Intraoperative intravitreal dexamethasone implant along with cataract surgery in eyes with diabetic macular edema: A systematic review

This systematic review evaluates the efficacy and safety of intraoperative intravitreal dexamethasone implant (DEXi) during cataract surgery in patients with diabetic macular edema (DME). Following PRISMA guidelines, PubMed and Scopus were searched up to March 2026, identifying 17 eligible studies. Intraoperative DEXi was associated with early improvements in best-corrected visual acuity (mean change from baseline ranging from approximately 0.15 to 0.60 logMAR across studies) and with reductions in central macular thickness (mean change from baseline ranging from an increase of approximately 7 µm to a reduction of approximately 195 µm), the magnitude of the anatomical response depending markedly on the timing of measurement and on baseline edema severity. Follow-up ranged from 3 to 24 months. Comparative evidence suggests simultaneous administration may accelerate visual recovery and anatomical stabilization compared with delayed treatment, potentially reducing postoperative interventions. Intraocular pressure elevation was the most frequently reported adverse event; it was generally mild and transient and manageable with topical therapy, with no major safety concerns, although long-term data remain limited. Despite study heterogeneity, the available findings are compatible with the feasibility and possible clinical benefit of combining cataract surgery with intraoperative DEXi in DME, although they do not allow firm conclusions to be drawn. However, the body of evidence consists predominantly of Level 3 and Level 4 studies, with only two small, randomized trials, and Low to Very Low certainty according to GRADE. Intraoperative DEXi may contribute to improving functional and anatomical outcomes but, given the Low to Very Low certainty of the current evidence, large-scale randomized trials are required before this approach can be routinely recommended, and to optimize patient selection and protocols.