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Sun L, Huang L, Li S, Lu J, Zheng S, Ding X. Safety and effectiveness of intravitreal dexamethasone implant in patients with ocular toxocariasis. Br J Ophthalmol 2024; 108:238-243. [PMID: 36596664 DOI: 10.1136/bjo-2022-322244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/27/2022] [Indexed: 01/05/2023]
Abstract
AIMS To evaluate the safety and effectiveness of intravitreal dexamethasone (DEX) implant in patients with active uveitis due to ocular toxocariasis (OT). METHODS Seventy-eight patients with OT were recruited in this retrospective study, including 51 patients in DEX group treated with intravitreal DEX implant and 27 patients in control group without intervention. The reduction of vitreous haze scores (VHS), the best-corrected visual acuity (BCVA) changes, intraocular pressure (IOP) and cataract progression and formation were recorded at baseline (V0), 1 (V1), 3 (V3) and 6 months (V6) after treatment in DEX group, and V0 and V6 in control group. RESULTS There was no change in VHS and BCVA in control group between V0 and V6. Better VHS (p=0.001) and BCVA (p=0.022) was achieved in DEX group; the rate of VHS=0 was 0%, 67.4%, 42.9% and 44.9% at V0, V1, V3 and V6, respectively (p<0.001), and the mean BCVA was improved from logMAR 1.5±0.9 to 1.2±0.9 at V1, 1.4±1.0 at V3 and 1.4±1.2 at V6. A favourable BCVA at V1 was associated with older age (p=0.038) and uninvolved macula (p=0.000) in DEX group. No significant difference in IOP elevation ≥10 mm Hg, cataract progression and formation between groups. More eyes needed retinal surgery in control group (p<0.001). CONCLUSIONS This was the first study to investigate use of intravitreal DEX implant in OT patients, which can efficiently reduce ocular inflammation and improve BCVA in macular uninvolved patients.
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Affiliation(s)
- Limei Sun
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Li Huang
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Songshan Li
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jinglin Lu
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Shuxin Zheng
- Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoyan Ding
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
- Sun Yat-Sen University Zhongshan Ophthalmic Center State Key Laboratory of Ophthalmology, Guangzhou, China
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Tang B, Yeow CES, Harney F, Townley D. Safety and Effectiveness of Intravitreal Dexamethasone Implant (Ozurdex®) for the Treatment of Refractory Cystoid Macular Oedema (CMO) in Galway University Hospital. Open Ophthalmol J 2022. [DOI: 10.2174/e18743641-v16-e2210210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aim:
The aim of this study is to assess the real-life effectiveness and safety of intravitreal Ozurdex in an Irish setting.
Background:
Ozurdex is an intravitreal dexamethasone implant that is used for the treatment of macular oedema secondary to retinal vein occlusion and diabetic macular oedema.
Methods:
This was a retrospective observational study of adult patients in University Hospital Galway who received an intravitreal dexamethasone implant (Ozurdex) for the treatment of cystoid macular oedema secondary to diabetic eye disease or retinal vein occlusion. The main outcome was the mean change in best-corrected visual acuity 3-6 months after the treatment.
Results and Discussion:
36 patients were included in the study. Overall, there was a 1.66 mean letter gain (SD 11.8) 3-6 months post-treatment. The proportion of patients who gained >10 letters was 15.6%. The mean reduction in CST was 110.6um (SD 255.7), and in the linear regression analysis, no variables were found to be significantly associated with a change in visual acuity. In terms of adverse events, 14.3% of patients had significant cataract progression and 20.6% of patients had a significant rise in IOP following intravitreal Ozurdex implant.
Conclusion:
Intravitreal Ozurdex was found to be safe and effective, supporting it as an appropriate second-line treatment in patients with refractory macular oedema secondary to diabetic eye disease and retinal vein occlusion. Further studies should be carried out to evaluate the possible predictors of visual acuity outcome.
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Dinh RH, Moushmoush O, Kolyvas P, Jacobsen BA, Mathai M, Sanghavi K, Levinson JD, Do BK. Describing Adverse Events Associated with Bilateral Same-Day Intravitreal Dexamethasone Implants. Ophthalmic Surg Lasers Imaging Retina 2022; 53:612-618. [PMID: 36378615 DOI: 10.3928/23258160-20221018-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES To explore the incidence of adverse events after bilateral same-day intravitreal 0.7-mg dexamethasone implant (SDIDI) injections. MATERIALS AND METHODS We performed an IRB approved, single-center, retrospective review of patients receiving bilateral SDIDI injections from January 1, 2016 to October 31, 2021 and reviewed adverse events that occurred within 3 months of injection. RESULTS A total of 206 bilateral (412 eyes) SDIDI injections were performed in 59 patients. Ocular hypertension or the addition of intraocular pressure (IOP) lowering drops occurred in 121 (29.4%) eyes after IDI. Two (0.5%) eyes required glaucoma drainage surgeries. Of the 117 phakic eyes, 32 (27.4%) had progression of cataract or cataract extraction. There were two (0.5%) episodes of vitreous hemorrhage and one (0.2%) retinal tear with retinal detachment. There were no cases of endophthalmitis. CONCLUSION Serious complication rates after bilateral same-day IDI injections appears low. Increased IOP that requires intervention can occur. [Ophthalmic Surg Lasers Imaging Retina 2022;53:612-618.].
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Nawar AE. Effectiveness of Suprachoroidal Injection of Triamcinolone Acetonide in Resistant Diabetic Macular Edema Using a Modified Microneedle. Clin Ophthalmol 2022; 16:3821-3831. [PMID: 36438589 PMCID: PMC9698330 DOI: 10.2147/opth.s391319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose The present study evaluated the effectiveness of suprachoroidal injection of triamcinolone acetonide (TA) in resistant diabetic macular edema (DME) using a modified microneedle. Patients and Methods This is a prospective nonrandomized interventional study that was conducted on 55 eyes of 39 patients with centrally involving DME resistant to previous antivascular endotheli qal growth factor (VEGF) agents. All patients received suprachoroidal injection of triamcinolone acetonide 4 mg/0.1 mL by a modified specialized microneedle. Results The mean central macular thickness (CMT) decreased sign ificantly from 478.7±170.2 µm before injection to 230.2±47.4 µm after 12 months with p-value <0.001. Significant improvement of the mean best corrected visual acuity (BCVA) from 1.193±0.2 by logMAR at the baseline to 0.76±0.3 by logMAR was achieved after 12 months with p-value <0.001. The IOP increased significantly at one month after injection and returned to the baseline value at the third month. Eyes with more baseline CMT and worse baseline BCVA achieved worse final BCVA 12 months after injection. Eyes with inner segment/outer segment (IS/OS) disruption and neurosensory detachment (NSD) showed worse final visual outcomes. IS/OS segment disruption, NSD and baseline BCVA were the main independent predictors of the final BCVA. Conclusion Suprachoroidal injection of TA using this new modified microneedle resulted in marked anatomical and functional results in cases of DME resistant to previous anti-VEGF drugs with no serious ocular or systemic side effects. The study was prospectively registered with clinical trial.gov ID (NCT04690608) in 27–12-2020.
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Affiliation(s)
- Amin E Nawar
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
- Correspondence: Amin E Nawar, Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, 31516, Egypt, Tel +20 1140095692, Email
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Iordachita II, de Smet MD, Naus G, Mitsuishi M, Riviere CN. Robotic Assistance for Intraocular Microsurgery: Challenges and Perspectives. Proc IEEE Inst Electr Electron Eng 2022; 110:893-908. [PMID: 36588782 PMCID: PMC9799958 DOI: 10.1109/jproc.2022.3169466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Intraocular surgery, one of the most challenging discipline of microsurgery, requires sensory and motor skills at the limits of human physiological capabilities combined with tremendously difficult requirements for accuracy and steadiness. Nowadays, robotics combined with advanced imaging has opened conspicuous and significant directions in advancing the field of intraocular microsurgery. Having patient treatment with greater safety and efficiency as the final goal, similar to other medical applications, robotics has a real potential to fundamentally change microsurgery by combining human strengths with computer and sensor-based technology in an information-driven environment. Still in its early stages, robotic assistance for intraocular microsurgery has been accepted with precaution in the operating room and successfully tested in a limited number of clinical trials. However, owing to its demonstrated capabilities including hand tremor reduction, haptic feedback, steadiness, enhanced dexterity, micrometer-scale accuracy, and others, microsurgery robotics has evolved as a very promising trend in advancing retinal surgery. This paper will analyze the advances in retinal robotic microsurgery, its current drawbacks and limitations, as well as the possible new directions to expand retinal microsurgery to techniques currently beyond human boundaries or infeasible without robotics.
