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Carnevali A, Taloni A, Gatti V, Lamonica L, Oliverio F, Randazzo G, Scorcia V. Effect of intralenticular dexamethasone implant: A case report. Eur J Ophthalmol 2024; 34:NP80-NP83. [PMID: 37165519 DOI: 10.1177/11206721231174934] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Intravitreal dexamethasone (DEX) implant is indicated for the treatment of macular oedema due to diabetic retinopathy, retinal vein occlusion and uveitis. The most common complications are cataract and elevated intraocular pressure (IOP). Accidental injection of DEX implant into the lens is a rare complication and only few papers presented it. CASE PRESENTATION A 40-year-old man was treated with DEX implant for diabetic macular oedema in both eyes. At 1 week follow-up visit, slit lamp examination showed the DEX implant was located in the crystalline lens of the right eye (RE) without any sign of inflammation, cataract or elevated IOP, so we decided to plan a normal follow-up schedule. Macular oedema relapsed 5 months after the injection in the left eye (LE), whereas the RE did not show any sing of intraretinal or subretinal fluid. Six months after DEX implantation an uneventful phacoemulsification and intraocular lens placement were performed in the RE because of IOP elevation. CONCLUSIONS The therapeutic effect of DEX implant can be maintained for a longer period of time than intravitreal implant, determining complete reabsorption of macular oedema. Intralenticular implant can be maintained inside the lens until either IOP increases, cataract progresses, or other complications occur.
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Affiliation(s)
- Adriano Carnevali
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
| | - Andrea Taloni
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
| | - Valentina Gatti
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
| | - Luca Lamonica
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
| | - Flavia Oliverio
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
| | - Giorgio Randazzo
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University "Magna Græcia", Catanzaro, Italy
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Taloni A, Coco G, Rastelli D, Buffon G, Scorcia V, Giannaccare G. Safety and Efficacy of Dexamethasone Intravitreal Implant Given Either First-Line or Second-Line in Diabetic Macular Edema. Patient Prefer Adherence 2023; 17:3307-3329. [PMID: 38106365 PMCID: PMC10725633 DOI: 10.2147/ppa.s427209] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Diabetic macular edema (DME) is a common sight-threatening complication of diabetic retinopathy (DR) and the leading cause of severe visual impairment among the working-age population. Several therapeutic options are available for the management of DME, including intravitreal corticosteroids. They have been traditionally used as second-line treatment, due to the risk of intraocular pressure increase and cataract-related adverse events. However, attention has recently been focused on the primary or early use of intravitreal corticosteroids, due to growing evidence of the crucial role of inflammation in the pathogenesis of DME. Furthermore, intravitreal steroid implants offer the additional advantage of a longer duration of action compared to anti-vascular endothelial growth factor agents (anti-VEGF). This review aims to summarize the available evidence on the efficacy and safety profile of dexamethasone (DEX) intravitreal implant, with a specific focus on clinical scenarios in which it might be considered or even preferred as first-line treatment option by adequate selection of patients, considering both advantages and possible adverse events. Patients with contraindications to anti-VEGF, DME with high inflammatory OCT biomarkers, pseudophakic patients and phakic patients' candidates to cataract surgery as well as vitrectomized eyes may all benefit from first-line DEX implant. Additionally, DME not responders to anti-VEGF should be considered for a switch to DEX implant and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent DME.
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Affiliation(s)
- Andrea Taloni
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Rastelli
- Department of Ophthalmology, Policlinico Casilino, Rome, Italy
| | - Giacinta Buffon
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Sanders FWB, Dumont Jones R, Jones DR, Phillips SV, Williams GS. Treatment of Diabetic Macular Edema or Macular Edema Following Retinal Vein Occlusion Based on Repeated Injection of the Dexamethasone Intravitreal Implant: A Retrospective Real-World Analysis. Clin Ophthalmol 2023; 17:3177-3187. [PMID: 37901284 PMCID: PMC10612511 DOI: 10.2147/opth.s402142] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Purpose To assess the "real world" utility of repeated injection with the dexamethasone intravitreal implant (DEX) in routine practice. Methods This was a retrospective, single-center analysis of consecutive patients with diabetic macular edema, or macular edema following retinal vein occlusion, treated with DEX. None had received prior intravitreal steroid treatment. DEX was implanted as per the manufacturer's instructions. Results Seventy-eight individuals (95 eyes) were included (50.0% female; mean age: 68.1 ± 12.4 years; mean duration of macular edema: 13.2 ± 12.9 months). Thirty-three eyes (34.7%) had received previous treatment with an anti-vascular endothelial growth factor (anti-VEGF) and/or laser. Thirty eyes (31.6%) underwent one round of DEX implantation; the remainder received 2-5 cycles (total: 225 cycles). Initial DEX treatment led to significant increases in visual acuity (VA) at 6 weeks (mean change: 4.6 letters; P=0.004). Greater VA improvements during the first treatment cycle were associated with inferior baseline VA (P=0.02), borderline associated with baseline central macular thickness (CMT; P=0.06), and independent of prior anti-VEGF treatment (P=0.39). In an analysis of all DEX injections, VA improvements were robust across cycles 1 and 2 but reduced in cycle 3 (P=0.03). CMT improvements did not differ based on injection number (P=0.20). Increases in intraocular pressure (IOP) were largest over the first 6 weeks (but rebounded towards baseline more rapidly) in cycle 1 versus cycles 2 and 3 (P<0.001). IOP rises were typically manageable with topical medications. Conclusion This analysis confirms the broad utility of DEX and may inform decision-making in routine practice.
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Affiliation(s)
| | | | - David R Jones
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
| | - Sean V Phillips
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
| | - Gwyn S Williams
- Department of Ophthalmology, Singleton Hospital, Swansea, UK
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Cheng Y, Chen C, Xiao Y, Wang S, Wang S, Peng X. Case report: A rare appearance of preretinal deposits in a patient with uveitis: multimodal imaging observation. Front Med (Lausanne) 2023; 10:1121419. [PMID: 37614954 PMCID: PMC10442564 DOI: 10.3389/fmed.2023.1121419] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 07/24/2023] [Indexed: 08/25/2023] Open
Abstract
Background Uveitis is a disease presenting with varied clinical symptoms and potentially devastates visual function. Here, we report a patient with uveitis exhibiting a rare appearance of preretinal deposits (PDs). Case presentation A 49-year-old female showed vitreous opacity and perivascular white PDs involving veins and arteries. The interferon-gamma release assay was strongly positive and chest computed tomography showed signs of calcified nodules; other tests were unremarkable. The patient was diagnosed with uveitis and tubercular infection. The patient was given systemic anti-tubercular therapy and steroids, which were subsequently combined with immunosuppressants. The shrinkage of HRD was more sensitively observed with OCT than on photographs during follow-up visits. The right eye was relieved subsequently, but the left eye showed vitreous opacity and responded poorly to the treatment. Three months after the dexamethasone intravitreal implant, the perivascular deposits in the left eye disappeared and the vitreous opacity was relieved. Conclusion PDs can appear as spotted deposits in the posterior pole and segmental deposits in the periphery in patients with uveitis, which mainly involves the vitreous cavity and is easily confused with retinal vasculitis. OCT can more sensitively observe the response than other examinations.
