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Koksaldi S, Kayabaşi M, Ayhan Z, Kaya M, öztürk T, Yaman A, Saatci AO. Dexamethasone intravitreal implant for macular edema and some other rare indications in uveitis. MEDICINE INTERNATIONAL 2023; 3:39. [PMID: 37560325 PMCID: PMC10407465 DOI: 10.3892/mi.2023.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023]
Abstract
In the present study, 110 eyes of 81 patients with uveitis who underwent intravitreal dexamethasone implant (IDI) injection and had a follow-up of at least 6 months between January, 2012 and September, 2022, were retrospectively analyzed. A total of 298 IDI injections were administered (mean, 2.71±2.37; range, 1-12). The mean age of the patients was 49.44±16.67 years (range, 15-86 years). The mean follow-up time after the first IDI was 34.31±26.53 months (range, 6-115 months). In total, 77 (95.1%) patients had non-infectious uveitis, while 4 patients (4.9%) received IDI for uveitic macular edema in association with infectious uveitis (1 patient with acute retinal necrosis and 3 patients with systemic tuberculosis). IDI was injected under the umbrella of intravitreal ganciclovir injection in the patient with healed acute retinal necrosis for the associated pseudophakic cystoid macular edema. A total of 6 patients (7.4%) received IDI prior to phacoemulsification surgery to control the possible post-operative macular edema. In addition, 3 patients (3.7%) with Vogt-Koyanagi-Harada disease received bilateral IDI as the systemic therapy could not be administered due to side-effects of the systemic treatment. In total, 1 patient (1.2%) with idiopathic retinal vasculitis, aneurysms and neuroretinitis was treated with IDI injections in both eyes in addition to systemic therapy to reduce the ongoing inflammation. Of note, two eyes (1.8%) received simultaneous single IDI and anti-vascular endothelial growth factor administration for the treatment of unilateral extrafoveal macular neovascularization (one with active serpiginous choroiditis and one with sympathetic ophthalmia). IDI was administered for the treatment of uveitic macular edema in 68 patients (83.9%). Best-corrected visual acuity improved from 0.69±0.64 to 0.60±0.76 logMAR at the final visit (P=0.008). Baseline mean central macular thickness (CMT) was 499.74±229.60 µm (range, 187-1,187 µm) and the mean final CMT was 296.60±152.02 µm (range, 126-848 µm). Intraocular pressure elevation requiring topical antiglaucomatous eye drops occurred in 28 eyes (25.5%). During the follow-up period, bilateral glaucoma surgery was required in 1 patient (1.2%) and 25 of 65 phakic eyes (38.4%) underwent phacoemulsification. Retinal detachment occurred in one eye (0.9%), endophthalmitis in one eye (0.9%), and transient intravitreal hemorrhage occurred in three eyes (2.7%) after the IDI injections. On the whole, the present study demonstrates that although IDI is mostly employed in non-infectious uveitic eyes with macular edema, it can also be administered in cases with systemic therapy intolerance, pseudophakic macular edema prophylaxis, and with great caution, in selected cases involving infectious uveitis and macular edema.
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Affiliation(s)
- Seher Koksaldi
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Mustafa Kayabaşi
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Zıya Ayhan
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | | | - Taylan öztürk
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Aylın Yaman
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, 35330 Izmir, Turkey
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Molimard J, Pajot C, Olle P, Belot A, Quartier P, Uettwiller F, Couret C, Coste V, Costet C, Bodaghi B, Dureau P, Bailhache M, Pillet P. Immunomodulatory treatment and surgical management of idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children: a French survey practice. Pediatr Rheumatol Online J 2021; 19:139. [PMID: 34479590 PMCID: PMC8414774 DOI: 10.1186/s12969-021-00626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgeries for idiopathic uveitis and juvenile idiopathic arthritis-associated uveitis in children are complex because of the high risk of inflammatory postoperative complications. There is no consensus about treatment adaptation during the perioperative period. The objectives of this study are to report the therapeutic changes made in France and to determine whether maintaining or stopping immunosuppressive therapies is associated with an increased risk of surgical site infection or an increased risk of uveitis or arthritis flare-up. METHODS We conducted a retrospective cohort study between January 1, 2006 and December 31, 2018 in six large University Hospitals in France. Inclusion criteria were chronic idiopathic uveitis or chronic uveitis associated with juvenile idiopathic arthritis under immunosuppressive therapies at the time of the surgical procedure, operated before the age of 16. Data on perioperative treatments, inflammatory relapses and post-operative infections were collected. RESULTS A total of 76 surgeries (42% cataract surgeries, 30% glaucoma surgeries and 16% posterior capsule opacification surgeries) were performed on 37 children. Adaptation protocols were different in the six hospitals. Immunosuppressive therapies were discontinued in five cases (7%) before surgery. All the children in the discontinuation group had an inflammatory relapse within 3 months after surgery compared to only 25% in the other group. There were no postoperative infections. CONCLUSIONS The results of this study show varying practices between centres. The benefit-risk balance seems to favour maintaining immunosuppressive therapies during surgery. Further studies are needed to determine the optimal perioperative treatments required to limit post-operative inflammatory relapses.
