Comparison of dexamethasone intravitreal implant with intravitreal anti-VEGF injections for the treatment of macular edema secondary to branch retinal vein occlusion: A meta-analysis

Topical Application of Cell-Penetrating Peptide Modified Anti-VEGF Drug Alleviated Choroidal Neovascularization in Mice

Background

Age-related macular degeneration (AMD) stands as the foremost cause of irreversible central vision impairment, marked by choroidal neovascularization (CNV). The prevailing clinical approach to AMD treatment relies on intravitreal injections of anti-vascular endothelial growth factor (VEGF) drugs. However, this method is encumbered by diverse complications, prompting exploration of non-invasive alternatives such as ocular administration via eye drops for anti-VEGF therapy.

Methods

Two complexes, 5-FITC-CPP-Ranibizumab (5-FCR) and 5-FITC-CPP-Conbercept (5-FCC), were synthesized by incorporating the anti-VEGF drugs Ranibizumab (RBZ) or Conbercept (CBC) with cell-penetrating peptide (CPP). Circular dichroism spectrum (CD) facilitated complexes characterization. Eye drops was utilized to address laser-induced CNV in mice. Fluorescein fundus angiography (FFA) observe the CNV lesion, while FITC-dextran and IB4 dual fluorescent staining, along with hematoxylin-eosin (HE) staining, assessed in lesion size. Tissue immunofluorescence examined CD31 and VEGF expression in choroidal/retinal pigment epithelial (RPE) tissues. Biocompatibility and biosafety of 5-FCR and 5-FCC was evaluated through histological examination of various organs or cell experiments.

Results

Both 5-FCR and 5-FCC exhibited favorable biocompatibility and safety profiles. VEGF-induced migration of Human umbilical vein endothelial cells (HUVECs) significantly decreased post-5-FCR/5-FCC treatment. Additionally, both complexes suppressed VEGF-induced tube formation in HUVECs. FFA results revealed a significant improvement in retinal exudation in mice. Histological examination unveiled the lesion areas in the 5-FCR and 5-FCC groups showed a significant reduction compared to the control group. Similar outcomes were observed in histological sections of the RPE-choroid-sclera flat mounts.

Conclusion

In this study, utilizing the properties of CPP and two anti-VEGF drugs, we successfully synthesized two complexes, 5-FCR and 5-FCC, through a straightforward approach. Effectively delivering the anti-VEGF drugs to the target area in a non-invasive manner, suppressing the progression of laser-induced CNV. This offers a novel approach for the treatment of wet AMD.

Intravitreal Dexamethasone Implant Has Better Retinal Perfusion than Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Retinal Vein Occlusion: A Five-Year Real-World Study

PURPOSE

The purpose of the study was to investigate the long-term effect of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (VEGF) injection on macular edema (ME) secondary to retinal vein occlusion (RVO) in a real-world setting.

METHODS

The medical records of RVO-ME cases, with intravitreal injections and followed up for at least 5 years, were retrospectively reviewed. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were primary outcomes. Images of fluorescence angiography and swept-source optical coherence tomography angiography were analyzed. Foveal avascular zone (FAZ) metrics and perfusion density at the last visit were also compared between the two treatments.

RESULTS

A total of 16 patients were recruited, 8 in the anti-VEGF group and 8 in the DEX group. At the 5th year, the BCVA and the CMT in the DEX group were not different from those in the anti-VEGF group (0.69 ± 0.36 LogMAR vs. 0.57 ± 0.30 LogMAR, p = 0.574; 183.25 ± 97.31 µm vs. 195.38 ± 40.92 µm, p = 0.442). Compared with the anti-VEGF group, the DEX group had higher FAZ circularity index (0.57 ± 0.14 vs. 0.68 ± 0.14, p = 0.130) and higher retinal perfusion density (0.45 ± 0.02 vs. 0.39 ± 0.03, p = 0.001), especially in the deep capillary plexus.

CONCLUSION

DEX implant and anti-VEGF injection had comparative long-term effects on RVO-ME. Compared with the anti-VEGF treatment, the DEX treatment had advantages in maintaining retinal perfusion in patients with RVO.

The Structural and Comparative Analysis of Intravitreal Dexamethasone Implant (Ozurdex) and Anti-VEGF Injection in Branched Retinal Vein Occlusion Patients by Optical Coherence Tomography Angiography Images Quantitation

Background and Objective: To evaluate and compare the structural changes of retinal vasculature after intravitreal dexamethasone implant (Ozurdex) insertion and antivascular endothelial growth factor (anti-VEGF) injection in patients with branched retinal vein occlusion (BRVO) using optical coherence tomography angiography (OCTA).Study Design/Materials and Methods: We retrospectively analyzed 39 patients with unilateral BRVO. Subjects were divided into two groups according to treatment agent: Ozurdex (n = 18) and anti-VEGF (n = 21). Swept Source (SS) OCT and OCTA were performed and images were analyzed quantitatively using ImageJ (National Institutes of Health) software. Intravitreal implant and anti-VEGF injections were performed following a prn regimen. The specific anti-VEGF agent used was chosen among bevacizumab, ranibizumab and aflibercept.Results: Of the 39 patients (mean ± SD age, 70.0 ± 8.9 years [range, 48-89 years]; 20 men [51.0%]) with unilateral BRVO, in an independent two-sample t test, there was greater vascular reperfusion of the choriocapillaris slab in the intravitreal Ozurdex implant group than in the anti-VEGF group using the angiography mode (P = .013). Increased number of particles was more prominent in intravitreal anti-VEGF injection group than intravitreal Ozurdex implant group in outer retina slab of En-face mode (P = .039). There was no statistically significant difference between the 2 treatment groups in relation to the Early Treatment Diabetic Retinopathy Study (ETDRS) density map and other angiography slabs; and the superficial, deep, and outer retina.Conclusions: Results of a quantitative analysis of OCTA images using ImageJ software suggest that the intravitreal Ozurdex implant induced increased retinal vascular perfusion compared with anti-VEGF injection for the treatment of BRVO.