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Affiliation(s)
- Iulian I Iordachita
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Marc D de Smet
- Microinvasive Ocular Surgery Center (MIOS), Lausanne, Switzerland
| | | | - Mamoru Mitsuishi
- Department of Mechanical Engineering, The University of Tokyo, Japan
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S Mehta N, Emami-Naeini P. A Review of Systemic Biologics and Local Immunosuppressive Medications in Uveitis. J Ophthalmic Vis Res 2022; 17:276-289. [PMID: 35765634 PMCID: PMC9185190 DOI: 10.18502/jovr.v17i2.10804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/28/2021] [Indexed: 01/15/2023] Open
Abstract
Uveitis is one of the most common causes of vision loss and blindness worldwide. Local and/or systemic immunosuppression is often required to treat ocular inflammation in noninfectious uveitis. An understanding of safety and efficacy of these medications is required to individualize treatment to each patient to ensure compliance and achieve the best outcome. In this article, we reviewed the effectiveness of systemic biologic response modifiers and local treatments commonly used in the management of patients with noninfectious uveitis.
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Affiliation(s)
- Neesurg S Mehta
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Parisa Emami-Naeini
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA, USA
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Kishore K, Bhat PV, Venkatesh P, Canizela CC. Dexamethasone Intravitreal Implant for the Treatment of Macular Edema and Uveitis: A Comprehensive Narrative Review. Clin Ophthalmol 2022; 16:1019-1045. [PMID: 35418744 PMCID: PMC8995179 DOI: 10.2147/opth.s209395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/10/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The purpose of this review article is to provide a comprehensive review of the current applications of intravitreal DEX implant (Ozurdex®, Allergan Inc, Irvine, CA) for a variety of ophthalmic conditions – ranging from FDA approved indications to off-label uses. We have attempted to provide relevant evidence from the literature to help a reader develop an understanding of the biological and pharmacokinetic properties of DEX implant, its uses, and potential side effects. Methods PubMed searches were performed using the terms “Ozurdex”, or “intravitreal DEX implant”, AND “retinal vein occlusion”, or “diabetic macular edema”, or “uveitis”. The search was performed in July of 2021, with an additional search in October 2021. All original English language articles were considered for this review. Results DEX implant has evidence of efficacy in a variety of clinical situations including macular edema associated with retinal vein occlusion, diabetes, uveitis, and others. Safety concerns include cataract formation and progression, intraocular pressure elevation, complications related to intravitreal injection, and opportunistic infections secondary to steroid-induced immune suppression. Conclusion DEX implant is a useful tool in the management of several retinal disorders. Further studies are needed for head-to-head comparison with other treatment modalities and to determine its precise place in clinical practice.
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Affiliation(s)
- Kamal Kishore
- Illinois Retina and Eye Associates, Peoria, IL, USA
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
- Correspondence: Kamal Kishore, Illinois Retina and Eye Associates, 4505 N Rockwood Drive, Suite 1, Peoria, IL, 61615, USA, Tel +1 3095891880, Fax +1 3095891885, Email
| | - Pooja V Bhat
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Cecilia C Canizela
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
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Zeng S, Yang L, Bai F, Liu T, Liu X. Intravitreal dexamethasone implant for noninfectious uveitis in Chinese patients. Int Ophthalmol 2022; 42:2063-2069. [PMID: 34984627 DOI: 10.1007/s10792-021-02204-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effectiveness and safety of the dexamethasone intravitreal implant (DEX-I) in Non-Infectious Uveitis (NIU) in Chinese patients. METHODS Ninety-one eyes of 77 patients (56 men, 21 women) receiving 130 implant injections for NIU were included. Treatment indication, uveitis diagnosis, best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze score, intraocular pressure, phakic status, number of injections, time to reinjection, and systemic treatments were collected at baseline, 1 week, 1 month, 3 and 6 months after treatment. RESULTS All patients were followed for at least 12 weeks and had a mean follow-up period of 5.1 months (range, 3-14 months) after the first implant. The main treatment indications were macular edema (ME), retinal vasculitis, retinal vasculitis with ME. Sixty-one eyes (67.03%) received only one injection, while 31 eyes (32.97%) received two or more. In eyes that received 2 injections, the mean time to the second injection was 3.83 months and in those that received 3 injections, the mean time to the third injection was 7.5 months. BCVA and CRT significantly improved at 1 week, 1 month, 3 months, and 6 months after treatment. When compared to baseline, the mean prednisone (or equivalent) dosage significantly decreased at 3- and 6-month follow-up evaluations after DEX implantation.14.29% of eyes developed a transient increase in intraocular pressure, and a cataract was removed from 1 phakic eye. CONCLUSIONS DEX implants, either alone or in combination with common adjunctive NIU treatments, is safe and effective in the treatment of NIU in Chinese patients.
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Affiliation(s)
- Shun Zeng
- Ophthalmologic Center of the Second Hospital, Jilin University, Ziqiang Street 218, Changchun, 130000, People's Republic of China
| | - Li Yang
- Ophthalmologic Center of the Second Hospital, Jilin University, Ziqiang Street 218, Changchun, 130000, People's Republic of China
| | - Feng Bai
- Ophthalmologic Center of the Second Hospital, Jilin University, Ziqiang Street 218, Changchun, 130000, People's Republic of China
| | - Tao Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Ziqiang Street 218, Changchun, 130000, People's Republic of China
| | - Xiaoli Liu
- Ophthalmologic Center of the Second Hospital, Jilin University, Ziqiang Street 218, Changchun, 130000, People's Republic of China.
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Liu W, Mohan SP, Nagaraj NR, Sundar Jaganathan S, Wen Y, Ramasubramanyan S, Irudayaraj J. Epigenetic alterations associated with dexamethasone sodium phosphate through DNMT and TET in RPE cells. Mol Vis 2021; 27:643-655. [PMID: 34924744 PMCID: PMC8645185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 11/18/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To elucidate the mechanism behind epigenetic alteration associated with dexamethasone (DEX) sodium phosphate treatment. METHODS We performed enzyme-linked immunosorbent assay to quantify changes in global DNA methylation and hydroxymethylation, quantitative real-time PCR (qRT-PCR) of the DNA methylation- and hydroxymethylation-related gene, in vitro DNA methyltransferase (DNMT) enzymatic activity assays with purified DNMTs, and DNA hydroxymethylation pattern with super-resolution imaging. RESULTS We identified global DNA hypomethylation and hyper-hydroxymethylation upon DEX treatment, associated with aberrant mRNA expression levels of DNMT and ten-eleven translocation (TET) proteins. Additionally, DEX exposure could directly hinder DNMT activities. CONCLUSIONS We showed that DEX-induced epigenetic alterations are linked to aberrant DNMT and TET expression, potentially through an essential role of DNMT.
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Affiliation(s)
- Wenjie Liu
- Department of Bioengineering, Cancer Center at Illinois, Micro and Nanotechnology Laboratory. University of Illinois at Urbana-Champaign, Urbana, IL,Biomedical Research Center in Mills Breast Cancer Institute, Carles Foundation Hospital, Urbana, IL
| | - Sruthi Priya Mohan
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBIRVO, Vision Research Foundation, Chennai, TN, India
| | | | - Shyam Sundar Jaganathan
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBIRVO, Vision Research Foundation, Chennai, TN, India
| | - Yi Wen
- Department of Bioengineering, Cancer Center at Illinois, Micro and Nanotechnology Laboratory. University of Illinois at Urbana-Champaign, Urbana, IL,Biomedical Research Center in Mills Breast Cancer Institute, Carles Foundation Hospital, Urbana, IL
| | - Sharada Ramasubramanyan
- R.S. Mehta Jain Department of Biochemistry and Cell Biology, KBIRVO, Vision Research Foundation, Chennai, TN, India
| | - Joseph Irudayaraj
- Department of Bioengineering, Cancer Center at Illinois, Micro and Nanotechnology Laboratory. University of Illinois at Urbana-Champaign, Urbana, IL,Biomedical Research Center in Mills Breast Cancer Institute, Carles Foundation Hospital, Urbana, IL
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Bae YH, Kim SM, Kim JY, Bae SH, Kim H, Ma DJ. Effect of Alternate Treatment with Intravitreal Corticosteroid and Anti-VEGF for Macular Edema Secondary to Retinal Vein Occlusion. J Ophthalmol 2021; 2021:5948113. [PMID: 34621544 DOI: 10.1155/2021/5948113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate whether treatment with intravitreal corticosteroid and anti-vascular endothelial growth factor (VEGF) injections alternately can improve treatment outcomes of macular edema (ME) caused by retinal vein occlusion (RVO). Methods This dual-center retrospective study included 112 eyes with treatment-naïve ME secondary to RVO that were alternately treated with intravitreal corticosteroid and anti-VEGF injections (33 eyes, alternate group) or treated only with intravitreal anti-VEGF injections (79 eyes, anti-VEGF group) on a pro re nata basis. Results During the 12-month follow-up period, the alternate group achieved a visual acuity gain of 0.39 logMAR, while the anti-VEGF group achieved a gain of 0.21 logMAR (P=0.042). The alternate group demonstrated a reduction in the central macular thickness of 229.9-μm, while the anti-VEGF group achieved a reduction of 220.1 μm (P=0.887). The alternate group required an average of 5.2 injections, while the anti-VEGF received 4.2 injections (P < 0.001). In a propensity score-matched cohort to compensate for the differences in the injection numbers between the two groups, the alternate group achieved a better visual acuity gain than the anti-VEGF group at month 12 (0.39 logMAR vs. 0.17 logMAR, P=0.048). Conclusions In ME secondary to RVO, treatment with intravitreal corticosteroid and anti-VEGF injections alternately resulted in a more favorable visual outcome compared with intravitreal anti-VEGF monotherapy.