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Affiliation(s)
- Julie Molimard
- Pediatric diseases and Rheumatology, CHU Bordeaux, Bordeaux, France.
| | - Christine Pajot
- grid.411175.70000 0001 1457 2980Department of Pediatric Nephrology, Internal Medicine and Hypertension, CHU Toulouse, Toulouse, France
| | - Priscille Olle
- grid.414282.90000 0004 0639 4960Department of Ophtalmology, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | - Alexandre Belot
- grid.413852.90000 0001 2163 3825Department of Pediatric Nephrology, Rheumatology, Dermatology, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Femme Mère Enfant, CHU Lyon, Lyon, France
| | - Pierre Quartier
- grid.412134.10000 0004 0593 9113Paediatric Hematology-Immunology and Rheumatology Department, Reference centre for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Florence Uettwiller
- grid.411167.40000 0004 1765 1600Department of Allergology and Clinical Immunology, Hôpital Clocheville, CHRU de Tours, Tours, France
| | - Chloé Couret
- grid.277151.70000 0004 0472 0371Department of Ophtalmology, Hôtel-Dieu, CHU Nantes, Nantes, France
| | - Valentine Coste
- grid.42399.350000 0004 0593 7118Department of Ophtalmology, CHU Bordeaux, Bordeaux, France
| | - Camille Costet
- grid.42399.350000 0004 0593 7118Department of Ophtalmology, CHU Bordeaux, Bordeaux, France
| | - Bahram Bodaghi
- grid.411439.a0000 0001 2150 9058Department of Ophtalmology, Hopital Pitié-Salpêtrière, APHP, Paris, France
| | - Pascal Dureau
- grid.417888.a0000 0001 2177 525XPediatric Ophthalmology Department, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Marion Bailhache
- grid.42399.350000 0004 0593 7118Department of Pediatric emergencies, CHU Bordeaux, Bordeaux, France
| | - Pascal Pillet
- grid.42399.350000 0004 0593 7118Pediatric diseases and Rheumatology, CHU Bordeaux, Bordeaux, France
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Sudhalkar A, Vasavada A, Bhojwani D, Vasavada V, Vasavada S, Vasavada V, Srivastava S. Intravitreal dexamethasone implant as an alternative to systemic steroids as prophylaxis for uveitic cataract surgery: a randomized trial. Eye (Lond) 2019; 34:491-498. [PMID: 31320735 DOI: 10.1038/s41433-019-0534-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 06/19/2019] [Accepted: 07/01/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine the utility of the dexamethasone implant (IVD) as an alternative to systemic steroids as prophylaxis against cystoid macular edema (CMO) in patients with chronic, recurrent CMO associated intermediate or posterior uveitis (IU/PU), and cataract undergoing cataract surgery. METHODS This was a randomized, parallel design, and clinical trial. Patients with IU/PU and cataract scheduled for cataract surgery were randomly assigned to receive the IVD concurrently with cataract surgery (Group 1: 20 patients) or systemic steroids (Group 2: 23 patients) tapered over 4-6 weeks along with uneventful cataract surgery and routine postoperative care. Patients with glaucoma/contraindications to steroids were excluded. All patients were followed up for 6 months. OUTCOME MEASURE Primary-incidence of postoperative CMO. Secondary-the change in BCVA (corrected distance visual acuity) and Central Subfield thickness (CST) and complications. Appropriate statistical analysis was done. RESULTS The median age was 47.3 ± 4.23 years (group 1) and 49.12 ± 5.32 years (Group 2). One patient (Group 1) and two (Group 2) developed CMO. The BCVA improved significantly in both groups (p = 0.013). The CST change was insignificant. Four patients (Group 1) required intraocular pressure (IOP) lowering medications. Three patients (Group 2) required early steroid taper. CONCLUSIONS IVD is a good alternative as prophylaxis in IU/PU and cataract in preventing postoperative CMO.