Effect of intravitreal dexamethasone implant versus ranibizumab on vessel density in branch retinal vein occlusion

PURPOSE

This study aimed to compare the effect of intravitreal dexamethasone implant with that of ranibizumab on vessel density (VD) in eyes with branch retinal vein occlusion (BRVO).

METHODS

Sixty-three eyes of 63 patients with superotemporal BRVO treated either with intravitreal dexamethasone implant (DEX group, n = 31) or ranibizumab (RNB group, n = 32) were prospectively enrolled. Swept-source optical coherence tomography angiography 6 × 6 mm scans of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in all eyes were analyzed.

RESULTS

The mean baseline VD of the SCP and the DCP was similar between groups in all quadrants (p > 0.05 for all). At 12 months, the VD of the SCP in the parafoveal superior and temporal quadrants was significantly higher in the RNB group than in the DEX group (p = 0.002 and p = 0.001, respectively). The VD of the DCP in the parafoveal temporal, nasal, and superior quadrants was significantly higher in the RNB group than in the DEX group (p < 0.05 for all). Further, there was a statistically significant positive correlation between the improvement of visual acuity and increased VD of the SCP and the DCP in the parafoveal temporal quadrant in both groups (R = 0.589, p = 0.001 and R = 0.455, p = 0 .017, respectively).

CONCLUSION

Our findings support that ranibizumab does not inhibit collateral vessel formation in eyes with superotemporal BRVO compared to dexamethasone implant. VD and vessel formation can positively affect the vision prognosis in long-term follow-up.

Microcatheter-Assisted Circumferential Trabeculotomy versus Conventional Trabeculotomy for the Treatment of Childhood Glaucoma: A Meta-analysis

Background

The aim of the current meta-analysis was to compare the efficacy of microcatheter-assisted circumferential trabeculotomy (Group 1) with that of conventional trabeculotomy (Group 2) for the treatment of childhood glaucoma.

Methods

Published studies were systematically searched via the Web of Science, PubMed, Embase, and Cochrane Library databases. Odds ratios and 95% confidence intervals were calculated for dichotomous variables. Mean ± the standard deviation, mean difference, and 95% confidence intervals were calculated for continuous variables. Heterogeneity was assessed. Random effects modeling and RevMan version 5.30 were used to analyze the data.

Results

Five eligible studies were included in the meta-analysis. Mean postoperative intraocular pressures were significantly lower in Group 1 than in Group 2 at 3 months (P = 0.03), 6 months (P = 0.03), and 12 months (P = 0.007) postoperatively. The complete success rates were higher in Group 1 than in Group 2 at 3 months (P = 0.008), 6 months (P = 0.01), and 12 months (P = 0.004) postoperatively, as were the respective qualified success rates (P = 0.04, P = 0.0007, and P = 0.001). The pooled estimate indicated lower antiglaucoma medication use in Group 1, especially at 1 month postoperatively (P = 0.003).

Conclusions

Microcatheter-assisted circumferential trabeculotomy resulted in excellent intraocular pressure control, higher success rates, and the utilization of less medication than conventional trabeculotomy for childhood glaucoma. Therefore, microcatheter-assisted circumferential trabeculotomy may be recommended as the initial procedure for the treatment of childhood glaucoma.

Effect of Dexamethasone Intravitreal Implant on Visual Acuity and Foveal Photoreceptor Integrity in Macular Edema Secondary to Retinal Vascular Disease

PURPOSE

The aim of this study was to evaluate the effect of the dexamethasone intravitreal (DEX) implant on the external limiting membrane (ELM) and ellipsoid zone (EZ) integrity in treatment-naïve patients with macular edema (ME) secondary to retinal vascular disease (RVD).

METHODS

This is a retrospective study conducted on patients with ME secondary to RVD, who underwent a DEX implant.

RESULTS

One-hundred eyes were included. Mean age was 70.3 ± 11.1 years. Mean ELM integrity significantly improved from 1,575.9 ± 285.9 μm at baseline to 1,711.7 ± 244.0 μm at month 3 (p < 0.0001). Similarly, there was a significant improvement in EZ integrity from baseline to month 3 (1,531.5 ± 317.1 vs. 1,694.3 ± 252.8 μm, respectively, p < 0.0001). At month 3, mean visual acuity (VA) gain was 9.9 ± 14.1 letters (p < 0.0001). Mean central retinal thickness (CRT) significantly decreased by -193.2 ± 185.7 μm from baseline to month 3 (p < 0.0001). Mean changes in VA and CRT were significantly correlated with baseline ELM integrity (p = 0.0065 and p = 0.0046, respectively) and EZ integrity (p = 0.0300 and p = 0.0035, respectively). At month 3, the proportion of eyes which had an intact ELM (mean difference 16.0%, 95% CI 5.4-26.4%, p = 0.0033) and EZ (mean difference 12.0%, 95% CI 1.8-22.1%, p = 0.0210) was significantly higher than at baseline.

CONCLUSIONS

DEX implant was able to significantly improve ELM and EZ integrity in naïve patients with ME.