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Garay-Aramburu G, Gómez-Moreno Á, Urcola A. Short-term effectiveness prognostic factors after dexamethasone intravitreal implant in macular edema due to retinal vein occlusion. Eur J Ophthalmol 2021; 32:1671-1679. [PMID: 34254547 DOI: 10.1177/11206721211032520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to describe functional and anatomical changes (best-corrected visual acuity [BCVA], central macular thickness [CMT], and central macular volume [CMV]) in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) treated with intravitreal dexamethasone implant (IDI) and identify its clinical predictors in a real-world setting. METHODS Data from 111 patients who underwent IDI to treat RVO-associated ME were retrospectively reviewed. Demographic, preoperative, and postoperative variables were assessed using a logistic regression analysis to determine predictors of visual and anatomical improvement. RESULTS Mean BCVA, CMT, and CMV improved from baseline after IDI (p < 0.001). The strongest predictors of different treatment outcomes were: a baseline BCVA ⩽60 ETDRS letters (OR = 50.600; p < 0.001) and first IDI injection (OR = 2.988; p < 0.001) for BCVA gain ⩾15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters; a baseline BCVA ⩽60 ETDRS letters (OR = 7.893; p = 0.002) and non-chronic ME (OR = 3.875; p = 0.019) for BCVA ⩾80 ETDRS letters achievement; a baseline CMT ⩾400 µm (OR = 49.083; p < 0.001) and a baseline CMV ⩾12 mm3 (OR = 4.235; p < 0.001) for CMT reduction ⩾50%; and a baseline CMT ⩾400 µm (OR = 11.471; p < 0.001) and a baseline CMV ⩾12 mm3 (OR = 10.284; p < 0.001) for CMV reduction ⩾15%. CONCLUSION This study confirmed the effectiveness of IDI to treat ME secondary to RVO and identified new predictive factors for two visual (⩾15 ETDRS letters gain and BCVA ⩾80 ETDRS letters) and two anatomical outcomes (>50% CMT and >15% CMV reduction).
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Affiliation(s)
- Gonzaga Garay-Aramburu
- Ophthalmology Department, Basurto University Hospital, Bilbao, Spain.,Universidad del Pais Vasco-Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Spain
| | | | - Aritz Urcola
- Universidad del Pais Vasco-Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Spain.,Ophthalmology Department, Araba University Hospital, Vitoria-Gasteiz, Spain
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Yuksel B, Karti O, Celik O, Kerci SG, Kusbeci T. Low frequency ranibizumab versus dexamethasone implant for macular oedema secondary to branch retinal vein occlusion. Clin Exp Optom 2021; 101:116-122. [DOI: 10.1111/cxo.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 01/20/2023] Open
Affiliation(s)
- Bora Yuksel
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | - Ozan Celik
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
| | | | - Tuncay Kusbeci
- Department of Ophthalmology, Bozyaka Training and Research Hospital, Izmir, Turkey,
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13
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Huang YT, Lin CJ, Chen HS, Tien PT, Lai CT, Hsia NY, Lin JM, Chen WL, Tsai YY. Risk factors for repeated dexamethasone intravitreal implant therapy for macular edema due to treatment-naïve branch retinal vein occlusion. BMC Ophthalmol 2021; 21:142. [PMID: 33743610 PMCID: PMC7981849 DOI: 10.1186/s12886-021-01904-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022] Open
Abstract
Background This study evaluated the effects of dexamethasone intravitreal implant on treatment-naïve branch retinal vein occlusion (BRVO)-induced macular edema (ME), and the risk factors for earlier repeated treatment. Methods Patients treated from 2013 to 2016 were enrolled. The patients’ demographics, medical history, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) were recorded. Risk factors for repeated treatment were identified using a Cox proportional hazard model and logistic regression. Results 29 patients (mean age: 58.64 ± 13.3 years) were included; 44.8% received only one injection, while 55.2% received two or more. The mean initial CRT was 457.8 ± 167.1 μm; the peak CRT and final CRT improved significantly to 248.9 ± 57.9 μm and 329.2 ± 115.1 μm, respectively. The peak BCVA improvement and final improvement were 29.5 ± 23.5 approximate ETDRS letters and 19.8 ± 24.4 letters, respectively, with 62.1% of patients improving by more than 15 letters. Older age, higher initial CRT, and diabetes were the risk factors for multiple injections. Conclusion Dexamethasone intravitreal implant results in significant peak CRT and BCVA improvements, while older age, higher initial CRT, and diabetes are risk factors for repeated injections. The optimal retreatment schedule for these patients should be further explored.
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Affiliation(s)
- Yu-Te Huang
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447. .,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Optometry, Asia University, Taichung, Taiwan.
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Ning-Yi Hsia
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,Department of Optometry, Asia University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, 2 Yuh-Der Road, Taichung City, Taiwan, 40447.,School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Optometry, Asia University, Taichung, Taiwan
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14
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Pranata R, Vania A, Vania R, Victor AA. Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: Systematic review and meta-analysis. Eur J Ophthalmol 2020; 31:1907-1914. [PMID: 32757629 DOI: 10.1177/1120672120947595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Intravitreal ranibizumab (RNB) and dexamethasone intravitreal implant (DII) were developed in the recent past and has been widely used for macular edema secondary to BRVO. We aimed to assess the efficacy and safety of intravitreal ranibizumab (RNB) compared to dexamethasone intravitreal implant (DII) in patients with macular edema secondary to branch retinal vein occlusion (BRVO). METHODS We performed a comprehensive search on topics that assess RNB and DII in patients with macular edema secondary to BRVO from several electronic databases. RESULTS There were 678 subjects from five studies. Ranibizumab was associated with a greater increase in best-corrected visual acuity (BCVA; mean difference 9.13, I2: 0%) compared to DII. Ranibizumab also demonstrated a greater ⩾10 (OR 2.76, I2: 0%) and ⩾15 letters (OR 2.78, I2: 0%) gain. RNB has better BCVA (logMAR scale) improvement at 6 months' follow up (mean difference -0.15, I2: 64%) in favor of RNB. Higher IOP was found in DII group on follow-up (mean difference -2.92, I2: 89%) and RNB has lesser IOP ⩾10 mmHg increase compared to DII (OR 0.08, I2: 0%). Cataract formation and/or progression was less in RNB (OR 0.53, I2: 75%). The need for rescue laser was similar the two groups. CONCLUSION Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.