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Affiliation(s)
- Aditya Sudhalkar
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India.
| | - Abhay Vasavada
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India
| | - Deepak Bhojwani
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India
| | - Viraj Vasavada
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India
| | - Shail Vasavada
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India
| | - Vaishali Vasavada
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India
| | - Samaresh Srivastava
- Raghudeep Eye Hospital and Ila Devi Cataract and IOL Research Centre, Ahmedabad, India
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Jinagal J, Gupta G, Agarwal A, Aggarwal K, Akella M, Gupta V, Suri D, Gupta A, Singh S, Ram J. Safety and efficacy of dexamethasone implant along with phacoemulsification and intraocular lens implantation in children with juvenile idiopathic arthritis associated uveitis. Indian J Ophthalmol 2019; 67:69-74. [PMID: 30574896 PMCID: PMC6324120 DOI: 10.4103/ijo.ijo_713_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of intraoperative intravitreal dexamethasone implant in patients of juvenile idiopathic arthritis (JIA)-associated uveitis undergoing phacoemulsification with posterior chamber intraocular lens (PCIOL) implantation. METHODS Retrospectively, data of patients with JIA-associated uveitis undergoing phacoemulsification with PCIOL implantation with intraoperative dexamethasone implant injection were analyzed. Patients with a minimum follow-up of 6 months were included. Primary outcome measures were ocular inflammation, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and worsening of uveitis. RESULTS 8 eyes of 6 patients were included. BCVA was significantly improved at 1, 3, and 6 months postoperatively 0.20 ± 0.09, P = 0.008; 0.18 ± 0.11, P = 0.008; and 0.24 ± 0.11, P = 0.01, respectively. No statistical difference noted in mean IOP at various follow-up visits. None developed worsening of uveitis or Cystoid macular edema. CONCLUSION Intraoperative intravitreal dexamethasone implant is a safe and effective in preventing and managing the postoperative inflammation in children with JIA-associated uveitic cataract.
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Affiliation(s)
- Jitender Jinagal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Gaurav Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Aniruddha Agarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Kanika Aggarwal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Madhuri Akella
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepti Suri
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Anju Gupta
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Surjit Singh
- Department of Pediatrics, Division of Allergy and Immunology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Heiligenhaus A, Minden K, Tappeiner C, Baus H, Bertram B, Deuter C, Foeldvari I, Föll D, Frosch M, Ganser G, Gaubitz M, Günther A, Heinz C, Horneff G, Huemer C, Kopp I, Lommatzsch C, Lutz T, Michels H, Neß T, Neudorf U, Pleyer U, Schneider M, Schulze-Koops H, Thurau S, Zierhut M, Lehmann HW. Update of the evidence based, interdisciplinary guideline for anti-inflammatory treatment of uveitis associated with juvenile idiopathic arthritis. Semin Arthritis Rheum 2018; 49:43-55. [PMID: 30595409 DOI: 10.1016/j.semarthrit.2018.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Uveitis in juvenile idiopathic arthritis (JIAU) is frequently associated with the development of complications and visual loss. Topical corticosteroids are the first line therapy, and disease modifying anti-rheumatic drugs (DMARDs) are commonly used. However, treatment has not been standardized. METHODS Interdisciplinary guideline were developed with representatives from the German Ophthalmological Society, Society for Paediatric Rheumatology, Professional Association of Ophthalmologists, German Society for Rheumatology, parents' group, moderated by the Association of the Scientific Medical Societies in Germany. A systematic literature analysis in MEDLINE was performed, evidence and recommendations were graded, an algorithm for anti-inflammatory treatment and final statements were discussed in a consensus meeting (Nominal Group Technique), a preliminary draft was fine-tuned and discussed thereafter by all participants (Delphi procedure). RESULTS Consensus was reached on recommendations, including a standardized treatment strategy according to uveitis severity in the individual patient. Thus, methotrexate shall be introduced for uveitis not responding to low-dose (≤ 2 applications/day) topical corticosteroids, and a TNFalpha antibody (preferably adalimumab) used, if uveitis inactivity is not achieved. In very severe active uveitis with uveitis-related deterioration of vision, systemic corticosteroids should be considered for bridging until DMARDs take effect. If TNFalpha antibodies fail to take effect or lose effect, another biological should be selected (tocilizumab, abatacept or rituximab). De-escalation of DMARDs should be preceded by a period of ≥ 2 years of uveitis inactivity. CONCLUSIONS An interdisciplinary, evidence-based treatment guideline for JIAU is presented.
