The anti-inflammatory effects of dexamethasone implants in eyes with heavy silicone oil: a prospective study on vitrectomy for diabetic retinopathy

TL;DR

This study examines how dexamethasone implants with heavy silicone oil affect inflammation and recovery in diabetic retinal surgery.

Contribution

This is the first study to evaluate dexamethasone implants with heavy silicone oil in diabetic retinal surgery.

Findings

Dexamethasone implants reduced anterior chamber fibrin exudation and PVR at one week post-surgery.

Dexamethasone implants showed lower rates of retinal reattachment and iris synechiae at three months.

No significant difference in visual acuity or intraocular pressure was found between groups.

Abstract

This study aims to assess the effects of heavy silicone oil (HSO) tamponade in patients with diabetic tractional retinal detachment (TRD) treated with pars plana vitrectomy (PPV), and to evaluate the role of extended-release hormone implantation in controlling inflammation and mitigating postoperative complications.

A prospective, randomized, controlled design was used in this study. This study included 96 eyes from 96 patients diagnosed with diabetic TRD, all of whom were treated at our institution between March 2024 and March 2025. Group 1 consisted of 54 eyes from 54 patients (PPV + HSO + dexamethasone implant), while Group 2 included 42 eyes from 42 patients (PPV + HSO). The primary outcomes included best-corrected visual acuity (BCVA), intraocular pressure (IOP), retinal reattachment rate, anterior chamber (AC) fibrin exudation, anterior proliferative vitreoretinopathy (PVR), and posterior iris synechiae during the 3-month postoperative follow-up period.

Eighty eyes from 80 patients were ultimately included in the study, with 40 eyes assigned to each group. Patient characteristics, including age, sex, preoperative HbA1c levels and preoperative blood pressure,DR severity were similar (P >0.05). Both groups demonstrated improvements in BCVA postoperatively compared to baseline (P <0.05,Bonferroni adjusted). Group 1 demonstrated a improvement in BCVA compared to Group 2 at 1 month and 3 months postoperatively,but P >0.05 after adjusted. At 3 months postoperatively, IOP did not differ significantly between the groups (P > 0.05). At 1 week postoperatively, AC fibrin exudation was decreased in Group 1(P = 0.007, P = 0.07 Bonferroni adjusted). At 3 months postoperatively,compared with Group 2, Group 1 had significantly lower postoperative anterior PVR (P = 0.010 Bonferroni adjusted), Group 1 had lower rates of retinal reattachment and posterior iris synechiae (P = 0.032 and P = 0.008, all P>0.05 Bonferroni adjusted).

To our knowledge, this first study of dexamethasone implants with HSO in PDR suggests intraoperative DEX may be a safe, potentially beneficial adjunct for diabetic TRD undergoing phacoemulsification plus vitrectomy with HSO, reducing inflammation and number of anti-VEGF injections over 3 months, and offering useful directions for future research in this preliminary prospective evaluation overall.

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