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Affiliation(s)
- Yizhe Cheng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Chunli Chen
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Yuanyuan Xiao
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
| | - Shuang Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing, China
| | - Sihui Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Peng
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Science Key Laboratory, Beijing, China
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Medina-Baena M, Cejudo-Corbalán O, Labella-Quesada F, Girela-López E. Cost-Effectiveness of Dexamethasone Intravitreal Implant in Naïve and Previously Treated Patients with Diabetic Macular Edema. Int J Environ Res Public Health 2023; 20:ijerph20085462. [PMID: 37107744 PMCID: PMC10138397 DOI: 10.3390/ijerph20085462] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE To compare the direct costs associated with the dexamethasone intravitreal implant (DEX-i) in treatment-naïve and previously treated eyes with diabetic macular edema (DME) in a real clinical setting. METHODS Retrospective and single-center study conducted in a real clinical scenario. Consecutive DME patients, either naïve or previously treated with vascular endothelial growth factor inhibitors (anti-VEGF), who received treatment with one or more DEX-i between May 2015 and December 2020, and who were followed-up for a minimum of 12 months, were included in the study. The cost analysis was performed from the perspective of the Andalusian Regional Healthcare Service. The primary effectiveness endpoint was the probability of achieving an improvement in best-corrected visual acuity (BCVA) ≥ 15 ETDRS letters after 1 year of treatment. The incremental cost-effectiveness ratio (ICER) of different improvements in BCVA was calculated. RESULTS Forty-nine eyes, twenty-eight (57.1%) eyes from the treatment-naïve group and twenty-one (42.9%) from the previously treated group, were included in the analysis. The total cost of one year of treatment was significantly lower in the treatment-naïve eyes than in the previously treated eyes [Hodges-Lehmann median difference: EUR 819.1; 95% confidence interval (CI): EUR 786.9 to EUR 1572.8; p < 0.0001]. The probability of achieving a BCVA improvement of ≥15 letters at month 12 was significantly greater in the treatment-naïve group than in the previously treated group (rate difference: 0.321; 95% CI: 0.066 to 0.709; p = 0.0272). The Cochran-Mantel-Haenszel Odds Ratio of achieving a BCVA improvement of ≥15 letters at month 12 was 3.55 (95% CI: 1.09 to 11.58; p = 0.0309). In terms of ICER, the treatment-naïve group showed cost savings of EUR 7704.2 and EUR 5994.2 for achieving an improvement in BCVA ≥ 15 letters at month 12 and at any of the measured time points, respectively. CONCLUSIONS DEX-i was found to be more cost-effective in treatment-naïve eyes than in those previously treated with anti-VEGF. Further studies are needed to determine the most cost-effective treatment based on patient profile.
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Affiliation(s)
- Marta Medina-Baena
- Puerta del Mar University Hospital, 11009 Cadiz, Spain
- Correspondence: ; Tel.: +34-956-002100
| | | | | | - Eloy Girela-López
- Faculty of Medicine and Nursing, University of Córdoba, 14004 Cordoba, Spain
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Gascon P, Borget I, Comet A, Carton L, Matonti F, Dupont-Benjamin L. Costs comparison of treating diabetic macular edema with aflibercept, ranibizumab or dexamethasone at 1 year in France (INVICOST study). Eur J Ophthalmol 2022; 32:1702-1709. [PMID: 34284605 PMCID: PMC9109236 DOI: 10.1177/11206721211033480] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 06/29/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE INVICOST, a medico-economic analysis, compared costs of managing treatment-naive patients with diabetic macular edema (DME) receiving intravitreal injections (IVIs) of aflibercept (AFL), dexamethasone implant (DXI) or ranibizumab (RAN) over 1 year. METHODS Healthcare resource use and associated costs were estimated using individual patient data from INVICTUS, a prospective, open-label, monocentric study. Healthcare costs comprised direct medical costs such as drug acquisition and administration, consultations and ophthalmological procedures. Costs were assessed from the French National Health Insurance perspective using published national tariffs expressed in 2019 euros. RESULTS Of the 60 treated eyes, 48 had no treatment switch; 14 received AFL, 19 received DXI and 15 received RAN. AFL-treated eyes received an average of 6.5 IVIs, DXI-treated patients received 2 IVIs and RAN-treated received 6.8 IVIs. All treated eyes received an initial prescription for adjunctive ocular medications and 349 follow-up procedures were performed including an average of 3.9 optical coherence tomography and 3.2 retinography procedures per eye. Average total direct cost of per-eye treatment was €4516 (€1128-€8257). Average cost was €5782 for eyes treated with AFL, €2779 with DXI and €5536 with RAN. Drug therapy was the cost driver: €4394 (76%) for AFL, €1915 for DXI (69%) and €4268 (77%) for RAN. CONCLUSION The difference in total treatment cost is largely explained by the significantly lower frequency of IVI and annual cost of therapy with DXI, compared with AFL and RAN. INVICOST is the first study comparing treatment costs with AFL, DXI and RAN in France in current clinical practice.