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Affiliation(s)
- A Heiligenhaus
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany.
| | - K Minden
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Tappeiner
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H Baus
- The Participation of the Following Bodies: Parents' Group for Children with Uveitis and their Families, Germany
| | - B Bertram
- Professional Association of Ophthalmologists (BVA), Germany
| | - C Deuter
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - I Foeldvari
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - D Föll
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Frosch
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - G Ganser
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - M Gaubitz
- German Society of Rheumatology (DGRh), Germany
| | - A Günther
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Heinz
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - G Horneff
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - C Huemer
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - I Kopp
- Association of the Scientific Medical Societies in Germany (AWMF), Germany
| | - C Lommatzsch
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - T Lutz
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - H Michels
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - T Neß
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - U Neudorf
- The Society for Paediatric Rheumatology (GKJR), Germany
| | - U Pleyer
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Schneider
- German Society of Rheumatology (DGRh), Germany
| | | | - S Thurau
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - M Zierhut
- Department of Ophthalmology, Guideline of the German Ophthalmological Society (DOG), St. Franziskus Hospital, Hohenzollernring 74, 48145 Muenster, Germany
| | - H W Lehmann
- The Society for Paediatric Rheumatology (GKJR), Germany
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Guindolet D, Dureau P, Terrada C, Edelson C, Barjol A, Caputo G, LeHoang P, Bodaghi B. Cataract Surgery with Primary Lens Implantation in Children with Chronic Uveitis. Ocul Immunol Inflamm 2016; 26:298-304. [PMID: 27599095 DOI: 10.1080/09273948.2016.1213855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the evolution of chronic uveitis in children undergoing cataract surgery with primary intraocular lens (IOL) implantation. METHODS Twelve children with chronic uveitis underwent cataract surgery with primary posterior chamber intraocular lens (IOL) implantation. RESULTS Fourteen eyes were implanted with a foldable hydrophobic acrylic IOL. The mean follow-up was 35.39 months (8.72-69.57). The mean BCDVA before surgery and at the end of follow-up was 1.11 (0.40-2.30; SD: 0.57) and 0.48 (0-3; SD: 0.77; p=0.007) respectively. The mean oral corticosteroids dosage after surgery and at the end of follow-up was 0.80 mg/kg/day (SD: 0.37) and 0.17 mg/kg/day (SD: 0.24; p=0.001) respectively. All patients except one were treated with methotrexate. Four patients (5 eyes) were additionally treated with anti-tumor necrosis factor agent. CONCLUSIONS Cataract surgery with primary posterior chamber hydrophobic IOL implantation is possible and leads to a good visual recovery in cases of pediatric chronic uveitis. This surgery requires aggressive anti-inflammatory management with immunosuppressive drugs to control inflammation and reduce the corticosteroids dosage.
