Managing DME When Anti-VEGF Response Is Limited - Summary - MDSpire

Managing DME When Anti-VEGF Response Is Limited

Retina Minute: Drs. Kuppermann and Singer discuss week-12 findings from the ERLYDEX trial in anti-VEGF suboptimal responders

  • By

  • Baruch D. Kuppermann, MD, PhD

  • Michael A. Singer, MD

  • March 1, 2026

  • 5 min

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Objective:

To evaluate the outcomes of switching to dexamethasone intravitreal implant (DEX-I) in diabetic macular edema (DME) patients with inadequate response to anti-VEGF therapy.

Key Findings:
  • Patients switched to DEX-I improved vision by approximately 8 letters compared to no vision gain in those maintained on anti-VEGF.
  • Significant improvement in central subfield thickness (CST) by more than 100 µm in DEX-I group by week 12.
  • 50% of patients switched to DEX-I gained 10 letters, compared to 6% on anti-VEGF.
  • No patients on DEX-I lost 10 or more letters, while 10% on anti-VEGF did.
  • The study supports earlier switching to DEX-I after 3 anti-VEGF injections instead of delaying until 6.
Interpretation:

Switching to DEX-I after a suboptimal response to anti-VEGF therapy can lead to significant vision improvement and reduced risk of vision loss in DME patients.

Limitations:
  • Retrospective design may introduce selection bias.
  • Lack of data on cataract incidence and intraocular pressure changes.
Conclusion:

Switching to dexamethasone implant after determining suboptimal response to anti-VEGF therapy is a viable strategy to enhance vision outcomes in DME patients.

Original Source(s)

Managing DME When Anti-VEGF Response Is Limited

  • by Baruch D. Kuppermann, MD, PhD, Michael A. Singer, MD

  • March 1, 2026

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