Aim: To share our experience in eyes with severe DME (exhibiting serous retinal detachment or\nlarge cysts) treated with simultaneous intravitreal ranibizumab and dexamethasone implant administration\nat the same setting as the first treatment step. Subjects and Results: Five eyes of three\npatients with DME who were either treatment naive or relatively undertreated were presented in\nthis report. As optical coherence tomography exhibited serous retinal detachment or severe cystoid\nedema with large cysts, intravitreal ranibizumab and dexamethasone implant were simultaneously\nemployed at the same setting as the first treatment step in those eyes. Panretinal photocoagulation\nwas also commenced bilaterally a week after the start of injections when at least one\neye had retinal neovascularization. Subsequent treatments of intravitreal ranibizumab and/or\ndexamethasone implant were administered. Patients were followed up for seven, eight and 13\nmonths respectively. All five eyes achieved a relative anatomic stability and experienced visual\nimprovement at the end of follow-up. Conclusion: In some cases with severe DME with or without\nproliferative diabetic retinopathy, simultaneous intravitreal ranibizumab and dexamethasone\nimplant administration at the same setting may be a better option to initiate the treatment over\nmono ranibizumab treatment. A randomized study comparing the mono anti-VEGF therapy and\nmono dexamethasone implant administration with simultaneous treatment may outline the place\nof this type of therapy in the treatment armamentarium of severe DME.
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