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Affiliation(s)
- Damien Guindolet
- a Deptartment of Ophthalmology , DHU Vision and Handicaps , Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.,b Deptartment of Ophthalmology , DHU Vision and Handicaps , Hôpital Pitié-Salpêtrière, Paris , France
| | - Pascal Dureau
- a Deptartment of Ophthalmology , DHU Vision and Handicaps , Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Céline Terrada
- b Deptartment of Ophthalmology , DHU Vision and Handicaps , Hôpital Pitié-Salpêtrière, Paris , France
| | - Catherine Edelson
- a Deptartment of Ophthalmology , DHU Vision and Handicaps , Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Amandine Barjol
- a Deptartment of Ophthalmology , DHU Vision and Handicaps , Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Georges Caputo
- a Deptartment of Ophthalmology , DHU Vision and Handicaps , Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Phuc LeHoang
- b Deptartment of Ophthalmology , DHU Vision and Handicaps , Hôpital Pitié-Salpêtrière, Paris , France
| | - Bahram Bodaghi
- b Deptartment of Ophthalmology , DHU Vision and Handicaps , Hôpital Pitié-Salpêtrière, Paris , France
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Mehta H, Gillies M, Fraser-Bell S. Perspective on the role of Ozurdex (dexamethasone intravitreal implant) in the management of diabetic macular oedema. Ther Adv Chronic Dis 2015; 6:234-45. [PMID: 26336592 DOI: 10.1177/2040622315590319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diabetic macular oedema (DMO) is the most common cause of visual loss in the working age population. Intravitreal therapy has superseded macular laser as the first-line treatment for the management of centre-involving DMO in most patients. As well as the proven efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, phase II and III clinical trials of Ozurdex intravitreal dexamethasone implants for DMO have also demonstrated a mean increase in visual acuity and corresponding mean reduction in central macular thickness, particularly in pseudophakic eyes. Because of the risk of visual loss from cataract, glaucoma and intraocular infection with the use of intravitreal steroids, Ozurdex tends to be reserved for use in patients unresponsive to anti-VEGF therapy for centre-involving DMO. Situations where Ozurdex may be considered a first-line treatment option for eyes with centre-involving DMO include pseudophakia, impending cataract surgery, or in the context of a recent arterial thromboembolic event. Because of their stable pharmacokinetics, Ozurdex slow-release implants may also be considered in vitrectomized eyes.
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Affiliation(s)
- Hemal Mehta
- The Save Sight Institute, University of Sydney, Australia
| | - Mark Gillies
- The Save Sight Institute, University of Sydney, Australia
| | - Samantha Fraser-Bell
- Macula Research Group, Save Sight and Eye Health Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW 2000, Australia
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Sella R, Oray M, Friling R, Umar L, Tugal-Tutkun I, Kramer M. Dexamethasone intravitreal implant (Ozurdex®) for pediatric uveitis. Graefes Arch Clin Exp Ophthalmol 2015; 253:1777-82. [PMID: 26228441 DOI: 10.1007/s00417-015-3124-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/24/2015] [Accepted: 07/18/2015] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the safety and effectiveness of an intravitreally injected dexamethasone-containing implant (Ozurdex(®)) in the treatment of uveitis in children. METHODS The study group included ten patients (14 eyes) aged 6.5-15 years (mean age 12 years) with intermediate or posterior uveitis who were treated with the Ozurdex implant at two tertiary medical centers between 2009 and 2014, following an insufficient response to standard uveitis therapy. All were followed for at least 6 months (mean 12.2 ± 4.9 months). Clinical data before and after treatment were collected retrospectively from the medical files. Outcome measures were best corrected visual acuity, vitreous haze, and macular thickness. Ocular complications were documented. RESULTS Visual acuity improved in 12 eyes (86 %) and intraocular inflammation decreased in 13 eyes (93 %) from 1 week to 3 months after the first injection. Macular edema decreased in all eyes from 1 month to 3 months after the first injection. Five patients underwent repeated injections because of an increase in macular thickness at 3-6 month follow-up. Complications included cataract progression in one patient after one injection and cataract formation in two patients after two injections, and an elevation in intraocular pressure in two patients who responded well to topical treatment. CONCLUSIONS Both single and repeated injections of a dexamethasone-containing implant are safe and effective for the treatment of noninfectious intermediate and posterior uveitis in children. The duration of the beneficial effect may be limited. More data are required to establish the safety profile of the implant in the pediatric age group.
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Affiliation(s)
- Ruti Sella
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, 49100, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Merih Oray
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ronit Friling
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, 49100, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lewaa Umar
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, 49100, Israel
| | - Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Michal Kramer
- Department of Ophthalmology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, 49100, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ragam AP, Kolomeyer AM, Nayak NV, Chu DS. The Use of Ozurdex (Dexamethasone Intravitreal Implant) During Anterior Segment Surgery in Patients with Chronic Recurrent Uveitis. J Ocul Pharmacol Ther 2015; 31:344-9. [DOI: 10.1089/jop.2015.0009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ashwinee P. Ragam
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School—Doctors Office Center, Newark, New Jersey
| | - Anton M. Kolomeyer
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School—Doctors Office Center, Newark, New Jersey
| | - Natasha V. Nayak
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School—Doctors Office Center, Newark, New Jersey
| | - David S. Chu
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School—Doctors Office Center, Newark, New Jersey
- Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey
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