Efficacy and Safety of Supraciliary Dexamethasone Implantation in Patients with Macular Edema: Preliminary and Comparative Study

Abstract Purpose To investigate the efficacy and safety of dexamethasone implantation (DEXI) in the supraciliary (SC) region, a potential new implantation site, compared to intravitreal (IVi) application. Methods This retrospective cohort study enrolled 39 eyes of 38 patients with macular edema who received DEXI between January and August 2023. Patients were randomized into SC and IVi treatment groups. All patients were followed up for 3 months after DEXI. The maximum retinal thickness (MRT) and central retinal thickness change (ΔCRT), intraocular pressure (IOP), and visual acuity (VA) were assessed preoperatively and postoperatively. Results The SC treatment group showed a significant reduction in MRT at 1st and 3rd month visits (p = 0.0002, p = 0.0002). IVi group showed a significant reduction at all postoperative visits (p = 0.0002, p = 0.0004, p = 0.0003). ΔCRT showed no significant difference between SC and IVi groups at any visit (p > 0.05). No significant IOP changes were observed (p > 0.05). No ocular hypertony or hypotony cases on day one post-SC DEXI. VA improved significantly in the SC group compared to the IVi group in the first week (p = 0.014). Subconjunctival hemorrhage was observed in all patients after IVi. No perioperative or postoperative complications were observed in any patients in either group other than subconjunctival hemorrhage. Conclusion SC DEXI appears to be a suitable alternative for managing macular edema. It offers comparable effectiveness to IVi administration with potentially fewer complications. Further larger-scale research is needed to validate its long-term safety and efficacy. Anterior segment optical coherence tomography can demonstrate SC DEXI.