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Affiliation(s)
| | - Amelinda Vania
- Universitas Kristen Krida Wacana, West Jakarta, Indonesia
| | - Rachel Vania
- Universitas Pelita Harapan, Tangerang, Banten, Indonesia
| | - Andi Arus Victor
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo National General Hospital, Jakarta, Daerah Istimewa Jakarta, Indonesia
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15
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Liu X, Yang L, Cai W, Gao L, Li Y. Clinical features and visual prognostic indicators after vitrectomy for Terson syndrome. Eye (Lond) 2019; 34:650-656. [PMID: 31455901 DOI: 10.1038/s41433-019-0547-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To determine clinical characteristics and identify factors associated with better visual outcomes in patients who had vitrectomy for vitreous haemorrhage (VH) associated with Terson syndrome (TS). METHODS The records of 48 patients (54 corresponding eyes) who underwent vitrectomy for VH associated with TS from January 2008 to December 2017 were retrospectively reviewed. The main outcome measure was the final postoperative visual acuity. RESULTS At the last visit, 34 eyes (63.0%) achieved a BCVA of 0.3 or better. Eyes associated with traumatic brain injury had a better visual outcome than those with primary intracerebral haemorrhage (P = 0.042). In the primary intracerebral haemorrhage group, patients with hypertension-induced intracranial haemorrhage (IH) showed poorer final visual acuities than the ruptured intracranial aneurysm group (P = 0.023). In the delayed vitrectomy group, epiretinal membrane and peripheral retina changes were more common (P < 0.05). However, the difference in final visual acuity between the early and delayed vitrectomy groups was not significant (P = 0.69). CONCLUSION Most of the patients obtained visual recovery after vitrectomy for TS. VH associated with ruptured intracranial aneurysm or traumatic brain injury or eyes without retinal haemorrhage are predictive of better prognosis. Although the timing of vitrectomy was not related to the final postoperative visual outcome, early vitrectomy by three months seems to suggest less epiretinal membrane formation, retinal tears, and retinal detachments.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Wenrui Cai
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Linlin Gao
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Yaping Li
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China.
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16
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Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, Midena E, Sivaprasad S, Tadayoni R, Wolf S, Loewenstein A. Guidelines for the Management of Retinal Vein Occlusion by the European Society of Retina Specialists (EURETINA). Ophthalmologica 2019; 242:123-162. [PMID: 31412332 DOI: 10.1159/000502041] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
The high prevalence of cardiovascular disease particularly in the elderly population is associated with retinal vascular disease. Retinal vein occlusions represent severe disturbances of the hypoxia-sensitive neurosensory retina. Acute and excessive leakage leads to the diagnostic hallmarks of retinal hemorrhage and edema with substantial retinal thickening. Advanced diagnostic tools such as OCT angiography allow to evaluate retinal ischemia and identify the risk for late complications and will soon reach clinical routine besides fluorescein angiography. Accordingly, the duration of non-perfusion is a crucial prognostic factor requiring timely therapeutic intervention. With immediate inhibition of vascular leakage, anti-VEGF substances excel as treatment of choice. Multiple clinical trials with optimal potential for functional benefit or a lesser regenerative spectrum have evaluated aflibercept, ranibizumab, and bevacizumab. As retinal vein occlusion is a chronic disease, long-term monitoring should be individualized to combine maintenance with practicability. While steroids may be considered in patients with systemic cardiovascular risk, surgery remains advisable only for very few patients. Destructive laser treatment is an option if reliable monitoring is not feasible. Ophthalmologists are also advised to perform a basic systemic workup to recognize systemic concomitants. The current edition of the EURETINA guidelines highlights the state-of-the-art recommendations based on the literature and expert opinions in retinal vein occlusion.
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Affiliation(s)
| | | | - Bianca S Gerendas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Edoardo Midena
- Department of Ophthalmology, University of Padua, Padua, Italy
| | - Sobha Sivaprasad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ramin Tadayoni
- Department of Ophthalmology, Lariboisière Hospital Paris, Paris, France
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
| | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
PURPOSE To assess the efficacy and safety of intravitreal dexamethasone implant injection in the management of sarcoidosis-related uveitis. METHODS A retrospective analysis was performed of the efficacy and safety of intravitreal dexamethasone implant injection for indications such as intractable vitritis, vasculitis, or cystoid macular edema. RESULTS This study comprised 20 patients with sarcoidosis-related uveitis. A single injection was performed in 13 eyes (65%) and 35% required more than 2 injections during the follow-up period [median 16.5 months (range 6-32)]. The best-corrected visual acuity showed significant improvement at 1 month (P = 0.004) and 3 months (P = 0.001), but there was no significance at 6 months after implant injection (P = 0.186). One month after treatment, the central macular thickness decreased to 278.95 ± 52.20 μm (P = 0.023). It further decreased to 274.70 ± 55.88 μm at 3 months (P = 0.027), but there was no significance at 6 months (280.65 ± 64.48 μm, P = 0.074).The anterior chamber cell grade (P = 0.003) and vitreous haze (P = 0.001) were significantly decreased for up to 6 months after a single implant injection. The most common ocular complication was worsening of cataracts during the first 6 months. CONCLUSION Intravitreal dexamethasone implant injection is efficacious in reducing anterior chamber inflammation, vitreous haze, and cystoid macular edema in patients with sarcoidosis-related uveitis. Considering that sarcoidosis shows a chronic course of disease in a significant proportion of cases, intravitreal dexamethasone implant injection is a possible option to relieve intraocular inflammation.
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Affiliation(s)
- Mirinae Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seong Ah Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Wookyung Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Rae Young Kim
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hoon Park
- Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Catholic Institute for Visual Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Lee JH, Park JY, Kim JS, Hwang JH. Rapid progression of cataract to mature stage after intravitreal dexamethasone implant injection: a case report. BMC Ophthalmol 2019; 19:1. [PMID: 30606142 PMCID: PMC6318997 DOI: 10.1186/s12886-018-1008-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/10/2018] [Indexed: 11/19/2022] Open
Abstract
Background This study aims to report a case of rapid progression of cataract to mature stage after intravitreal dexamethasone implantation for macular edema due to branch retinal vein occlusion. Case presentation A 59-year-old Korean male with complaints of sudden metamorphopsia and reduced visual acuity for three days in the left eye was referred to our clinic. Ophthalmological investigations included fundus photography, fluorescein angiography, and optical coherence tomography. In the left eye, branch retinal vein occlusion with macular edema was observed. We performed intravitreal dexamethasone implantation in the left eye three times within a period of one year. One week after the third intravitreal dexamethasone implantation, grade 1 posterior subcapsular opacity and raised intraocular pressure were observed in the left eye. Three weeks later, mature cataract was observed in the left eye. We performed cataract surgery along with intravitreal ranibizumab injection in the left eye. The procedure was uneventful, and the visual acuity improved postoperatively. Conclusions Posterior subcapsular cataract developed due to intravitreal dexamethasone implantation can progress rapidly to mature stage. Therefore, short-term follow-up examinations may be necessary for early diagnosis and treatment of this complication.
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Affiliation(s)
- Jae Hyung Lee
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, Catholic Institute for Visual Science, The Catholic University of Korea, College of Medicine, Seoul, South Korea
| | - Jae Yong Park
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-Gu, Seoul, 139-707, South Korea
| | - Jae Suk Kim
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-Gu, Seoul, 139-707, South Korea
| | - Je Hyung Hwang
- Department of Ophthalmology, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-Gu, Seoul, 139-707, South Korea.
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19
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Blanc J, Deschasse C, Kodjikian L, Dot C, Bron A, Creuzot-garcher C. Safety and long-term efficacy of repeated dexamethasone intravitreal implants for the treatment of cystoid macular edema secondary to retinal vein occlusion with or without a switch to anti-VEGF agents: a 3-year experience. Graefes Arch Clin Exp Ophthalmol 2018; 256:1441-8. [DOI: 10.1007/s00417-018-4016-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/27/2018] [Accepted: 05/21/2018] [Indexed: 11/24/2022] Open
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Battaglia Parodi M, Iacono P, Scaramuzzi M, Bandello F. OUTER RETINAL LAYER CHANGES AFTER DEXAMETHASONE IMPLANT FOR CENTRAL RETINAL VEIN OCCLUSION. Retina 2017; 37:1888-95. [PMID: 28030428 DOI: 10.1097/IAE.0000000000001429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To analyze the outer retinal layer changes on spectral-domain optical coherence tomography after dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusions (CRVO). METHODS Thirty patients affected by macular edema related to CRVO (8 patients less than 50 years of age with nonischemic CRVO [<50-niCRVO], 12 patients more than 50 years with niCRVO [>50-niCRVO], and 10 patients with ischemic CRVO [iCRVO]) were included in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity, fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first implant. Further retreatments were performed on the basis of macular edema detection from the fourth month. Main outcome measure was the change in outer retinal layers at the 12-month examination. RESULTS The retinal layers of interest (external limiting membrane; ellipsoid zone; and retinal pigment epithelium) were classified as absent, disrupted, or present. The best baseline optical coherence tomography profile was found in <50-niCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium layers in no patients; present and disrupted external limiting membrane in 25% and 75% of cases, respectively; disrupted ellipsoid zone and retinal pigment epithelium in 100% of cases), whereas the worst was detected in the iCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium in 40%, 40%, and 10% of cases, respectively). A significant recovery of the retinal layers was observed in all CRVO subgroups; the greatest improvement was found in <50-niCRVO group. Median best-corrected visual acuity in the whole group improved from 0.85 to 0.45 (P = 0.0001). It is noteworthy that a significant best-corrected visual acuity gain was achieved only in eyes showing present or disrupted layers at baseline regardless of the CRVO subgroup examined, whereas eyes with absent layers at baseline were unable to attain any improvement. CONCLUSION Dexamethasone implant can promote the resolution of macular edema in patients affected by any CRVO subform, but a beneficial functional outcome could be achieved by eyes showing no absence of outer retinal layers on spectral-domain optical coherence tomography at baseline.
