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Billant J, Douma I, Agard E, Levron A, Bouvarel H, Leroux P, Badri Y, Dot C. [Late steroid-induced ocular hypertension after intravitreal dexamethasone implants: A series of 20 cases]. J Fr Ophtalmol 2023; 46:1039-1046. [PMID: 37758545 DOI: 10.1016/j.jfo.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders. MATERIAL AND METHODS A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg). RESULTS Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively. CONCLUSION Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).
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Affiliation(s)
- J Billant
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France.
| | - I Douma
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - E Agard
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - A Levron
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - H Bouvarel
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - P Leroux
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - Y Badri
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France; École du Val-de-Grâce, Paris, France; Service d'ophtalmologie, hôpital Édouard-Herriot, hospices civils de Lyon, Lyon, France
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2
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Mehanna CJ, Souied E, Coscas F, Razavi S, Cohen SY. [Update on practice of intravitreal injections. Recommendations of the Fédération France Macula, the Société française de la rétine, and the Club francophone des spécialistes de la rétine]. J Fr Ophtalmol 2023; 46:956-960. [PMID: 37120345 DOI: 10.1016/j.jfo.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 05/01/2023]
Affiliation(s)
- C-J Mehanna
- Centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - E Souied
- Centre hospitalier intercommunal de Créteil, 94000 Créteil, France; Fédération France Macula, CHIC, 94000 Créteil, France
| | - F Coscas
- Société française de la rétine, 113, boulevard Saint-Germain, 75006 Paris, France
| | - S Razavi
- Club francophone des spécialistes de la rétine, 2, rue Ambroise-Paré, 75010 Paris, France
| | - S-Y Cohen
- Centre hospitalier intercommunal de Créteil, 94000 Créteil, France; Centre ophtalmologique d'imagerie et de laser, 11, rue Antoine-Bourdelle, 75015 Paris, France.
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3
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Dot C, Poli M, Aptel F, Labbe A, Kodjikian L, Baillif S, Bodaghi B, Denis P. Ocular hypertension and intravitreal steroids injections, update in 2023. French guidelines of the French glaucoma society and the French ophthalmology society. J Fr Ophtalmol 2023; 46:e249-e256. [PMID: 37302867 DOI: 10.1016/j.jfo.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
These guidelines are a consensus of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in a third of the cases after corticosteroid implant intravitreal injections. They update the first guidelines published in 2017. Two implants are marketed in France: the dexamethasone implant (DEXi) and the fluocinolone acetonide implant (FAci). It is essential to assess the pressure status before injecting a patient with a corticosteroid implant. A molecule-specific monitoring of the intraocular pressure is needed throughout the follow-up and at the time of reinjections. Real-life studies have allowed optimizing the management algorithm by significantly increasing the safety of these implants. Corticosteroid testing with DEXi should be performed before switching to FAci to optimize pressure tolerance of FAci. Beyond topical hypotensive treatments, selective laser trabeculoplasty may be considered in the therapeutic arsenal for the management of steroid-induced OHT and subsequent injections.
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Affiliation(s)
- C Dot
- HIA Desgenettes/CHU E. Herriot, Lyon, France.
| | - M Poli
- Pôle vision, Ecully, France
| | | | - A Labbe
- CHNO des XV-XX, Paris, France
| | | | | | - B Bodaghi
- CHU de Pitié Salpétrière, Paris, France
| | - P Denis
- CHU de Croix-Rousse, Lyon, France
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4
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Dot C, Poli M, Aptel F, Labbe A, Kodjikian L, Baillif S, Bodaghi B, Denis P. [Intraocular pressure elevation and intravitreal steroid implant injection: State of the art in 2023. Recommendations of the French Glaucoma Society and French Ophthalmology Society [French version]]. J Fr Ophtalmol 2023; 46:803-810. [PMID: 37481449 DOI: 10.1016/j.jfo.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
These are the recommendations of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in 1/3 of cases after intravitreal steroid implant injections. They are an update to the recommendations first published in 2017. There are two implants on the French market: the dexamethasone (DEXi) and fluocinolone acetonide (FAci) implants. It is important to know the pressure status before injecting a patient with a steroid implant. Monitoring of the IOP adapted to the specific drug is necessary throughout follow-up and reinjections. Real-life studies have made it possible to optimize the management algorithm by significantly increasing the safety of use of these implants. A corticosteroid test with DEXi is necessary before switching to FAci to optimize the pressure tolerance of the latter. In addition to topical glaucoma medications, SLT laser can be considered in the therapeutic arsenal for the management of steroid-induced OHT and future injections.
