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Tommi Karttunen,1 Lasse Nummelin,2 Kai Kaarniranta,1,2 Kati Kinnunen1,2 1Department of Ophthalmology, Kuopio University Hospital, Kuopio, Finland; 2Department of Ophthalmology, University of Eastern Finland, Kuopio, FinlandCorrespondence: Tommi KarttunenDepartment of Ophthalmology, Kuopio University Hospital, Puijonlaaksontie 2, Kuopio 70210, FinlandTel +358 44 717 9582Email tommi.karttunen@kuh.fiPurpose: The purpose of this retrospective study was to examine the efficacy of dexamethasone implant in refractory diabetic macular oedema (DMO) in real life settings.Methods: In all, 24 eyes of 22 patients that required treatment with single or multiple intravitreal dexamethasone implants for refractory DMO were included in the study. Patients having macular oedema for another retinal disease were excluded from the study. The patient data were collected and analyzed retrospectively. As a demographic data age, gender, the type of diabetes and the duration of DMO were collected. Changes in central foveal thickness and the number of hyper reflective spots (HRS) were analyzed with Heidelberg SD-OCT. Furthermore, the best-corrected visual acuity (BCVA) and changes in the intraocular pressure (IOP) were measured.Results: In all, 50.0% of the eyes with baseline BCVA 0.45 (±2.4) lines in ETDRS LogMAR scale received only one implant during the follow-up of 332 (±79) days. At the end of the follow-up, BCVA was 0.26 (±2.0) lines. The other 50.0% of the eyes with baseline BCVA 0.64 (±3.0) lines received the second implant in 156 (±38) days. Central retinal thickness (CRT) at baseline was 333 (±44) μm in the eyes with only one implant and 497 (±125) μm in the eyes with 2 or more implants. IOP lowering medication was needed for 8.3% of the eyes. The decrease in the number of HRS was significant (8±17, p=0.048) in response to dexamethasone implantation.Conclusion: The dexamethasone implant is a useful treatment in refractory DMO and HRS seen in the OCT might indicate inflammation in the retina.Keywords: diabetic macular oedema, DMO, dexamethasone implant, hyper reflective spots, HRS, optical coherence tomography, OCT

Abstract: Diabetic retinopathy (DR) has mainly been regarded as a microvascular disease that is caused by hyperglycaemia and characterized by retinal vascular leakage, macular oedema and preretinal neovascularisation. Increasing clinical evidence from electroretinographic, contrast sensitivity, perimetric, and colour vision studies suggest that neuronal changes may occur prior to clinically detectable microvasculopathy. Thus, there may be a primary neurodegenerative process which contributes to loss of vision in DR. Neuronal apoptosis in DR has been reported both in vivo and in vitro. Consequently, neuroprotection in DR may be a valuable therapeutic target. This review outlines the recent new concepts of neurodegeneration in the pathogenesis of DR, particularly emphasising its potential for new therapeutic approaches. [Copyright &y& Elsevier]