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Pohlmann D, Vom Brocke GA, Winterhalter S, Steurer T, Thees S, Pleyer U. Dexamethasone Inserts in Noninfectious Uveitis: A Single-Center Experience. Ophthalmology 2018; 125:1088-1099. [PMID: 29459041 DOI: 10.1016/j.ophtha.2017.12.038] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 11/22/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To report the effectiveness of repeated intravitreal dexamethasone (DEX) inserts in noninfectious uveitis patients. DESIGN Prospective, single-center, interventional clinical trial between February 2010 and March 2015. PARTICIPANTS Patients with noninfectious uveitis with cystoid macular edema and/or vitreitis. METHODS Patients were treated with a 700-μg intravitreal DEX insert (Ozurdex; Allergan, Inc., Irvine, CA). Follow-up visits were scheduled 1, 3, and 6 months after injection. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze (VH) score, intraocular pressure (IOP), and adverse events were recorded. MAIN OUTCOME MEASURES Primary outcome was the reduction of CRT. Secondary outcome was the improvement in BCVA and reduction of VH. RESULTS In total, 109 eyes of 76 patients received 298 DEX inserts. Fifty-two patients were women (68%). The mean age of all participants was 57 years (range, 24-88 years). More than 3 DEX inserts were injected into 44% of eyes. Mean number of injections were 1.54±0.5 (standard deviation [SD]), 1.98±0.84, and 2.46±1.1 over 12, 18, and 24 months, respectively. Central retinal thickness decreased significantly (P < 0.001) from 465 μm at baseline to 318, 342, and 388 μm after 1, 3, and 6 months, respectively. Similar trends were seen in eyes receiving a second, third, and fourth DEX insert. Patients with idiopathic uveitis and sarcoidosis benefited well from DEX inserts. The greatest overall benefit was achieved in patients with no systemic treatment and patients receiving antimetabolites and cyclosporin A. A significant VH score reduction was documented in 44% of eyes after 1 month. A gain of more than 3 lines in BCVA was recorded in 31% to 37%, 26% to 39%, and 8% to 32% of eyes after 1, 3, and 6 months, respectively. A transient rise in mean IOP after 1 month (P < 0.001) and after 3 months (P = 0.001) was seen. CONCLUSIONS The repeated longer-term administration of DEX inserts in noninfectious uveitis patients, either alone or in combination with other therapies, led to improved CRT, BCVA, and VH. Underlying diseases and concomitant systemic therapy seem to have an impact on overall treatment benefit. Ocular complications were reversible and were managed by local treatment, with exception of cataract formation.
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Affiliation(s)
- Dominika Pohlmann
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerrit A Vom Brocke
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Theresa Steurer
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Sabrina Thees
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Uwe Pleyer
- Charité - Department of Ophthalmology, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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22
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Lin CJ, Chen HS, Su CW, Tien PT, Lin JM, Chen WL, Kuo CY, Lai CT, Tsai YY. The Effect of Age and Initial Central Retinal Thickness on Earlier Need of Repeat Ozurdex Treatment for Macular Edema Due to Retinal Vein Occlusion: A Retrospective Case Series. J Ocul Pharmacol Ther 2017; 33:763-772. [PMID: 28949790 DOI: 10.1089/jop.2017.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Cheng-Wen Su
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Yuan Kuo
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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Gonenc B, Chae J, Gehlbach P, Taylor RH, Iordachita I. Towards Robot-Assisted Retinal Vein Cannulation: A Motorized Force-Sensing Microneedle Integrated with a Handheld Micromanipulator †. Sensors (Basel) 2017; 17:E2195. [PMID: 28946634 PMCID: PMC5677255 DOI: 10.3390/s17102195] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022]
Abstract
Retinal vein cannulation is a technically demanding surgical procedure where therapeutic agents are injected into the retinal veins to treat occlusions. The clinical feasibility of this approach has been largely limited by the technical challenges associated with performing the procedure. Among the challenges to successful vein cannulation are identifying the moment of venous puncture, achieving cannulation of the micro-vessel, and maintaining cannulation throughout drug delivery. Recent advances in medical robotics and sensing of tool-tissue interaction forces have the potential to address each of these challenges as well as to prevent tissue trauma, minimize complications, diminish surgeon effort, and ultimately promote successful retinal vein cannulation. In this paper, we develop an assistive system combining a handheld micromanipulator, called "Micron", with a force-sensing microneedle. Using this system, we examine two distinct methods of precisely detecting the instant of venous puncture. This is based on measured tool-tissue interaction forces and also the tracked position of the needle tip. In addition to the existing tremor canceling function of Micron, a new control method is implemented to actively compensate unintended movements of the operator, and to keep the cannulation device securely inside the vein following cannulation. To demonstrate the capabilities and performance of our uniquely upgraded system, we present a multi-user artificial phantom study with subjects from three different surgical skill levels. Results show that our puncture detection algorithm, when combined with the active positive holding feature enables sustained cannulation which is most evident in smaller veins. Notable is that the active holding function significantly attenuates tool motion in the vein, thereby reduces the trauma during cannulation.
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Affiliation(s)
- Berk Gonenc
- Computer Integrated Surgical Systems and Technology Engineering Research Center (CISST ERC), Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Jeremy Chae
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
| | - Peter Gehlbach
- Wilmer Eye Institute, The Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
| | - Russell H Taylor
- Computer Integrated Surgical Systems and Technology Engineering Research Center (CISST ERC), Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Iulian Iordachita
- Computer Integrated Surgical Systems and Technology Engineering Research Center (CISST ERC), Johns Hopkins University, Baltimore, MD 21218, USA.
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Ayar O, Alpay A, Koban Y, Akdemir MO, Yazgan S, Canturk Ugurbas S, Ugurbas SH. The Effect of Dexamethasone Intravitreal Implant on Retinal Nerve Fiber Layer in Patients Diagnosed with Branch Retinal Vein Occlusion. Curr Eye Res 2017. [PMID: 28632411 DOI: 10.1080/02713683.2017.1313430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the effect of a single dose of intravitreal dexamethasone (DEX) implant on retinal nerve fiber layer (RNFL) thickness in patients with branch retinal vein occlusion (BRVO) in a 6-month period. MATERIALS AND METHODS This retrospective observational study included the patients with BRVO who received intravitreal DEX implant and whose assessment included the baseline RNFL thickness measurements. The data of 26 eyes of 24 patients were retrospectively analyzed. Spectral domain optic coherence tomography was used to measure peripapillary RNFL thickness in six regional subfields. Intraocular pressure (IOP) values at each visit were recorded. The data of single dose DEX implant during 6 months were assessed. RESULTS The mean preoperative and postoperative 6th month nasal RNFL values were 85.4 ± 23.0 μm and 82.1 ± 17.6 μm, respectively, and the difference between the measurements was not statistically significant (p = 0.372). There was a slight decrease in the mean RNFL values postoperatively compared to the baseline values in all quadrants except supero-temporal quadrant; however, none of them reached statistically significant level (p > 0.05). The mean IOP values before and 6 months after implantation were 15.7 ± 2.9 mmHg and 16.5 ± 4.2 mmHg, respectively. The difference between the 6th month IOP values and baseline IOP values was not statistically significant (p = 0.236). CONCLUSION Intravitreal DEX implant seems to have no adverse effect on RNFL thickness in BRVO patients in a 6-month period.