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Affiliation(s)
- C Dot
- HIA Desgenettes, CHU É.-Herriot, Lyon, France.
| | - M Poli
- Pôle vision, Écully, France
| | | | - A Labbe
- CHNO des XV-XX, Paris, France
| | | | | | - B Bodaghi
- CHU Pitié-Salpêtrière, Paris, France
| | - P Denis
- CHU Croix-Rousse, Lyon, France
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5
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Daka Q, Špegel N, Atanasovska Velkovska M, Steblovnik T, Kolko M, Neziri B, Cvenkel B. Exploring the Relationship between Anti-VEGF Therapy and Glaucoma: Implications for Management Strategies. J Clin Med 2023; 12:4674. [PMID: 37510790 PMCID: PMC10380425 DOI: 10.3390/jcm12144674] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/03/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
A short-term increase in intraocular pressure (IOP) is a common side effect after intravitreal anti-VEGF therapy, but a sustained increase in IOP with the development of secondary glaucoma has also been reported in some studies after repeated intravitreal anti-VEGF injections. The aim of this review is to present and discuss the possible pathophysiological mechanisms and factors contributing to a sustained rise in IOP, as well as treatment strategies for patients at risk. Close monitoring and adjustable IOP-lowering treatment are recommended for high-risk patients, including those with glaucoma, angle-closure anomalies, ocular hypertension or family history of glaucoma; patients receiving a high number of injections or at shorter intervals; and patients with capsulotomy. Strategies are needed to identify patients at risk in a timely manner and to prevent sustained elevation of IOP.
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Affiliation(s)
- Qëndresë Daka
- Department of Pathophysiology, Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Eye Clinic, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Špegel
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Tjaša Steblovnik
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet, 2600 Glostrup, Denmark
| | - Burim Neziri
- Department of Pathophysiology, Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Barbara Cvenkel
- Department of Ophthalmology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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6
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Mathis T, Rezkallah A, Ricard C, Vartin C, Abukhashabah A, Devin F, Kodjikian L. REAL WORLD STUDY COMPARING PHAKIC VERSUS PSEUDOPHAKIC EYES IN DIABETIC MACULAR EDEMA TREATED WITH DEXAMETHASONE IMPLANT: The PHAKIDEX Study. Retina 2023; 43:1088-1096. [PMID: 36977332 DOI: 10.1097/iae.0000000000003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE Dexamethasone implant (DEX-implant) is one treatment choice in diabetic macular edema. However, steroid-induced cataract is a common complication when treating a chronic disease and could lead to vision loss. Because of the lack of studies specifically focused on the functional outcomes according to the lens status, the authors therefore aim to analyze the effectiveness and safety of DEX-implant treatment for diabetic macular edema in phakic versus pseudophakic eyes. METHODS This multicenter, retrospective study conducted in France included eyes of consecutive patients who had received a DEX-implant for diabetic macular edema. RESULTS A total of 328 eyes were included: 158 eyes (48.2%) were phakic, 167 eyes (50.9%) were pseudophakic and three were unknown. According to the lens status, mean change in best-corrected visual acuity from baseline was never significantly different between phakic and pseudophakic eyes (likelihood ratio test, P = 0.09) nor in the change in central macular thickness (likelihood ratio test, P = 0.79) in multivariate analysis. Cataract surgery was performed in 63 phakic eyes (39.9%) during the study period with a mean delay of 8.1 months (CI95% [6.59-9.69]). The mean change in best-corrected visual acuity between phakic eyes who underwent cataract surgery and those who did not, was not significantly different during the follow-up at each visit. The risk of ocular hypertension was not statistically different between phakic and pseudophakic subsets ( P = 0.9). CONCLUSION The authors showed here that phakic eyes treated with DEX-implant for diabetic macular edema did not have a significant difference in visual gain in comparison to pseudophakic eyes, with a comparable safety profile.
