This evidence-based review evaluated the effectiveness and safety of triamcinolone acetonide (TA) and dexamethasone (DEX) implant for treating diabetic macular edema (DME) with massive hard exudates (HE), including the special subtype of plaque-like HE, in both non-vitrectomized and vitrectomized eyes.
Both TA and DEX implant effectively promote resorption of scattered punctate and plaque-like HE in non-vitrectomized and vitrectomized eyes; however, DEX implant is preservative-free and maintains more stable drug concentration than TA specifically in vitrectomized eyes.
This is a narrative/evidence-based review rather than a systematic review or meta-analysis, which limits the strength of conclusions. No pooled quantitative outcomes or head-to-head RCT data comparing TA vs. DEX implant are reported.
For DME with massive or plaque-like hard exudates, both TA and DEX implant are viable corticosteroid options — but prefer DEX implant in vitrectomized eyes due to its preservative-free formulation and more stable drug levels. Monitor all patients for ocular hypertension, cataracts, sterile endophthalmitis, and anterior chamber migration.