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Affiliation(s)
- Orhan Ayar
- a Faculty of Medicine, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Atilla Alpay
- a Faculty of Medicine, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Yaran Koban
- b Faculty of Medicine, Department of Ophthalmology , Kafkas University , Kars , Turkey
| | - Mehmet Orcun Akdemir
- a Faculty of Medicine, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Serpil Yazgan
- a Faculty of Medicine, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Sılay Canturk Ugurbas
- a Faculty of Medicine, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
| | - Suat Hayri Ugurbas
- a Faculty of Medicine, Department of Ophthalmology , Bulent Ecevit University , Zonguldak , Turkey
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de Smet MD, Meenink TCM, Janssens T, Vanheukelom V, Naus GJL, Beelen MJ, Meers C, Jonckx B, Stassen JM. Robotic Assisted Cannulation of Occluded Retinal Veins. PLoS One 2016; 11:e0162037. [PMID: 27676261 PMCID: PMC5046264 DOI: 10.1371/journal.pone.0162037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/13/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To develop a methodology for cannulating porcine retinal venules using a robotic assistive arm after inducing a retinal vein occlusion using the photosensitizer rose bengal. METHODOLOGY Retinal vein occlusions proximal to the first vascular branch point were induced following intravenous injection of rose bengal by exposure to 532nm laser light delivered by slit-lamp or endolaser probe. Retinal veins were cannulated by positioning a glass catheter tip using a robotically controlled micromanipulator above venules with an outer diameter of 80μm or more and performing a preset piercing maneuver, controlled robotically. The ability of a balanced salt (BSS) solution to remove an occlusion by repeat distention of the retinal vein was also assessed. RESULTS Cannulation using the preset piercing program was successful in 9 of 9 eyes. Piercing using the micromanipulator under manual control was successful in only 24 of 52 attempts, with several attempts leading to double piercing. The best location for cannulation was directly proximal to the occlusion. Infusion of BSS did not result in the resolution of the occlusion. CONCLUSION Cannulation of venules using a robotic microassistive arm can be achieved with consistency, provided the piercing is robotically driven. The model appears robust enough to allow testing of therapeutic strategies aimed at eliminating a retinal vein thrombus and its evolution over time.
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Affiliation(s)
- Marc D. de Smet
- MicroInvasive Ocular Surgery Center (MIOS sa), Lausanne, Switzerland
- Preceyes nv, Einhoven, The Netherlands
- * E-mail:
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Smit-McBride Z, Moisseiev E, Modjtahedi SP, Telander DG, Hjelmeland LM, Morse LS. Comparison of In Vivo Gene Expression Profiling of RPE/Choroid following Intravitreal Injection of Dexamethasone and Triamcinolone Acetonide. J Ophthalmol 2016; 2016:9856736. [PMID: 27429799 DOI: 10.1155/2016/9856736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To identify retinal pigment epithelium (RPE)/choroid genes and their relevant expression pathways affected by intravitreal injections of dexamethasone and triamcinolone acetonide in mice at clinically relevant time points for patient care. Methods. Differential gene expression of over 34,000 well-characterized mouse genes in the RPE/choroid of 6-week-old C57BL/6J mice was analyzed after intravitreal steroid injections at 1 week and 1 month postinjection, using Affymetrix Mouse Genome 430 2.0 microarrays. The data were analyzed using GeneSpring GX 12.5 and Ingenuity Pathway Analysis (IPA) microarray analysis software for biologically relevant changes. Results. Both triamcinolone and dexamethasone caused differential activation of genes involved in “Circadian Rhythm Signaling” pathway at both time points tested. Triamcinolone (TAA) uniquely induced significant changes in gene expression in “Calcium Signaling” (1 week) and “Glutamate Receptor Signaling” pathways (1 month). In contrast, dexamethasone (Dex) affected the “GABA Receptor Signaling” (1 week) and “Serotonin Receptor Signaling” (1 month) pathways. Understanding how intraocular steroids affect the gene expression of RPE/choroid is clinically relevant. Conclusions. This in vivo study has elucidated several genes and pathways that are potentially altering the circadian rhythms and several other neurotransmitter pathways in RPE/choroid during intravitreal steroid injections, which likely has consequences in the dysregulation of RPE function and neurodegeneration of the retina.
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Abstract
INTRODUCTION Retinal vein occlusion (RVO) is the second most common retinal vascular disorder. This multifactorial disease frequently leads to visual impairment. Some risk factors for RVO can be managed prophylactically. Given the complex physiopathology of RVO, most of the latest therapeutic strategies focus on secondary clinical features (such as macular oedema and neovascularization). AREAS COVERED This author reviews ongoing, prospective, open-label Phase I and Phase II clinical trials of novels treatments for RVO (primarily intravitreal steroids and anti-VEGF agents). Specifically, they review the pharmacokinetics, safety profile, study design and adverse events associated with innovative drugs in clinical development. EXPERT OPINION A number of innovative, early-phase clinical trials are based on combination therapy with an anti-VEGF agent and steroids. There is good evidence that early treatment of RVO has clinical benefits. Larger, randomized studies are now required for a better understanding of patient selection, treatment timing and dosing, and thus the optimized use of novel drugs and medical devices.
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Affiliation(s)
- Dominique Bremond-Gignac
- a Ophthalmology Department , University Hospital Necker-Enfants Malades , Paris , France.,b CNRS FR3636 , Paris V René Descartes University , Paris , France
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Proença Pina J, Turki K, Labreuche J, Duhamel A, Tran TH. Efficacy and Safety in Retinal Vein Occlusion Treated with at Least Three Consecutive Intravitreal Dexamethasone Implants. J Ophthalmol 2016; 2016:6016491. [PMID: 27022479 DOI: 10.1155/2016/6016491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the effects of repeated intravitreal dexamethasone implant (DI) (Ozurdex®) in eyes with macular edema (ME) due to retinal vein occlusion (RVO). Methods. Multicenter observational study including patients who received more than three consecutive DI on an "as-needed" basis for the treatment of ME in RVO. Results. A total of 18 eyes were included for analysis. Mean interval of retreatment with DI was 5.1 months between the first and second DI and 5.4 months following the second DI. Baseline BCVA was 0.74 ± 0.08 log-Mar; it significantly improved to 0.45 ± 0.04 2 months after the 3rd DI. There was no significant difference between the 3 first postinjection BCVA. CMT decreased from 617 μm ± 120 μm (baseline) to 330 ± 109 μm two months after the third DI. Elevated intraocular pressure occurred in 50% and was controlled medically. Cataract progression leading to cataract surgery occurred in 69% of phakic eyes after a mean interval of 17 months. Conclusion. Repeated DI on an "as-needed" basis, with a retreatment interval <6 months, are effective in the long term in the management of ME due to RVO. Rates of increased intraocular pressure and cataract surgery seem to be higher than previously described when eyes were followed during a longer period.
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Abstract
There are 3 approved pharmaceutical agents for treating macular edema secondary to retinal vein occlusion (RVO): dexamethasone (a corticosteroid) implant and ranibizumab and aflibercept (both antivascular endothelial growth factor agents). All show a superior ability to improve vision and reduce macular thickness in comparison with sham injections or macular grid laser treatment. Prompt treatment with these agents may lead to a better outcome. A review of randomized trials of injected aflibercept or ranibizumab reveals protocol variations. They include "as needed" injections until functional and anatomical changes are achieved, preceded by either 1 injection or 3 to 6 monthly injections as loading doses. Ocular and systemic adverse effects of vascular endothelial growth factor antagonists for macular edema secondary to RVO are rarely severe. The antiedematous response to a single intravitreal dexamethasone implant is maximal 1 to 3 months after the injection. Intraocular pressure elevation and cataract aggravation should be monitored after the use of intravitreal dexamethasone implants. Intravitreal dexamethasone implants and ranibizumab injections reduce not only macular edema, but also the risk of retinal ischemia and neovascularization in patients with RVO.