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Affiliation(s)
- Thibaud Mathis
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Univ Lyon, UCBL, INSA Lyon, CNRS, MATEIS, UMR5510, Villeurbanne, France
| | - Amina Rezkallah
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
| | - Cécile Ricard
- StatMed74, Independent Epidemiologist, Annecy, France
| | - Cristina Vartin
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Amro Abukhashabah
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Devin
- Centre Monticelli Paradis, Marseille, France; and
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Univ Lyon, UCBL, INSA Lyon, CNRS, MATEIS, UMR5510, Villeurbanne, France
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7
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Calci C, Castro DG, Schuetz YP, Mermoud A, Ambresin A. Rapidly Progressive Visual Field Deterioration in a Glaucomatous Patient Treated with Several Anti-VEGF Injections for Neovascular AMD: A Case Report. Klin Monbl Augenheilkd 2023; 240:478-480. [PMID: 37164425 DOI: 10.1055/a-2004-5664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Coraline Calci
- Ophthalmology, Swiss Visio Montchoisi - Centre B Lausanne, CH, Lausanne, Switzerland
| | | | | | - André Mermoud
- Ophthalmology, Swiss Visio Montchoisi - Centre B Lausanne, CH, Lausanne, Switzerland
- Ophthalmology, Swiss Glaucoma Research Fondation, Lausanne, Switzerland
| | - Aude Ambresin
- Ophthalmology, Swiss Visio Montchoisi - Centre B Lausanne, CH, Lausanne, Switzerland
- Ophthalmology, Swiss Visio Retina Research, Center, Lausanne, Switzerland
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8
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Rezkallah A, Kodjikian L, Barbarroux A, Laventure C, Motreff A, Chacun S, Matonti F, Denis P, Mathis T. Intra-Ocular Pressure Response to Dexamethasone Implant Injections in Patients with a History of Filtering Surgery: The TRABEX Study. Pharmaceutics 2022; 14:pharmaceutics14091756. [PMID: 36145504 PMCID: PMC9502767 DOI: 10.3390/pharmaceutics14091756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with both macular edemas, of various etiologies such as diabetes and glaucoma, may suffer serious loss of vision if either disease goes untreated. Where no effective alternative therapies are available, dexamethasone implant (DEX-I) injections may be the only choice of treatment, despite the risk of a possible increase in intraocular pressure (IOP) when using steroids. Although many studies have reported on IOP evolution in eyes treated with DEX-I, little is known specifically about eyes with a history of filtering surgery. The aim of this observational series was to evaluate the IOP response following DEX-I injection in eyes presenting conventional filtering surgeries or microinvasive glaucoma surgeries (MIGS). Twenty-five eyes were included in this study. A total of 64% of the eyes did not experience OHT during follow-up. Additional IOP-lowering therapy was needed for 32% of eyes, and 20% of eyes (all showing bleb fibrosis) required further filtering surgery: 50% of eyes in the MIGS group and 10.5% of eyes in the conventional filtering surgery group. A significant positive correlation was found between IOP at baseline and the maximum IOP throughout follow-ups after DEX-I (r = 0.45, p = 0.02). In conclusion, if DEX-I is used when there are no alternative therapies for treating macular edema, IOP in eyes with a history of filtering surgery is generally manageable. Those eyes which previously underwent conventional therapy with effective blebs obtained better IOP control after DEX-I injections and mostly did not require any additional IOP-lowering therapy or surgery.