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Affiliation(s)
- Pierre Gascon
- Ophthalmology Department, Aix-Marseille University, Hôpital Nord, Marseille, France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Oncostat U1018, Inserm, labeled Ligue Contre le Cancer Gustave Roussy, University Paris-Saclay, Villejuif, France
- EA GRADES, University Paris-Saclay, Châtenay-Malabry, France
| | - Alban Comet
- Ophthalmology Department, Aix-Marseille University, Hôpital Nord, Marseille, France
| | | | - Frédéric Matonti
- Centre Monticelli Paradis, Marseille, France
- Aix Marseille University, CNRS, INT, Timone Neurosciences Institute, Marseille, France
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
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Călugăru D, Călugăru M. Early treatment with dexamethasone intravitreal implants in diabetic macular edema: Naïve versus refractory patients. Eur J Ophthalmol 2022; 32:NP93-NP94. [PMID: 35354323 DOI: 10.1177/11206721211067334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dan Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca, Romania
| | - Mihai Călugăru
- Department of Ophthalmology, University of Medicine, Cluj-Napoca, Romania
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Gao S, Zhang Y, Li X, Ge G, Duan J, Lei C, Zeng Y, Cai Z, Zhang M. Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis. Front Pharmacol 2021; 12:752048. [PMID: 34955825 PMCID: PMC8692786 DOI: 10.3389/fphar.2021.752048] [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: 08/02/2021] [Accepted: 11/17/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: This network meta-analysis was conducted to obtain the relative effectiveness of different pharmacotherapy of macular edema secondary to retinal vein occlusion (RVO) by summarizing all available evidences. Methods: PubMed, Embase, and Cochrane Library databases were searched for all relevant randomized controlled trials. The outcomes were estimated through a network meta-analysis, including the mean change in best-corrected visual acuity (BCVA) from baseline, the proportion of patients who gained ≥15 letters in BCVA from baseline, the mean change in central retinal thickness (CRT). Results: We identified 15 randomized controlled trials (RCTs) involving 3,431 patients with RVO in our study. Different therapeutic regimens were compared including three anti-vascular endothelial growth factor (VEGF) agents (ranibizumab, bevacizumab, and aflibercept), ranibizumab with laser, dexamethasone intravitreal implant, and laser. For branch RVO, ranibizumab 0.5 mg monthly [weighted mean difference (WMD) = 11, 95% confidence intervals (CrI) 3.6 to 19], ranibizumab 0.5 mg 3 + pro re nata (WMD = 9.4, 95% CrI 0.43–18) is most effective in terms of changes of BCVA and 15 letters or more of BCVA improvement. For central RVO, three anti-VEGF regimens can improve visual acuity and there is no significant difference of efficacy among ranibizumab, bevacizumab and aflibercept (p > 0.05). Ranibizumab 0.5 mg monthly could achieve additional efficacy in CRT reduction in eyes with branch RVO or central RVO (WMD = -130, 95% CrI -400 to 140 or WMD = -280, 95% CrI -590 to 16)). Dexamethasone intravitreal implant (WMD = 1.7, 95% CrI -4.2 to 7.1 or WMD = 0.38, 95% CrI -9.8 to 8.8)) did not show a significant improvement in visual acuity at the end of 6 months follow-up in eyes with branch RVO or central RVO. Conclusion: In summary, this network meta-analysis demonstrated several anti-VEGF agents had equivalent effects on mean visual acuity changes and anatomical recovery in 6 months in eyes with branch or central RVO. Only one injection of dexamethasone intravitreal implant in 6 months could not maintain the visual benefit. Patients and clinicians could choose pharmacotherapies with further consideration toward personal factors.
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Affiliation(s)
- Sheng Gao
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Xun Li
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Ge
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Jianan Duan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China.,Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
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Gupta PC, Ram J, Kumar MP, Agarwal A, Gupta V, Singh R, Bansal R, Katoch D, Dogra MR, Gupta A. Effect of sustained-release long-acting intravitreal dexamethasone implant in patients of non-proliferative diabetic retinopathy undergoing phacoemulsification: A randomized controlled trial. Indian J Ophthalmol 2021; 69:3263-3272. [PMID: 34708785 PMCID: PMC8725102 DOI: 10.4103/ijo.ijo_749_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/28/2022] Open
Abstract
Purpose: Cataract and diabetes, both being a major health care problem, an intervention evaluated for the combination of the two attains paramount importance. The purpose of the study was to determine the role of intraoperative intravitreal dexamethasone implant in patients with diabetic retinopathy with/without macula edema undergoing phacoemulsification. Methods: The study was a two-arm, single-center, randomized, assessor-blinded trial of 151 patients with type-2 diabetes mellitus and cataract. It had two groups: dexamethasone group (DEX) versus standard of care (SOC) group, i.e. phacoemulsification and intraocular lens (IOL) implantation without injection of dexamethasone drug delivery system (DDS). The number of rescue interventions required, central macular thickness by optical coherence tomography (OCT), Early Treatment Diabetic Retinopathy Study (ETDRS) score, laser flare meter (LFM) values, intraocular pressure (IOP), and grade of diabetic retinopathy (DR) were recorded until three months follow up. Macular thickness and number of rescue medications between the treatment groups were the co-primary outcomes. Results: A statistically significant interaction was present between treatment and time on OCT score (P < 0.001). The requirement of rescue interventions in the dexamethasone DDS group [40.2% (33/82)] was lesser as compared to the SOC group [49.3% (34/69)] at the end of 12 weeks [odds ratio (OR), 0.70 (0.36–1.33)] follow up although not statistically significant (P = 0.343). A statistically significant interaction was present between treatment and time on LFM score (P = 0.003). No statistically significant interaction was present between the treatment and time on visual acuity score (P = 0.08) and IOP score (P = 0.375). Conclusion: Dexamethasone implant may have potential as a valuable therapy for patients undergoing cataract surgery with DR with/without macular edema with effects lasting for at least three months.
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Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - M Praveen Kumar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aniruddha Agarwal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishali Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reema Bansal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deeksha Katoch
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mangat R Dogra
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Udaondo P, Hervas-Ontiveros A, Rosemblatt A, Garcia-Delpech S. Impact of Different Clinical Baseline Characteristics on Intravitreal Dexamethasone Implant Ozurdex ® Outcomes. Clin Ophthalmol 2021; 15:4153-4162. [PMID: 34703201 PMCID: PMC8524257 DOI: 10.2147/opth.s336865] [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: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the impact of different baseline clinical characteristics on the improvement in best corrected visual acuity (BCVA) in patients with diabetic macular edema (DME) who underwent the intravitreal dexamethasone implant (DEX) Ozurdex®. Methods This was a single center retrospective study conducted on patients with DME, either naïve or previously treated, who were treated with one or more DEX and had a follow-up of at least 6 months. The main outcome measure was the proportion of DEX achieving an improvement ≥15 letters in BCVA. Results The study analyzed 192 DEX implants administered to 97 eyes (65 patients). Among the 192 DEX analyzed, 57 (29.7%) implants achieved a BCVA improvement ≥15 letters (ETDRS) from baseline, with a mean time for achieving such improvement of 89.2 (39.7) days. Eyes who received an additional DEX and those with a duration of DME < 6 months had a greater probability of achieving a BCVA improvement ≥15 letters (odds-ratio: 2.55, p = 0.0028 and odds-ratio: 1.93, p = 0.0434). The mean (standard deviation) change in BCVA from baseline was 7.5 (14.5) letters, p < 0.0001. The mean change in central macular thickness (CMT) from baseline was -128.0 (151.0) µm, p < 0.0001. The mean number of DEX implanted was 1.9 (0.8). Four (2.1%) DEX experienced an intraocular pressure increased ≥10 mm Hg; all the cases were successfully managed with topical antiglaucoma medication. Conclusion The results of this study confirmed previous evidence suggesting that DEX is effective for improving BCVA and CMT in patients with DME.
