The dexamethasone intravitreal implant (Ozurdex) is most appropriate as an intravitreal treatment in patients with diabetic macular edema who are:

• A Phakic young patients with high IOP risk
• B All patients regardless of lens status as a first-line agent
• C Pseudophakic, or with chronic refractory DME not responding to anti-VEGF ✓
• D Patients who have active proliferative diabetic retinopathy

Explanation

The dexamethasone biodegradable implant (Ozurdex) is preferred in pseudophakic patients (avoids steroid-induced cataract) or in those with refractory DME who have failed multiple anti-VEGF injections. In phakic patients, it carries the risk of accelerated posterior subcapsular cataract formation in addition to steroid-induced IOP elevation, limiting its use as first-line. It is not indicated in active PDR. First-line therapy for DME remains anti-VEGF.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.