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Affiliation(s)
- Jia-Kang Wang
- From the Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City; Department of Medicine, National Yang Ming University, Taipei City; Department of Healthcare Administration and Department of Nursing, Oriental Institute of Technology, New Taipei City; and Department of Medicine, National Taiwan University, Taipei City, Taiwan
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Kim TH, Yoon CK, Lee JE, Lee JE, Chung IY, Sagong M, Kim KH, Kim HW. One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion. J Korean Ophthalmol Soc 2016. [DOI: 10.3341/jkos.2016.57.12.1918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Tae Hoon Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Ki Yoon
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Joo Eun Lee
- Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - In Young Chung
- Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Kun Hyung Kim
- Institute of Environmental and Occupational Medicine, Department of Occupational and Environmental Medicine, Inje University College of Medicine, Busan, Korea
| | - Hyun Woong Kim
- Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Reid GA, Sahota DS, Sarhan M. OBSERVED COMPLICATIONS FROM DEXAMETHASONE INTRAVITREAL IMPLANT FOR THE TREATMENT OF MACULAR EDEMA IN RETINAL VEIN OCCLUSION OVER 3 TREATMENT ROUNDS. Retina 2015; 35:1647-55. [DOI: 10.1097/iae.0000000000000524] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Parodi MB, Iacono P, Petruzzi G, Parravano M, Varano M, Bandello F. DEXAMETHASONE IMPLANT FOR MACULAR EDEMA SECONDARY TO ISCHEMIC RETINAL VEIN OCCLUSIONS. Retina 2015; 35:1387-92. [DOI: 10.1097/iae.0000000000000492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sheu SJ, Wu TT, Horng YH. Efficacy and Safety of Dexamethasone Intravitreal Implant for Treatment of Refractory Macular Edema Secondary to Retinal Vein Occlusion in Taiwan. J Ocul Pharmacol Ther 2015; 31:461-7. [PMID: 26067779 DOI: 10.1089/jop.2014.0119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To evaluate the long-term efficacy and safety of slow-release dexamethasone intravitreal implant (DEX implant) in patients with refractory macular edema (ME) secondary to retinal vein occlusion (RVO) in Taiwan. METHODS We conducted a retrospective chart review of patients with a diagnosis of ME secondary to RVO who received the DEX implant at Kaohsiung Veterans General Hospital from October 2010 to February 2014. RESULTS A total of 28 patients with an average age of 60.7 ± 11.1 years were examined. Of these patients, 17 were diagnosed with branch RVO (BRVO) and 11 were diagnosed with central RVO (CRVO). The mean maximal change in vision from the baseline after the final injection was an improvement of 1.7 ± 2.8 lines (equivalent to 8.5 ETDRS letters; p<0.0001). The response to the first injection was similar across both BRVO and CRVO groups, but patients with BRVO showed a more favorable response than those with CRVO after the second injection. The response in patients who had refractory ME after at least 3 previous interventions was similar to the whole group. Three patients (10.7%) had elevated intraocular pressure (IOP) that was well controlled by IOP-lowering medications. None of these patients required laser or glaucoma surgery. Five patients (17.9%) exhibited cataract progression during the observation period. CONCLUSION The DEX implant is an effective and safe treatment for ME, secondary to RVO, including refractory ME.
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Affiliation(s)
- Shwu-Jiuan Sheu
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan .,2 School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Tsung-Tien Wu
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan .,2 School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Yu-Harn Horng
- 1 Department of Ophthalmology, Kaohsiung Veterans General Hospital , Kaohsiung, Taiwan
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Girmens JF, Glacet-Bernard A, Kodjikian L, Nghiêm-Buffet S, Massé H, Fourmaux E, Wolff B, Roquet W, Gaucher D, Baillif S, Tadayoni R. [Management of macular edema secondary to retinal vein occlusion]. J Fr Ophtalmol 2015; 38:253-63. [PMID: 25683131 DOI: 10.1016/j.jfo.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO. METHODS A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article. RESULTS The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters. DISCUSSION Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.
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Chiquet C, Dupuy C, Bron AM, Aptel F, Straub M, Isaico R, Romanet JP, Creuzot-Garcher C. Intravitreal dexamethasone implant versus anti-VEGF injection for treatment-naïve patients with retinal vein occlusion and macular edema: a 12-month follow-up study. Graefes Arch Clin Exp Ophthalmol 2015; 253:2095-102. [DOI: 10.1007/s00417-015-2947-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/17/2014] [Accepted: 01/21/2015] [Indexed: 01/06/2023] Open
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Augustin AJ, Holz FG, Haritoglou C, Mayer WJ, Bopp S, Scheuerle AF, Maier M, Sekundo W, Sandner D, Shirlaw A, Hattenbach LO. Retrospective, observational study in patients receiving a dexamethasone intravitreal implant 0.7 mg for macular oedema secondary to retinal vein occlusion. Ophthalmologica 2014; 233:18-26. [PMID: 25503473 DOI: 10.1159/000368840] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/02/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To retrospectively evaluate the re-injection interval, efficacy and safety of dexamethasone (DEX) intravitreal implant 0.7 mg in the treatment of macular oedema (ME) due to retinal vein occlusion (RVO) in Germany in 2009-2012. METHODS Retrospective, multicentre, anonymised observational study of data collected from the first DEX implant 0.7 mg injection through 3-6 months following the last injection. Data were included if the patient was >18 years old, had a diagnosis of ME secondary to branch or central RVO, and received at least 2 DEX implant 0.7 mg injections during routine practice. RESULTS Data from 87 patients were analysed. Mean time to re-injection between first and second treatments was 5.03 months in the total RVO population, and 5.46 and 4.52 months for the branch and central RVO subpopulations, respectively. An intraocular pressure increase of >25 mm Hg was recorded in 20% of patients, and 34% of patients began treatment with anti-glaucoma medication, but surgery was not needed for this condition. CONCLUSIONS DEX implant 0.7 mg was found to be well tolerated and effective with repeat treatments in clinical practice.
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Nghiem-Buffet S, Fajnkuchen F, Buffet M, Ayrault S, Le Gloahec-Lorcy A, Grenet T, Delahaye-Mazza C, Quentel G, Cohen SY. Intravitreal Ranibizumab and/or Dexamethasone Implant for Macular Edema Secondary to Retinal Vein Occlusion. Ophthalmologica 2014; 232:216-22. [DOI: 10.1159/000365639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/28/2014] [Indexed: 11/19/2022]
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Veritti D, Macor S, Lanzetta P. Early effects of dexamethasone implant on macular morphology and visual function in patients with macular edema secondary to retinal vein occlusion. Ophthalmologica 2014; 232:144-8. [PMID: 25300393 DOI: 10.1159/000366232] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/19/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the early effects of the intravitreal erodible dexamethasone implant Ozurdex in patients with macular edema due to retinal vein occlusion (RVO). METHODS Eyes with macular edema due to RVO were prospectively included in the study and received a 700-μg dexamethasone implant. Best-corrected visual acuity (BCVA) measurement, complete ophthalmic evaluation and spectral-domain optical coherence tomography were performed at baseline and 1, 2, 3, 7, 14, 21, 28, 60, and 90 days after treatment. RESULTS Nineteen eyes of 18 patients were included in the study. Mean central retinal thickness (CRT) decreased rapidly after treatment (p < 0.0001) from 503 μm at baseline to 288 μm after 1 day and 199 μm at the end of the follow-up. BCVA gained on average +6 ETDRS letters after 1 day and +11 letters at day 90 (p = 0.0001). CONCLUSION The intravitreal dexamethasone implant showed a fast effect in reducing CRT and improving BCVA in RVO patients.
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Affiliation(s)
- Daniele Veritti
- Department of Medical and Biological Sciences - Ophthalmology, University of Udine, Udine, Italy
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Fedorchak MV, Conner IP, Medina CA, Wingard JB, Schuman JS, Little SR. 28-day intraocular pressure reduction with a single dose of brimonidine tartrate-loaded microspheres. Exp Eye Res 2014; 125:210-6. [DOI: 10.1016/j.exer.2014.06.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 11/18/2022]
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Sorkin N, Loewenstein A, Habot-Wilner Z, Goldstein M. Intravitreal dexamethasone implant in patients with persistent macular edema of variable etiologies. Ophthalmologica 2014; 232:83-91. [PMID: 24942067 DOI: 10.1159/000360304] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/01/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the effect of an intravitreal dexamethasone drug delivery system (DEX-DDS) in the treatment of persistent cystoid macular edema (CME) of different etiologies. METHODS Thirty-seven eyes with persistent CME were treated with DEX-DDS and analyzed for changes in best-corrected visual acuity (BCVA) and optical coherence tomography. Eyes were categorized into three groups: diabetic macular edema (DME, n = 14), vein occlusion (n = 15) and uveitis (n = 7). RESULTS The mean follow-up was 22 ± 6.9 weeks. BCVA improved from 0.62 ± 0.38 to 0.35 ± 0.29 logMAR (p < 0.0001). Central macular thickness decreased by 184 ± 246 µm from baseline (p < 0.0001). In eyes where CME resolved and recurred, the average CME-free period was 11 weeks. The uveitis group showed faster CME resolution (2 weeks) and a longer CME-free period (20 weeks). Similar efficacy was shown for repeat DEX-DDS injections. The safety profile was good. CONCLUSION DEX-DDS is beneficial in the treatment of persistent CME. In cases of uveitis, CME resolution is rapid, resulting in the longest effect duration, when compared with other CME etiologies.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tomkins-Netzer O, Taylor SRJ, Bar A, Lula A, Yaganti S, Talat L, Lightman S. Treatment with repeat dexamethasone implants results in long-term disease control in eyes with noninfectious uveitis. Ophthalmology 2014; 121:1649-54. [PMID: 24650556 DOI: 10.1016/j.ophtha.2014.02.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To describe the long-term outcome of eyes with uveitis after repeated treatment with dexamethasone implants (Ozurdex; Allergan, Inc., Irvine, CA). DESIGN Retrospective, observational case series. PARTICIPANTS Thirty-eight eyes of 27 patients with uveitis that were treated with 61 dexamethasone implants. METHODS All eyes underwent dexamethasone pellet implantation. Anatomic and functional outcomes, as well as ocular complications, were noted. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze score, and presence of increased intraocular pressure or cataract. RESULTS Average follow-up was 17.3 ± 1.8 months after the first implant (median, 13.3 months; range, 3-54.5 months; 54.65 eye-years), with 14 eyes (36.9%) receiving a single implant and 24 eyes (63.1%) receiving multiple implantations. After the first implantation, average BCVA improved significantly from 0.47 ± 0.05 logarithm of the minimum angle of resolution (logMAR) units (Snellen equivalent, 20/60) to 0.27 ± 0.07 logMAR (Snellen equivalent, 20/37; P<0.001); CRT decreased by 263 ± 44.22 μm (P = 0.003), although macular edema persisted in 50% of eyes, and the percentage of eyes achieving a vitreous haze score of 0 increased from 58% to 83% (P = 0.03). The median duration of therapeutic effect after the first injection was 6 months (range, 2-42 months), with a similar response achieved after each repeat implantation. The accumulated effect of repeat dexamethasone implants resulted in a continued improvement in BCVA (R(2) = 0.91; P<0.0001), with significant improvement and stabilization of CRT. After repeated implantations, 2 eyes had progression of posterior subcapsular opacities, although neither required surgery. There were 7 instances of increased intraocular pressure of more than 21 mmHg at a rate of 0.13 per eye-year, all of which responded to pharmacologic treatment. CONCLUSIONS The accumulated effect of repeat dexamethasone pellet implantations improves retinal thickness and resolves ocular inflammation, resulting in restoration of ocular function. Ocular complications were minimal, with no eyes requiring surgery for increased ocular pressure or progression of cataract.