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Affiliation(s)
- Patricia Udaondo
- Ophthalmology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Aiken Prevencción y Cirugía Ocular, Valencia, Spain
| | - Ana Hervas-Ontiveros
- Ophthalmology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Aiken Prevencción y Cirugía Ocular, Valencia, Spain
| | - Amir Rosemblatt
- Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Salvador Garcia-Delpech
- Ophthalmology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Aiken Prevencción y Cirugía Ocular, Valencia, Spain
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11
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Neves P, Ornelas M, Matias I, Rodrigues J, Santos M, Dutra-Medeiros M, Martins D. Dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes. Int J Ophthalmol 2021; 14:1571-1580. [PMID: 34667735 DOI: 10.18240/ijo.2021.10.15] [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] [Received: 07/24/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the safety and efficacy of intravitreal dexamethasone implants (Ozurdex®/DEX) in patients with diabetic macular edema (DME) either naïve or non-naïve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors (anti-VEGFs). METHODS This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients naïve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) was collected over 6mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients (57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment naïve before receiving DEX implant, was collected. RESULTS Improvement in mean BCVA was observed from 1-4mo after injection with a decreased effect at month 6 as expected, with better outcomes in naïve compared to non-naïve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2mo after DEX therapy. The mean number of injections of the overall population during the 6mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported. CONCLUSION This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in naïve patients.
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Affiliation(s)
- Pedro Neves
- Department of Ophthalmology, Centro Hospitalar de Setúbal, Setúbal 2910-549, Portugal
| | - Mário Ornelas
- Department of Ophthalmology, Centro Hospitalar de Setúbal, Setúbal 2910-549, Portugal
| | - Inês Matias
- Department of Ophthalmology, Centro Hospitalar de Setúbal, Setúbal 2910-549, Portugal
| | - João Rodrigues
- Department of Ophthalmology, Hospital Beatriz Ângelo, Loures 2674-514, Portugal
| | - Margarida Santos
- Department of Ophthalmology, Hospital da Luz Setúbal, Setúbal 2900-722, Portugal
| | - Marco Dutra-Medeiros
- Department of Ophthalmology, Centro Hospitalar Lisboa Central, Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon 1990-237, Portugal
| | - David Martins
- Department of Ophthalmology, Hospital da Luz Setúbal, Setúbal 2900-722, Portugal
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Chen PL, Chen SN. Efficacy of intravitreal dexamethasone implant in patients with Vogt-Koyanagi-Harada Disease and bilateral panuveitis: Two case reports. Medicine (Baltimore) 2021; 100:e27394. [PMID: 34622843 PMCID: PMC8500637 DOI: 10.1097/md.0000000000027394] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/27/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Vogt-Koyanagi-Harada (VKH) disease is a multisystemic disorder characterized by intraocular inflammation associated with serous retinal detachment, optic disc edema, uveitis, and vitritis, and is often associated with neurologic and cutaneous manifestations. Diagnosis can be assisted by fluorescein angiography and optical coherence tomography that can help evaluate changes in the retina. Therapy relies mainly on the use of corticosteroids, administrated through oral or intravenous high-dose pulses, and immunosuppressants. The purpose of our study was to assess the outcome of VKH disease with bilateral panuveitis treated with dexamethasone intravitreal implant. PATIENT CONCERNS Two patients without underlying disease had severe vision deterioration, eye pain, following flu-like symptoms. DIAGNOSIS At initial diagnosis, macular edema and sub-retinal fluid lobulated accumulation were noted under SD-OCT exam. FAG revealed multiple pinpoint leakage around macula and pooling of dye within sub-retinal space. INTERVENTIONS All two patients received intravenous pulse methylprednisolone at the diagnosis, followed by oral prednisolone and cyclosporine. One patient received bilateral eye dexamethasone intravitreal implant two weeks after diagnosis, while the other received left eye dexamethasone intravitreal implant at the time of diagnosis. OUTCOMES Vision and macular structure recovered more rapidly after receiving dexamethasone implants in the short-term follow-up. All macular structures recovered to normal, and vision recovered to 20/20 in both eyes. One patient, receiving bilateral dexamethasone implant, didn't relapse during the 13-month follow-up; the other, receiving left eye dexamethasone implant, didn't relapse during the 6-month follow-up. None of them required intravenous high-dose steroids again. CONCLUSION VKH disease is a multisystemic disorder; intravenous pulse steroid therapy and oral prednisolone can control systemic inflammation. In addition to systemic prednisolone treatment of VKH disease in the acute phase, dexamethasone implants can enhance short-term and long-term control of intraocular anti-inflammation.
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Affiliation(s)
- Po-Lin Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
| | - San-Ni Chen
- Department of Ophthalmology, Changhua Christian Hospital, Changhua, Taiwan
- Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan
- Department of Ophthalmology, China Medical University, Taichung, Taiwan
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Abstract
Sympathetic ophthalmia (SO) is a panuveitis that usually occurs after trauma to one eye. We describe two cases of SO occurring after 23-gauge vitrectomy. Case 1 involved a 66-year-old woman who underwent pars plana vitrectomy (PPV) for a rhegmatogenous retinal detachment. Two months later, she presented with decreased visual acuity (VA) and bilateral uveitis. Case 2 involved a 43-year-old woman who underwent a second PPV for recurrent retinal detachment. Two months later, she presented with bilateral panuveitis. Both patients were diagnosed with SO and were treated with methylprednisolone and cyclosporine. The first patient was further treated with a dexamethasone intravitreal implant (Ozurdex®) owing to the side effects of methylprednisolone. The VA and symptoms improved significantly after treatment in both patients. Bilateral granulomatous panuveitis following PPV should alert surgeons to consider SO. Appropriate interventions for SO can produce positive outcomes.
