness at 1 and 6 months. |
Dexamethasone implant in diabetic vitrectomy
RCT · PDR with retinal detachment · 12 months
Adding an intravitreal dexamethasone implant during diabetic vitrectomy cut preretinal reproliferation from 88% to 24% and improved 12-month visual acuity. Small single-centre RCT; larger trials needed before routine use.
Expert Commentary
This sits at the surgical end of diabetic eye disease, so I read it less as someone who operates and more as the physician who refers these patients and shares responsibility for their glycaemic control, but the result is striking enough to register clearly. Reproliferation falling from 88% to 23%, with two extra Snellen lines of acuity at a year, is a large effect with a coherent anti-inflammatory mechanism, since postoperative fibrosis is exactly what wrecks these reattachments. I am genuinely encouraged while staying alert to how the study is built: thirty patients in a single centre, only twelve months of follow-up, and silicone oil itself influencing both proliferation and vision, which muddies the implant’s isolated effect. I would also want clearer reporting of intraocular pressure and cataract surveillance, the predictable downsides of an intravitreal steroid. Can I use this with my patients? Not my decision to make at the operating table, but it is a finding I would happily raise with my vitreoretinal colleagues, and it reinforces my own job of optimising glucose and blood pressure around surgery. I want a larger multicentre trial before this becomes routine.
References
Cao Y, Wang B, Li M, et al. Outcome of silicone oil tamponade combined dexamethasone implantation in patients with proliferative diabetic retinopathy and retinal detachment undergoing vitrectomy: a prospective randomized controlled clinical trial. BMC Ophthalmol. 2025;25(1):523. doi:10.1186/s12886-025-04344-w