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Affiliation(s)
- Amina Rezkallah
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
| | - Aymeric Barbarroux
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Corentin Laventure
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Antoine Motreff
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Samuel Chacun
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Frédéric Matonti
- Centre Monticelli Paradis, 13008 Marseille, France
- CNRS, INT, Institut Neuroscience Timone, Univeristé Aix Marseille, 13005 Marseille, France
- Groupe Almaviva Santé, Clinique Juge, 13008 Marseille, France
| | - Philippe Denis
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thibaud Mathis
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
- Correspondence:
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9
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Use of selective laser trabeculoplasty as an alternative in patients who developed ocular hypertension after intravitreal dexamethasone implants: a series of 35 eyes. Graefes Arch Clin Exp Ophthalmol 2022; 260:3665-3673. [PMID: 35665853 DOI: 10.1007/s00417-022-05725-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Steroid-induced ocular hypertension (OHT) occurs in about a third of cases after dexamethasone implant (DEXi) intravitreal injection (IVI), for which treatment discontinuation may be required. The aim of this study was to assess the benefit of selective laser trabeculoplasty (SLT) in patients who developed transient OHT after DEXi injection to prevent subsequent steroid-induced OHT peaks during reinjections. METHODS A real-life, retrospective, and observational study was conducted to assess the intraocular pressure (IOP) after SLT in steroid responders after DEXi injection (IOP > 21 mmHg). Were analyzed: IOP 1 and 2 months after SLT, maximum IOP (IOPmax) after each new DEXi IVI, and the number of prophylactic hypotensive treatments needed at the time of DEXi reinjections. RESULTS Thirty-five eyes of 29 patients were included. The mean macular edema follow-up duration was 38.4 ± 28.4 months. SLT was performed after a mean number of 6.3 ± 4.7 DEXi IVIs. After SLT, the IOPmax measured after the first reinjection was lowered by 36.6 ± 14.7% (p < 0.0001). The mean number of hypotensive treatments was 2.1 ± 0.9 before versus 1.5 ± 0.8 after SLT. The post-reinjection lowering in OHT peak was maintained during the subsequent 3 DEXi IVIs: - 29.1 ± 25.5% (p = 0.0009), - 35.8 ± 13.1% (p = 0.0078), and - 45.4 ± 8.6% (p = 0.0312) after the second, third, and fourth DEXi reinjections. SLT allowed continuing injections in 88.6% of patients. CONCLUSION The use of 180° SLT in this indication could be an effective therapeutic alternative to control steroid-induced OHT and safely continue DEXi injections.
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Mathis T, Papegaey M, Ricard C, Rezkallah A, Matonti F, Sudhalkar A, Vartin C, Dot C, Kodjikian L. Efficacy and Safety of Intravitreal Fluocinolone Acetonide Implant for Chronic Diabetic Macular Edema Previously Treated in Real-Life Practice: The REALFAc Study. Pharmaceutics 2022; 14:pharmaceutics14040723. [PMID: 35456557 PMCID: PMC9025285 DOI: 10.3390/pharmaceutics14040723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients and a chronic disease requiring long-term treatments. The fluocinolone acetonide (FAc) implant has recently been approved to treat DME in patients considered insufficiently responsive to available therapies. This study evaluates the functional and anatomical efficacy of the FAc implant in real-life practice. A total of 62 eyes with chronic DME were included and followed for a mean of 13.9 (+7.5) months. Previous treatment included at least anti-vascular endothelial growth factor (VEGF) in 83.9% of eyes, dexamethasone implant (DEX-I) in 100% of eyes, vitrectomy in 29.0% of eyes, and laser photocoagulation (either panretinal or focal photocoagulation) in 75.8% of eyes. The mean baseline best corrected visual acuity (BCVA) was 64.0 (+/−17.2) letters (median: 67.5 letters) with a mean DME duration of 60.3 (+/−30.6) months. The maximum BCVA gain occurred at 21 months with a mean gain of 5.0 (+/−12.7) letters. A total of 50.0% of eyes gained ≥5 letters during follow-up. Patients with lower BCVA at baseline had the lowest final BCVA (p < 0.001) but the highest BCVA gain (p = 0.02). The best overall improvement in mean central macular thickness (CMT) occurred at 18 months (p < 0.0001). The improvement in BCVA was inversely associated with the decrease in CMT and showed a decrease when CMT increased (DME recurrence). According to the history of vitrectomy, we did not find any significant difference in mean final BCVA (p = 0.1) and mean BCVA gain (p = 0.2) between eyes previously vitrectomized or not. A total of 23 eyes (37.1%) required additional treatment for DME, and 17.7% required an IOP-lowering procedure during follow-up. In conclusion, this real-life observational study demonstrated the efficacy and safety of the FAc implant in patients with chronic DME already treated with other available therapies.