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Affiliation(s)
- Junhui Shen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zheng Zhang
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Dian Ye
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zuohui Wen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xupeng Shu
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Zhiqing Chen
- Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.,Key Laboratory of Ophthalmology of Zhejiang Province, Hangzhou, Zhejiang, China
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Figueira J, Henriques J, Carneiro Â, Marques-Neves C, Flores R, Castro-Sousa JP, Meireles A, Gomes N, Nascimento J, Amaro M, Silva R. Guidelines for the Management of Center-Involving Diabetic Macular Edema: Treatment Options and Patient Monitorization. Clin Ophthalmol 2021; 15:3221-3230. [PMID: 34354341 PMCID: PMC8331083 DOI: 10.2147/opth.s318026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/29/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual impairment associated with diabetic retinopathy (DR) and macular laser, during approximately three decades, and was the single treatment option. More recently, intravitreous injections of anti-angiogenics and corticosteroids modified the treatment paradigm associated with significant vision improvements. Nevertheless, not all patients respond satisfactorily to anti-VEGF or corticosteroid injections, so an adequate treatment choice and a prompt switch in therapeutic class is recommended. Several algorithms and guidelines have been proposed for treating center involving DME to improve patients’ vision and quality of life. However, in Portugal, such guidelines are lacking. The present review aimed to provide guidelines for the treatment options and patient monitorization in the management of center-involving DME. We recommend anti-vascular endothelial growth factor (VEGF) as first-line therapy after a clinical evaluation accompanied by a rigorous metabolic control. Depending on the response obtained after 3–6 monthly intravitreal injections we suggest switching outside the class in case of a non-responder, maintaining the anti-VEGF-therapy in responders to anti-angiogenics. The treatment regimen for Dexamethasone intravitreal implant (DEXii) should be pro-re-nata with bi-monthly or quarterly monitoring visits (with a scheduled visit at 6–8 weeks after DEXii for intraocular pressure control). If a patient does not respond to DEXii, switch again to anti-VEGF therapy, combine therapies, or re-evaluate patients diagnose. There is a resilient need to understand the disease, its treatments, regimens available, and convenience for all involved to propose an adequate algorithm for the treatment of diabetic retinopathy (DR) and DME in an individualized regimen. Further understanding of the contributing factors to the development and progression of DR should bring new drug discoveries for more effective and better-tolerated treatments.
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Affiliation(s)
- João Figueira
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal
| | - José Henriques
- Retina Department, Retinal Surgical Unit, Dr. Gama Pinto Ophthalmology Institute, Lisbon, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Carlos Marques-Neves
- Department of Ophthalmology, Centro Hospitalar Universitário de Lisboa Norte, EPE - Hospital de Santa Maria, Lisbon, Portugal.,Department of Ophthalmology, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,ALM Oftalmolaser, Lisbon, Portugal
| | - Rita Flores
- Department of Ophthalmology, Centro Hospitalar de Lisboa Central EPE, Lisbon, Portugal.,CEDOC, Chronic Diseases Research Center, NOVA Medical School, Lisbon, Portugal
| | - João Paulo Castro-Sousa
- Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal.,CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal.,Faculty of Medical Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Angelina Meireles
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Gomes
- Ophthalmology Department, Hospital de Braga, Braga, Portugal
| | - João Nascimento
- Instituto de Retina e Diabetes Oculares de Lisboa, Lisbon, Portugal
| | - Miguel Amaro
- Ophthalmology Department, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Rufino Silva
- Ophthalmology Department, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal; Faculty of Medicine, University of Coimbra (FMUC), Coimbra, Portugal.,AIBILI - Association for Innovation and Biomedical Research on Light and Image, Coimbra, Portugal.,Coimbra Medical Space, Coimbra, Portugal
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Ding YH, Yao BT, Zhao XG, Yu H, Liu G, Wang XY. Refractory adult Coats disease treated with dexamethasone intravitreal implant: A case report. Medicine (Baltimore) 2020; 99:e20249. [PMID: 32443362 PMCID: PMC7254772 DOI: 10.1097/md.0000000000020249] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Coats disease is a sporadic, retinal vascular abnormality, causing blindness. Several interventional methods, including laser photocoagulation, have been proposed; however, the use of intravitreal dexamethasone in refractory Coats disease is not well described. PATIENT CONCERNS A 38-year-old man presented with a painless reduction in visual acuity in his right eye, commencing 15 days prior to initial assessment. DIAGNOSIS Clinical manifestations and multimodal imaging indicated Coats disease. INTERVENTIONS Retinal laser photocoagulation was performed in the nonperfused areas, 15 months later, the exudative retinal detachment, and macular edema remained, the patient was then treated with an intravitreal slow-release dexamethasone implant. OUTCOMES The exudative retinal detachment and macular edema had resolved, and the BCVA had also improved. CONCLUSION Dexamethasone intravitreal implantation was effective in treating refractory Coats disease.
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Affiliation(s)
- Yu-hua Ding
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University
| | - Bang-tao Yao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Xiao-gui Zhao
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Hao Yu
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Gang Liu
- Department of Ophthalmology, Lishui District People's Hospital, Lishui branch of Southeast University Affiliated Zhongda Hospital, Nanjing, Jiangsu Province, China
| | - Xiu-ying Wang
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University
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Kaya C, Zandi S, Pfister IB, Gerhardt C, Garweg JG. Adding a Corticosteroid or Switching to Another Anti-VEGF in Insufficiently Responsive Wet Age-Related Macular Degeneration. Clin Ophthalmol 2019; 13:2403-2409. [PMID: 31824134 PMCID: PMC6901048 DOI: 10.2147/opth.s224456] [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: 07/24/2019] [Accepted: 11/15/2019] [Indexed: 12/19/2022] Open
Abstract
Purpose To compare the effect of adding a corticosteroid or switching to another anti-VEGF treatment in patients with exudative age-related macular degeneration (eAMD) with persisting intraretinal fluid on anti-VEGF monotherapy. Methods This retrospective, interventional case series involved 43 pseudophakic eyes with eAMD and persistent intraretinal fluid on anti-VEGF treatment that switched treatment to a combination of Ozurdex® or Triamcinolone and anti-VEGF therapy (group 1) or to another anti-VEGF agent (group 2). The number of injections, time to re-injection, change in central retinal thickness (CRT), and best-corrected visual acuity (BCVA) from 12 months prior to 12 months after switch to third-line therapy were defined as primary outcomes. Results Whereas the treatment demand was reduced (from 8.8±2.2 to 4.6±2.9 injections; p=0.001) and the re-injection interval extended in group 1 (from 1.5±0.4 months to 4.4±3.8 months; p=0.001), these parameters did not change in group 2 (7.4±1.6 to 7.3±2.2; p=0.90 and 1.7±0.3 months to 1.9±0.8 months; p=0.75). Mean CRT decreased from 455.7±30.1 and 427.6±36.0µm (groups 1 and 2, respectively) to 359.1±38.2 and 303.1±44.4µm (intergroup p=0.03). The mean baseline BCVA of 62.6±3.8 letters (group 1) and 63.0±1.9 letters (group 2) remained stable under therapy in both groups (intergroup p=0.67). Conclusion In eyes with eAMD with persistent intraretinal fluid on anti-VEGF monotherapy despite frequent re-injections, corticosteroids achieved a similar functional and morphological outcome over 12 months as switching to another anti-VEGF therapy, but with a reduced injection burden. In selected cases, corticosteroid treatment may thus be an option for third-line therapy in refractory exudative AMD.