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Affiliation(s)
- Oren Tomkins-Netzer
- Uveitis Service, Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; Department of Ophthalmology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Simon R J Taylor
- Department of Ophthalmology, Royal Surrey County Hospital, Guildford, United Kingdom; Division of Immunology & Inflammation, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Asaf Bar
- Uveitis Service, Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; Department of Ophthalmology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Albert Lula
- Department of Ophthalmology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Satish Yaganti
- Department of Ophthalmology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Lazha Talat
- Uveitis Service, Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom
| | - Sue Lightman
- Uveitis Service, Moorfields Eye Hospital, London, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; Department of Ophthalmology, Royal Surrey County Hospital, Guildford, United Kingdom.
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Abstract
Retinal vein occlusions are important causes of loss of vision; indeed, they are the second most common retinal vascular disease, following diabetic retinopathy. For this reason alone, primary eye-care providers must be well versed in diagnosis and management. Risk factors, though not universally agreed upon, include but are not limited to advancing age, systemic hypertension, arteriolarsclerosis, diabetes, hyperlipidaemia, blood hyperviscosity, thrombophilia, ocular hypertension and glaucoma. Typically, visual loss is secondary to macular oedema and/or retinal ischaemia. Treatment modalities have included observation, systemic thrombolysis and haemodilution, radial optic neurotomy, chorioretinal anastomosis, vitrectomy, laser photocoagulation and intravitreal injection of anti-inflammatory and, most recently, anti-vascular endothelial growth factors.
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Matonti F, Meyer F, Guigou S, Barthelemy T, Dumas S, Gobert F, Hajjar C, Merite PY, Parrat E, Rouhette H, Pommier S. Ozurdex in the management of the macular edema following retinal vein occlusion in clinical practice. Acta Ophthalmol 2013; 91:e584-6. [PMID: 23764276 DOI: 10.1111/aos.12190] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Frederic Matonti
- Network P1.5, Mougins, FranceOphthalmology Department, Aix Marseille Université, Hôpital Nord, Chemin de Bourrely, Marseille, FranceINT UMR 7289, Aix Marseille Université, Marseille, France
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Abstract
BACKGROUND Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. METHODS Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search. RESULTS Treatment modalities were analyzed. CONCLUSIONS There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).
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Coscas G, Augustin A, Bandello F, de Smet MD, Lanzetta P, Staurenghi G, Parravano MC, Udaondo P, Moisseiev E, Soubrane G. Retreatment with Ozurdex for macular edema secondary to retinal vein occlusion. Eur J Ophthalmol. 2014;24:1-9. [PMID: 24249150 DOI: 10.5301/ejo.5000376] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To review the current practice of retreatment with Ozurdex injections in patients with macular edema (ME) secondary to retinal vein occlusion (RVO), and to recommend simple guidelines for Ozurdex reinjection in management of RVO. METHODS This was a multicenter retrospective study of patients who received more than 2 Ozurdex injections for the treatment of ME in RVO. Recorded parameters included percent of patients with a 15-letter gain, visual acuity (VA) improvement from baseline, change in central macular thickness (CMT), time to reinjection, and occurrence of any complications. RESULTS A total of 128 patients were included, 58 (45.3%) with central RVO (CRVO) and 70 (54.7%) with branch RVO (BRVO). Mean interval for Ozurdex reinjection was 5.9 months following the first injection and 8.7 months following the second. A >15-letter gain in VA was observed in 34 (48.8%) patients with CRVO and 16 (28%) patients with BRVO. Mean overall VA improvement at month 6 did not show significance (p>0.05); however, a significantly better mean VA improvement was seen in treatment-naïve eyes (p<0.03). The CMT was significantly reduced compared to baseline. The mean CMT decreased by 214.6 µm in eyes with BRVO (n = 53) and by 355.1 µm in eyes with CRVO (n = 63) (p = 0.002). Complication rates were very low. CONCLUSIONS Repeated injections of Ozurdex are effective and have a favorable safety profile. In current practice, the retreatment interval with Ozurdex injections might be too long, precluding the full therapeutic potential of this treatment modality. A strategy for managing RVO patients treated with Ozurdex on an as-needed basis is provided.
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Fialho SL, Souza PAF, Fulgêncio GO, Miranda MMO, Pereira BG, Haddad A, Messias A, Jorge R, Silva-Cunha A. In vivorelease and retinal safety of intravitreal implants of thalidomide in rabbit eyes and antiangiogenic effect on the chorioallantoic membrane. J Drug Target 2013; 21:837-45. [DOI: 10.3109/1061186x.2013.829074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fenicia V, Balestrieri M, Perdicchi A, Maraone G, Recupero SM. Intravitreal Injection of Dexamethasone Implant in Serous Macular Detachment Associated with Waldenström's Disease. Case Rep Ophthalmol 2013; 4:64-9. [PMID: 24019788 PMCID: PMC3764974 DOI: 10.1159/000354066] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose To evaluate the efficacy of one intravitreal injection of dexamethasone (Ozurdex®; Allergan, Inc., Irvine, Calif., USA) in serous macular detachment (SMD) of one eye, associated with bilateral central retinal vein occlusion (CRVO) in a patient affected by Waldenström's macroglobulinemia (WM). Patients and Methods A female patient, affected by WM, complained of a progressive decrease in visual acuity, mainly in the left eye (LE). SMD in the LE associated with bilateral CRVO was diagnosed. One intravitreal injection of dexamethasone was administered in the LE and the patient was tested 1, 2, and 6 months after the injection. Results 1, 2, and 6 months after the injection, the spectral domain optical coherence tomography (SD-OCT) showed a progressive slight reduction of foveal thickness that was not related to any improvement of visual function. Conclusions Treatment with dexamethasone (Ozurdex) induced a progressive slight reduction of SMD but no improvement of visual acuity, and it is possible that this is related to the condition of hematic hyperviscosity that is present in WM.
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Affiliation(s)
- Vito Fenicia
- Ophthalmology Unit, NESMOS Department, S. Andrea Hospital, Faculty of Medicine and Psychology, 'Sapienza' University of Rome, Rome, Italy
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Joshi L, Yaganti S, Gemenetzi M, Lightman S, Lindfield D, Liolios V, Menezo V, Shao E, Taylor SRJ. Dexamethasone implants in retinal vein occlusion: 12-month clinical effectiveness using repeat injections as-needed. Br J Ophthalmol 2013; 97:1040-4. [DOI: 10.1136/bjophthalmol-2013-303207] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Querques G, Triolo G, Casalino G, García-Arumí J, Badal J, Zapata M, Boixadera A, Castillo VM, Bandello F. Retinal Venous Occlusions: Diagnosis and Choice of Treatments. Ophthalmic Res 2013; 49:215-22. [DOI: 10.1159/000346734] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 12/27/2022]
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