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Affiliation(s)
- Thibaud Mathis
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
- Correspondence: (T.M.); (L.K.)
| | - Maxence Papegaey
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
| | | | - Amina Rezkallah
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
| | - Frédéric Matonti
- Centre Monticelli Paradis, 13008 Marseille, France;
- Institut Neuroscience Timone, Univeristé Aix Marseille, CNRS, INT, 13005 Marseille, France
- Groupe Almaviva Santé, Clinique Juge, 13008 Marseille, France
| | | | - Cristina Vartin
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
| | - Corinne Dot
- Service d’Ophtalmologie, Hôpital Militaire Desgenettes, 69003 Lyon, France;
- Hôpital D’instruction des Armées, Val-de-Grâce, 75005 Paris, France
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
- Correspondence: (T.M.); (L.K.)
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11
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Kodjikian L, Bandello F, de Smet M, Dot C, Zarranz-Ventura J, Loewenstein A, Sudhalkar A, Bilgic A, Cunha-Vaz J, Dirven W, Behar-Cohen F, Mathis T. Fluocinolone acetonide implant in diabetic macular edema: International experts' panel consensus guidelines and treatment algorithm. Eur J Ophthalmol 2022; 32:1890-1899. [PMID: 35139688 DOI: 10.1177/11206721221080288] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Center-involving diabetic macular edema (DME) is a leading cause of vision impairment in working-age adults. While its management is particularly challenging in a poorly compliant population, continuous innovation and the advent of new molecules have improved its outcome. The control of glycemia and of systemic aggravating factors remain essential to slow down progression of disease complications including DME. The indications for macular laser photocoagulation has progressively been phased out as a standard of care and replaced by local intraocular anti-VEGFs biologics and glucocorticoids (GCs). Intravitreal GCs in controlled-release drug delivery systems have allowed to reduce injection frequency and treatment burden. The non biodegradable Fluocinolone Acetonide (FAc) implant allows a long-lasting stabilization of both functional and anatomic improvements. However, adequate patient selection and monitoring through regular follow-up are essential for optimal results. Based on their experience and the latest literature, the aim of the present review is to provide international expert panel consensus on the place of the FAc implant in the treatment algorithm of DME, as well as its safety profile and how to manage it.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University Milan, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marc de Smet
- Department of Ophthalmology, 4496University of Leiden, Leiden, the Netherlands.,MicroInvasive Ocular Surgery Center, Lausanne, Switzerland
| | - Corrine Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.,French Military Health Service Academy, Val de Grâce, Paris, France
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), 16493Hospital Clínic de Barcelona, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alper Bilgic
- Sudhalkar Eye Hospital and Retina Centre, Baroda, India
| | - José Cunha-Vaz
- Faculty of Medicine, AIBILI - Association for Innovation and Biomedical Research on Light and Image, University of Coimbra, Coimbra, Portugal
| | - Werner Dirven
- Department of Ophthalmology, AZ Turnhout Hospital, Turnhout, Belgium
| | - Francine Behar-Cohen
- Department of Ophthalmology, 26935Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, From physiopathology of retinal diseases to clinical advances, Paris, France
| | - Thibaud Mathis
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
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12
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Goñi FJ, Barton K, Dias JA, Diestelhorst M, Garcia-Feijoo J, Hommer A, Kodjikian L, Nicolò M. Intravitreal Corticosteroid Implantation in Diabetic Macular Edema: Updated European Consensus Guidance on Monitoring and Managing Intraocular Pressure. Ophthalmol Ther 2022; 11:15-34. [PMID: 34993882 PMCID: PMC8770785 DOI: 10.1007/s40123-021-00427-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
Intravitreal therapy for diabetic macular edema can, in susceptible patients, increase intraocular pressure (IOP). As uncontrolled IOP can potentially be sight threatening, monitoring is an essential component of patient management. It can be challenging for retina specialists to ensure that monitoring is rigorous enough to detect and resolve any potential problems at the earliest opportunity without it also being overburdensome for patients who have the lowest risk of developing an IOP rise. We have developed dynamic algorithms that: (1) tailor the frequency and extent of monitoring according to individual susceptibility and current IOP and (2) assist retina specialists in deciding when they should consider a referral to a glaucoma specialist. One algorithm is for patients with a relatively low susceptibility to developing an IOP rise (those whose baseline IOP is < 22 mmHg and who do not have a history of IOP events). Depending on their first post-implantation IOP check, the algorithm classifies them as: low risk if IOP remains < 22 mmHg; medium risk if IOP is 22-25 mmHg and any rise from baseline is < 10 mmHg; or high risk if IOP is > 25 mmHg or any rise from baseline is ≥ 10 mmHg. Thereafter, the algorithm guides on the frequency and extent of monitoring required in each of these groups and, if IOP rises or falls during treatment, patients may move up or down the risk groups accordingly. A different algorithm is provided for patients who are more susceptible to developing an IOP rise (those with a baseline IOP of ≥ 22 mmHg or a prior history of an IOP event). These patients need monitoring more closely so this algorithm has only medium- or high-risk classifications. These algorithms update the previous monitoring guidance by Goñi et al. (Goñi et al. in Ophthalmol Ther 5:47-61, 2016).