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Affiliation(s)
- Cagdas Kaya
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Souska Zandi
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department Ophthalmology, University Hospital Bern, Bern, Switzerland
| | - Christin Gerhardt
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department Ophthalmology, University Hospital Bern, Bern, Switzerland
| | - Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department Ophthalmology, University Hospital Bern, Bern, Switzerland
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Hernández Martínez A, Pereira Delgado E, Silva Silva G, Castellanos Mateos L, Lorente Pascual J, Lainez Villa J, García Vicente P, Almeida-González CV. Early versus late switch: How long should we extend the anti-vascular endothelial growth factor therapy in unresponsive diabetic macular edema patients? Eur J Ophthalmol 2019; 30:1091-1098. [PMID: 31096782 DOI: 10.1177/1120672119848257] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 12/15/2022]
Abstract
PURPOSE To compare the results of early versus late switch to the dexamethasone intravitreal implant Ozurdex® in patients with diabetic macular edema who had a poor response to vascular endothelial growth factor inhibitors. METHODS Retrospective and single-center study conducted, in a real setting, on consecutive diabetic macular edema patients who were switch to an intravitreal dexamethasone implant after a poor response to anti-vascular endothelial growth factor treatment. Study sample was divided into two groups: (1) early-switch group, included those eyes who received three anti-vascular endothelial growth factor injections before switch and (2) late-switch group, included those eyes that received six or more anti-vascular endothelial growth factor injections before switch. The primary end-point was the difference in mean change in best-corrected visual acuity and in central subfoveal thickness. RESULTS A total of 69 (31 early-switch group and 38 late-switch group) eyes were included. In the early-switch group, median (25-75 quartile range) best-corrected visual acuity significantly increase from 0.2 (0.2-0.5) at baseline to 0.4 (0.3 -0.7) at month 24 (p = 0.0043). Whereas, in the late-switch group, best-corrected visual acuity did not increase (p = 0.8602). Central subfoveal thickness was significantly reduced in both early- and late-switch groups, p = 0.0002 and 0.0038, respectively. The proportion of eyes obtaining a central subfoveal thickness reduction ⩾ 10% was significantly greater in the early-switch group than in the late-switch group (71.0% vs 47.4%, respectively, p = 0.0498). Three (9.7%) and 10 (26.3%) eyes have developed ocular hypertension during the study in the early- and late-switch groups, respectively, p = 0.0816. CONCLUSION Early switch to Ozurdex in patients who did not adequately respond to anti-vascular endothelial growth factor therapy provided better functional and anatomical outcomes.
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Affiliation(s)
- Adrian Hernández Martínez
- Ophthalmology Department, Nuestra Señora de Valme University Hospital, Seville, Spain.,Oftalvist Sevilla, Sevilla, Spain
| | - Ernesto Pereira Delgado
- Ophthalmology Department, Nuestra Señora de Valme University Hospital, Seville, Spain.,Oftalvist Sevilla, Sevilla, Spain
| | - Guillermo Silva Silva
- Ophthalmology Department, Nuestra Señora de Valme University Hospital, Seville, Spain
| | | | - José Lorente Pascual
- Ophthalmology Department, Nuestra Señora de Valme University Hospital, Seville, Spain
| | - Julian Lainez Villa
- Ophthalmology Department, Nuestra Señora de Valme University Hospital, Seville, Spain
| | - Paula García Vicente
- Ophthalmology Department, Nuestra Señora de Valme University Hospital, Seville, Spain
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Ji K, Zhang Q, Tian M, Xing Y. Comparison of dexamethasone intravitreal implant with intravitreal anti-VEGF injections for the treatment of macular edema secondary to branch retinal vein occlusion: A meta-analysis. Medicine (Baltimore) 2019; 98:e15798. [PMID: 31145307 PMCID: PMC6709010 DOI: 10.1097/md.0000000000015798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This meta-analysis compared the efficacy and safety of dexamethasone intravitreal implant (DEX) and anti-vascular endothelial growth factor (anti-VEGF) in the treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for published studies comparing DEX with anti-VEGF for the treatment of ME caused by BRVO. Outcomes of the selected studies included best-corrected visual acuity (BCVA), central macular thickness (CMT), and adverse events. Review Manager (RevMan) 5.3 was used to analyze the data. RESULTS Six trials comparing the efficacy and safety of DEX with anti-VEGF were included in this meta-analysis. At 1 month, DEX achieved a mean BCVA superior to that achieved by anti-VEGF (MD = -0.11, P < .0001), in addition to a superior mean BCVA change (MD = -0.35, P < .00001). At 3 months, the mean BCVA showed a significant difference (MD = -0.06, P = .03) between DEX and anti-VEGF treatment, while the mean BCVA change was similar to that with anti-VEGF treatment (MD = -0.06, P = .11). However, neither mean BCVA nor mean BCVA change showed a significant difference between DEX and anti-VEGF treatment at 6 months (MD = 0.08, P = .06; MD = 0.06, P = .43, respectively). Mean CMT and mean CMT change were significantly lower in the DEX group than in the anti-VEGF group at 1 month (MD = -53.63 μm, P < .00001; MD = -60.1 μm, P = .005, respectively). However, at 3 months, mean CMT and mean CMT change were similar between DEX and anti-VEGF treatment (MD = 17.4 μ, P = .74; MD = 18.01 μm, P = .72, respectively). Although mean CMT in the anti-VEGF group was not significantly lower than that in the DEX group at 6 months (MD = 55.53, P = .07), the mean CMT change from baseline achieved by the anti-VEGF treatment was significantly superior to that obtained with DEX (MD = 75.53, P = .0002). Concerning adverse events, no statistically significant differences were observed in the incidence of cataract (OR = 4.25, P = .07), but the use of DEX led to a higher risk of intraocular pressure elevation compared with anti-VEGF treatment (OR = 12.04, P = .006). CONCLUSIONS Our results show that visual acuity recovery and CMT were better in the DEX group than in the anti-VEGF group after 1 and 3 months, although the difference in CMT at 3 months was not significant. However, there were no significant differences in terms of visual acuity and CMT between the two groups after 6 months of follow-up. Therefore, DEX may be recommended as the first treatment option in ME associated with BRVO.
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Affiliation(s)
- Kaibao Ji
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan Hubei
| | - Qinglin Zhang
- Affiliated Eye Hospital of Nanchang University, Nanchang Jiangxi, China
| | - Man Tian
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan Hubei
| | - Yiqiao Xing
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan Hubei
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Bandello F, Augustin A, Tufail A, Leaback R. A 12-month, multicenter, parallel group comparison of dexamethasone intravitreal implant versus ranibizumab in branch retinal vein occlusion. Eur J Ophthalmol 2018; 28:697-705. [PMID: 29631435 PMCID: PMC6210573 DOI: 10.1177/1120672117750058] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 12/01/2022]
Abstract
Purpose: Dexamethasone intravitreal implant and intravitreal ranibizumab are indicated for the treatment of macular edema secondary to retinal vein occlusion. This non-inferiority study compared dexamethasone with ranibizumab in patients with branch retinal vein occlusion. Methods: In this randomized, 12-month head-to-head comparison, subjects with branch retinal vein occlusion were assigned to dexamethasone 0.7 mg at day 1 and month 5 with the option of retreatment at month 10 or 11, or ranibizumab 0.5 mg at day 1 and monthly through month 5 with subsequent as-needed injections at month 6–month 11. The primary efficacy outcome was the mean change from baseline in best-corrected visual acuity at month 12; secondary outcomes included average change in best-corrected visual acuity, proportion of eyes with ≥10- and ≥15-letter gain/loss, change in central retinal thickness, and change in Vision Functioning Questionnaire-25 score. Results: In all, 307 of a planned 400 patients were enrolled in the study and received (mean) 2.5 dexamethasone injections (n = 154) and 8.0 ranibizumab injections (n = 153) over 12 months. The mean change from baseline in best-corrected visual acuity at month 12 was 7.4 letters for dexamethasone versus 17.4 letters for ranibizumab (least-squares mean difference (dexamethasone minus ranibizumab), −10.1 letters; 95% confidence interval, −12.9, −7.2; p = 0.0006). Conclusion: Dexamethasone and ranibizumab improved best-corrected visual acuity and anatomical outcomes; however, dexamethasone did not show non-inferiority to ranibizumab in this under-powered study. Dexamethasone was associated with an increased risk of intraocular pressure elevation and cataract progression, but a lower injection burden, compared to ranibizumab.
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Affiliation(s)
- Francesco Bandello
- 1 Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Albert Augustin
- 2 Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
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Abstract
PURPOSE To discuss the characteristics, indications and adverse events (AEs) of sustained-release corticosteroid devices for the treatment of cystoid macular edema (CME). RECENT FINDINGS Ozurdex® is approved for the treatment of diabetic macular edema (DME), retinal vein occlusion related-CME and noninfectious posterior uveitis (NIPU). It releases dexamethasone over a maximum period of 6 months making repeated intravitreal injections necessary for recurrent CME. Iluvien® releases fluocinolone for up to 36 months and is effective for the treatment of chronic DME. Retisert® (Bausch & Lomb, Rochester, NY) also releases fluocinolone, and is approved for chronic NIPU. Both Iluvien® and Retisert® are non-biodegradable devices and are highly associated with cataract and glaucoma. SUMMARY Long-acting intraocular corticosteroid formulations offer a more predictable drug-release profile and reduced dosing frequency in comparison to conventional formulations of the same compounds but the risk-benefit ratio must be taken into consideration previous to the implantation of those devices.
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Rezar-Dreindl S, Eibenberger K, Pollreisz A, Bühl W, Georgopoulos M, Krall C, Dunavölgyi R, Weigert G, Kroh ME, Schmidt-Erfurth U, Sacu S. Effect of intravitreal dexamethasone implant on intra-ocular cytokines and chemokines in eyes with retinal vein occlusion. Acta Ophthalmol 2017; 95:e119-e127. [PMID: 27417275 DOI: 10.1111/aos.13152] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 03/11/2016] [Accepted: 05/04/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the influence of intravitreal dexamethasone implant on inflammatory and angiogenic cytokine levels in the aqueous of patients with retinal vein occlusion (RVO). METHODS Forty eyes of 40 consecutive patients with macular oedema (ME) due to branch and central retinal vein occlusion (BRVO/CRVO) were treated with an intravitreal dexamethasone implant (Ozurdex® ) at baseline and evaluated until month 6. Retreatment was performed in case of recurrent ME earliest 4 months after the baseline treatment. Aqueous humour samples were taken at baseline, months 1, 3, 6 and at the time of each retreatment. Concentrations of 29 different cytokines were measured by Luminex® bead assays. The control group comprised healthy patients undergoing cataract surgery. RESULTS At baseline concentrations of interleukin (IL)-8, angiopoietin (ANG)-2 and intercellular adhesion molecule (ICAM)-1 were highly elevated in patients with CRVO compared with controls (p = 0.006; p = 0.02; p = 0.03). Vascular endothelial growth factor (VEGF) concentrations were upregulated in patients with BRVO and CRVO (p = 0.003; p = 0.001). Retreatment with a dexamethasone implant was necessary after 4 months in 14/8 (BRVO/CRVO) patients, 5 months in 5/3 patients and 6 months in one patient (BRVO). After the initial treatment, macrophage chemo-attractant protein (MCP)-1 and IL17-E concentrations decreased in BRVO (p < 0.001; p = 0.01) and MCP-1 and IL1-α in CRVO (p = 0.01; p = 0.003). Vascular endothelial growth factor (VEGF) concentrations did not change during treatment in either group (p = 0.3). A mixed-effect model showed that cytokine concentrations positively correlated with central retinal thickness changes. CONCLUSIONS Intravitreal dexamethasone treatment resulted in alterations in the concentrations of pro-inflammatory cytokines MCP-1 and IL17-E in patients with BRVO and MCP-1 and IL1-α in patients with CRVO. These data highlight the important role of inflammatory mediators involved in ME due to RVO.