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Affiliation(s)
- Francisco J. Goñi
- Ophthalmology Department, Mollet Hospital, Ronda dels Pinetons 6, 08100 Mollet del Vallès, Barcelona, Spain
| | - Keith Barton
- Glaucoma Service, Moorfields Eye Hospital, London, UK
| | | | | | - Julián Garcia-Feijoo
- Ophthalmology Department, Complutense University, San Carlos Hospital, Madrid, Spain
| | | | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Lyon, France
- UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
| | - Massimo Nicolò
- University Eye Clinic, DINOGMI, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
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13
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Rezkallah A, Mathis T, Abukhashabah A, Voirin N, Malclès A, Agard É, Lereuil T, Denis P, Dot C, Kodjikian L. LONG-TERM INCIDENCE AND RISK FACTORS OF OCULAR HYPERTENSION FOLLOWING DEXAMETHASONE-IMPLANT INJECTIONS: THE SAFODEX-2 STUDY. Retina 2021; 41:1438-1445. [PMID: 33315814 DOI: 10.1097/iae.0000000000003080] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To analyze the incidence, risk factors, and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of dexamethasone implant and to evaluate the long-term cumulative probability of intraocular pressure elevation. METHODS Eyes of patients having received at least one dexamethasone implant IVI between October 2010 and February 2015 were included in the present study. Ocular hypertension was defined as intraocular pressure > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline intraocular pressure. RESULTS Four hundred ninety-four eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion, and glaucoma treated with a double- or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (P = 0.248). CONCLUSION This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of intraocular pressure elevation in a large cohort of eyes treated with dexamethasone implant IVI. Repeat injections of dexamethasone implant neither increase nor decrease the risk of OHT.
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Affiliation(s)
- Amina Rezkallah
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- UMR-CNRS 5510 Matéis, Villeurbane, France
| | - Amro Abukhashabah
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Voirin
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ariane Malclès
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Émilie Agard
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
- French Military Health Service Academy, Val de Grâce, Paris, France
| | - Théo Lereuil
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
- French Military Health Service Academy, Val de Grâce, Paris, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- UMR-CNRS 5510 Matéis, Villeurbane, France
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14
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Mathis T, Lereuil T, Abukashabah A, Voirin N, Sudhalkar A, Bilgic A, Denis P, Dot C, Kodjikian L. Long-term follow-up of diabetic macular edema treated with dexamethasone implant: a real-life study. Acta Diabetol 2020; 57:1413-1421. [PMID: 32656710 DOI: 10.1007/s00592-020-01561-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022]
Abstract
AIMS To evaluate the efficacy and safety of intravitreal dexamethasone implant (DEX-implant) for diabetic macular edema (DME) in real-life practice with an extended follow-up for up to 5 year. METHODS This multicentric retrospective study reviewed 227 eyes of 152 patients with DME treated by DEX-implant. Main outcome measures included changes in best corrected visual acuity (BCVA), central macular thickness (CMT), time to retreatment and incidence of adverse effects. RESULTS The mean number of DEX-implant received by patients was 2.6 (± 2.2) with a mean (SD) follow-up of 20.1 (± 15.8) months, median [IQR] 15.8 [7.4-30.1]. The mean time of retreatment was 6.9 months. The mean maximal BCVA gain during follow-up was 12.3 (± 12.7) letters. A gain of ≥ 5, ≥ 10 and ≥ 15 letters from baseline BCVA was obtained for 71.8%, 48.9% and 34.8% of eyes, respectively. A total of 62.6% of eyes presented a significant anatomical response (decrease of CMT ≥ 20%), and DME was resolved (absence of cystoid macular spaces on OCT) in 37% of cases at the end of the follow-up. A transient increase in intraocular pressure ≥ 25 mmHg occurred in 14.1% of eyes, and cataract surgery was performed for 49.1% of the phakic eyes during the follow-up. Four eyes developed a proliferative diabetic retinopathy. CONCLUSION This large cohort study showed favorable long-term outcomes when using DEX-implant, which provides substantial long-term benefits in the treatment of DME in real life.