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Affiliation(s)
| | | | - Andreas Pollreisz
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | - Wolf Bühl
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | | | - Christoph Krall
- Department of Medical Statistics; Medical University of Vienna; Vienna VIE Austria
| | - Roman Dunavölgyi
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | - Günther Weigert
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
| | | | | | - Stefan Sacu
- Department of Ophthalmology; Medical University of Vienna; Vienna VIE Austria
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Giannaccare G, Fresina M, Pazzaglia A, Versura P. Long-lasting corneal endothelial graft rejection successfully reversed after dexamethasone intravitreal implant. Int Med Case Rep J 2016; 9:187-91. [PMID: 27468251 PMCID: PMC4946863 DOI: 10.2147/imcrj.s107926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/23/2022] Open
Abstract
Graft rejection is the most significant complication corneal transplantation and the leading indication for overall corneal transplantation. Corticosteroid therapy represents the mainstay of graft rejection treatment; however, the optimal route of administration of corticosteroid remains uncertain. We report herein for the first time the multimodal imaging of a case of long-lasting corneal endothelial graft rejection successfully reversed 3 months after dexamethasone intravitreal implant. A 29-year-old Asian female presented with a long-lasting corneal endothelial graft rejection in her left phakic eye. She underwent penetrating keratoplasty for advanced keratoconus 24 months before presentation. Hourly dexamethasone eyedrops, daily intravenous methylprednisolone, and one parabulbar injection of methylprednisolone acetate were administered during the 5 days of hospitalization. However, the clinical picture remained approximately unchanged despite therapy. By mutual agreement, we opted for the off-label injection of dexamethasone 0.7 mg intravitreal implant in order to provide therapeutic concentrations of steroid for a period of ~6 months. No other concomitant therapies were prescribed to the patient. Visual acuity measurement, slit lamp biomicroscopy, anterior segment photography, confocal microscopy, anterior segment optical coherence tomography, laser cell flare meter, intraocular pressure measurement, and ophthalmoscopy were performed monthly for the first postoperative 6 months. Three months after injection, both clinical and subclinical signs of rejection disappeared with a full recovery of visual acuity to 20/30 as before the episode. Currently, at the 12-month follow-up visit, the clinical picture remains stable without any sign of rejection, recurrence, or graft failure. Dexamethasone intravitreal implant seems to be a new potential effective treatment for corneal graft rejection, particularly in case of poor compliance or lack of response to conventional treatment. In addition, it could be especially useful in diabetic patients unable to receive systemic steroids.
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Affiliation(s)
- Giuseppe Giannaccare
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - Michela Fresina
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - Alberto Pazzaglia
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy
| | - Piera Versura
- Ophthalmology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Sant'Orsola-Malpighi Teaching Hospital, Bologna, Italy
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Nobre-Cardoso J, Champion E, Darugar A, Fel A, Lehoang P, Bodaghi B. Treatment of Non-infectious Uveitic Macular Edema with the Intravitreal Dexamethasone Implant. Ocul Immunol Inflamm 2016; 25:447-454. [PMID: 27003221 DOI: 10.3109/09273948.2015.1132738] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/18/2022]
Abstract
PURPOSE To describe the clinical outcome of phakic eyes with macular edema (ME) due to non-infectious uveitis treated with a dexamethasone intravitreal implant. METHODS A retrospective analysis of 41 eyes treated with a total of 58 dexamethasone intravitreal implants was conducted. Best corrected visual acuity (BCVA), central retinal thickness (CRT) and complications data were collected. RESULTS One month after the first implant, even as CRT improved significantly in most eyes (p<0.001), 31.7% showed no improvement in BCVA. At 6 months post-implantation, CRT and BCVA had deteriorated in up to 70% of patients. Thirteen eyes were re-implanted, with a similar effect to that of the first implant. Ocular hypertension developed in 36.2% of eyes, and three eyes had cataract surgery, all in eyes with repeated implants. CONCLUSIONS The dexamethasone intravitreal implant can be safely used to treat ME due to non-infectious uveitis, but with a limited and short effect on BCVA.
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Affiliation(s)
- João Nobre-Cardoso
- a Département Hospitalo-Universitaire Vision and Handicaps 'ViewMaintain' , Pitié-Salpêtrière University Hospital , Paris , France.,b Department of Ophthalmology , Hospital Garcia de Orta E.P.E , Almada , Portugal
| | - Emmanuelle Champion
- a Département Hospitalo-Universitaire Vision and Handicaps 'ViewMaintain' , Pitié-Salpêtrière University Hospital , Paris , France
| | - Adil Darugar
- a Département Hospitalo-Universitaire Vision and Handicaps 'ViewMaintain' , Pitié-Salpêtrière University Hospital , Paris , France
| | - Audrey Fel
- a Département Hospitalo-Universitaire Vision and Handicaps 'ViewMaintain' , Pitié-Salpêtrière University Hospital , Paris , France
| | - Phuc Lehoang
- a Département Hospitalo-Universitaire Vision and Handicaps 'ViewMaintain' , Pitié-Salpêtrière University Hospital , Paris , France
| | - Bahram Bodaghi
- a Département Hospitalo-Universitaire Vision and Handicaps 'ViewMaintain' , Pitié-Salpêtrière University Hospital , Paris , France
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Güçlü H, Gurlu VP, Ozal SA, Esgin H. A Moyamoya Patient with Bilateral Consecutive Branch Retinal Vein Occlusion. Neuroophthalmology 2016; 40:93-96. [PMID: 27928391 DOI: 10.3109/01658107.2016.1148174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/17/2015] [Revised: 01/20/2016] [Accepted: 01/26/2016] [Indexed: 11/13/2022] Open
Abstract
We describe a moyamoya (MMD) patient with bilateral consecutive branch retinal vein occlusion (BRVO). The patient had a medical history of severe headache, cranial haemorrhage, bilateral supraclinoid carotid artery occlusion, and "puff of smoke" collaterals on cerebral angiography and an encephalomyosynangiosis operation. On ophthalmic examination, he had superior temporal branch vein occlusion with intraretinal haemorrhage and visual acuity of 20/25 in the right eye. Twelve years later, he presented with superior temporal branch vein occlusion in the left eye and visual acuity of 20/60. The patient was initially treated with a dexamethasone intravitreal implant, and later intravitreal ranibizumab injections. We describe the first reported case of bilateral consecutive BRVO and management in MMD.
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Affiliation(s)
- Hande Güçlü
- Trakya University Faculty of Medicine, Department of Ophthalmology , Edirne, Turkey
| | - Vuslat Pelitli Gurlu
- Trakya University Faculty of Medicine, Department of Ophthalmology , Edirne, Turkey
| | - Sadık Altan Ozal
- Trakya University Faculty of Medicine, Department of Ophthalmology , Edirne, Turkey
| | - Haluk Esgin
- Acıbadem Taksim Hospital, Department of Ophthalmology , Istanbul, Turkey
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Dutra Medeiros M, Alkabes M, Nucci P. Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema. Eur Endocrinol 2014; 10:111-116. [PMID: 29872474 DOI: 10.17925/ee.2014.10.02.111] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/25/2014] [Indexed: 12/27/2022]
Abstract
Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex®; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment.
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Affiliation(s)
- Marco Dutra Medeiros
- Consultant Ophthalmologist - Vitreoretinal Surgeon, Central Lisbon Hospital Center, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Micol Alkabes
- Consultant Ophthalmologist - Vitreoretinal Surgeon, University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Paolo Nucci
- Professor of Ophthalmology University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
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