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Affiliation(s)
- Thibaud Mathis
- Service D'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
- Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, Villeurbane, France
| | - Théo Lereuil
- Service D'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
| | - Amro Abukashabah
- Service D'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
| | - Nicolas Voirin
- EPIMOD, 75 route du Mas Vernon, Dompierre Sur Veyle, France
| | - Aditya Sudhalkar
- Alphavision Augenzentrum, Bremerhaven, Germany
- MS Sudhalkar Medical Research Foundation, Baroda, India
| | | | - Philippe Denis
- Service D'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France
- French Military Health Service Academy of Val-de-Grâce, Paris, France
| | - Laurent Kodjikian
- Service D'Ophtalmologie, Hôpital Universitaire de La Croix-Rousse, Hospices Civils de Lyon, Université Lyon 1, 103, Grande Rue de la Croix-Rousse, 69317, Lyon Cedex 04, France.
- Laboratoire UMR-CNRS 5510 Matéis, Université Lyon 1, Villeurbane, France.
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15
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The Effect of Selective Laser Trabeculoplasty on Intraocular Pressure in Patients with Dexamethasone Intravitreal Implant-Induced Elevated Intraocular Pressure. J Ophthalmol 2020; 2020:3439182. [PMID: 33110658 PMCID: PMC7578731 DOI: 10.1155/2020/3439182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/13/2020] [Accepted: 09/26/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction To assess the safety and efficacy of selective laser trabeculoplasty (SLT) for ocular hypertension (OHT) induced by a dexamethasone (DEX) intravitreal implant. Materials and Methods We performed a retrospective study of patients who underwent an SLT procedure for ocular hypertension induced by injection of a DEX intravitreal implant. Patients had, at least, one injection of the DEX-implant for symptomatic macular edema. SLT was delivered to 360° of the trabecular meshwork in two sessions. The primary outcome was a decrease in IOP, evaluated at one, three, and six months after the SLT procedure. Results Twenty-six eyes of 22 patients were included. The mean intraocular pressure (IOP) measured after DEX-implant injection was 25.4 ± 5.4 mmHg, and the mean increase in IOP was 35.8 ± 14.6%. The mean follow-up after SLT was 18.3 ± 7.7 months. After SLT, the mean IOP dropped by 30.9% at one month (16.9 ± 4.5 mmHg, p=0.01), 33.6% at three months (16.0 ± 2.7 mmHg, p < 0.01), and 34.9% at six months (15.6 ± 2.1 mmHg, p < 0.01). Each patient had a minimum follow-up of 6 months after SLT. Eight eyes (31%) received a second DEX-implant injection after the SLT procedure without experiencing an increase in the IOP above 21 mmHg or >20%. No glaucoma surgery was required during the follow-up. The mean number of medications (1.65 ± 1.36) was significantly reduced at one (1.19 ± 1.20, p=0.04), three (0.96 ± 1.03, p < 0.01), and six months (0.77 ± 0.95, p < 0.01) after SLT. Conclusion SLT is an effective and safe procedure to control OHT following DEX-implant intravitreal injection.
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Majstruk L, Qu-Knafo L, Sarda V, Fajnkuchen F, Nghiem-Buffet S, Grenet T, Chaine G, Giocanti-Auregan A. [Dexamethasone intravitreal implant (Ozurdex) in patients with diabetic macular edema: Real life safety and efficacy]. J Fr Ophtalmol 2020; 43:197-204. [PMID: 32000989 DOI: 10.1016/j.jfo.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE The goal of this study was to investigate the safety and efficacy of the intravitreal dexamethasone implant (DI) for patients with diabetic macular edema (DME) in real life. METHODS We conducted a monocentric retrospective analysis of the change in visual acuity and central macular thickness (CMT) after intravitreal injection of the DI at peak efficacy (2 months after injection) as well as the timing of reinjections and complications in patients with a loss of vision due to DME. RESULTS Forty eyes of 33 patients were included, with a mean follow-up of 12.6 months. Thirty percent of the eyes experienced an increase in best corrected visual acuity (BCVA)>15 letters at peak efficacy (P<0.05) after each ID injection. Treatment-naive patients had a sustained response after Ozurdex injection, with better visual acuity at 3 months (P=0.02) and 4 months (P=0.04) than non-naïve patients and better visual acuity at 6 months despite identical baseline visual acuity (P<0.05). Anatomical efficacy was good, with approximately 60% of patients with CMT<300 microns at peak efficacy after each injection of ID. Thirty percent of eyes demonstrated ocular hypertension (OHT)>25mmHg at peak efficacy, and 12.5% of eyes required cataract surgery during follow-up. CONCLUSION The DI has good functional and anatomic efficacy in these patients, with a good safety profile. Treatment-naïve patients with more recent DME had a more sustained increase in visual acuity after the injections and better visual recovery at 6 months. This encourages us to initiate DI therapy early if there is no response to anti-vascular endothelial growth factor (anti-VEGF) treatment.
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Affiliation(s)
- L Majstruk
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - L Qu-Knafo
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - V Sarda
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - F Fajnkuchen
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - S Nghiem-Buffet
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - T Grenet
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - G Chaine
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A Giocanti-Auregan
- Ophthalmology department, Avicenne hospital, DHU Vision and Handicaps, Paris XIII university, 125, rue de Stalingrad, 93000 Bobigny, France.
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17
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Leleu I, Penaud B, Blumen-Ohana E, Rodallec T, Adam R, Laplace O, Akesbi J, Nordmann JP. [Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery (French translation of the article)]. J Fr Ophtalmol 2018; 41:789-801. [PMID: 30348599 DOI: 10.1016/j.jfo.2018.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 10/28/2022]
Abstract
We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1% and 13% according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.
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Affiliation(s)
- I Leleu
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France.
| | - B Penaud
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - E Blumen-Ohana
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - T Rodallec
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - R Adam
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - O Laplace
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
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18
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Leleu I, Penaud B, Blumen-Ohana E, Rodallec T, Adam R, Laplace O, Akesbi J, Nordmann JP. Late and sustained intraocular pressure elevation related to intravitreal anti-VEGF injections: Cases requiring filtering surgery. J Fr Ophtalmol 2018; 41:e329-e340. [PMID: 30197188 DOI: 10.1016/j.jfo.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/17/2018] [Accepted: 07/24/2018] [Indexed: 01/13/2023]
Abstract
We report cases of delayed, sustained elevated intraocular pressure (IOP) associated with repeated intravitreal anti-VEGF injections (IVI), which ultimately resulted in the need for filtering surgery. Two of the three cases demonstrated severe IOP elevation despite maximal medical treatment following unilateral IVI and required urgent filtering surgery. Optic nerve involvement was severe in all three cases. These intravitreal injections were performed for exudative age-related macular degeneration (AMD), and the patients did not show any sign of glaucoma or ocular hypertension prior to the initiation of treatment. Elevated IOP secondary to intravitreal steroids is a well-known side effect, as is immediate transient IOP elevation associated with anti-VEGF injection. Late, sustained IOP elevation after repeated injections of anti-VEGF, described approximately ten years ago, is often underestimated. Its incidence is estimated between 2.1 % and 13 % according to studies and increases with the number of IVI (cumulative effect). The pathophysiologic process is becoming increasingly understood, and several risk factors for this chronic IOP elevation have been identified. Most often, it is a moderate IOP elevation for which topical monotherapy is sufficient, or sometimes two, three or four medications or even selective laser trabeculoplasty (SLT). However, filtering surgery may rarely be required. Our findings illustrate a little-described phenomenon: a sudden, severe, late IOP elevation in response to anti-VEGF by an "overflow" effect, requiring urgent filtering surgery.
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Affiliation(s)
- I Leleu
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France.
| | - B Penaud
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - E Blumen-Ohana
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - T Rodallec
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - R Adam
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - O Laplace
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J Akesbi
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
| | - J-P Nordmann
- Centre hospitalier national d'ophtalmologie des 15-20, 28, rue de Charenton, 75012 Paris, France
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