scholarly journals Adjunct Intravitreous Triamcinolone Acetonide in the Treatment of Diabetic Macular Edema with Anti-VEGF Agents

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Robert B. Garoon ◽  
Robert E. Coffee ◽  
Lai Jiang ◽  
Christina Y. Weng ◽  
Petros E. Carvounis
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Anti Vegf ◽  
Treatment Naïve ◽  
The Mean ◽  
Group 2 ◽  
Endothelial Growth Factor ◽  
Phakic Eyes ◽  
Group 1

Aims.To compare visual and anatomic outcomes of adjunct intravitreous (IVT) triamcinolone acetonide to antivascular endothelial growth factor (VEGF) injections to IVT anti-VEGF injections alone for center-involving diabetic macular edema (DME) in treatment-naïve eyes.Methods.Retrospective study of treatment-naïve eyes with center-involving DME. The primary outcome was the change in best corrected visual acuity (BCVA) in eyes receiving only IVT anti-VEGF (group 1) and eyes receiving IVT anti-VEGF and adjunct IVT-TA (group 2).Results.Included were 192 eyes. The mean change in BCVA was +3.5 letters in group 1 compared to −3.5 letters in group 2 (p=0.048). Final macular thickness improved by −94 μm in group 1 versus −68 μm in group 2 (p=0.26). In group 1, 5/150 eyes compared to 9/42 eyes in group 2 (3.3% versus 21%,p=0.0005) had a IOP >10 mmHg increase. Six of 126 phakic eyes in group 1 versus 12/33 phakic eyes in group 2 underwent cataract surgery (4.7% versus 36.3%,p=0.00009).Conclusions.IVT-TA results in no additional benefit in eyes treated with anti-VEGF agents for DME.

scholarly journals Efficacy of Intravitreal Dexamethasone Implant in Different Patterns of Diabetic Macular Edema

2020 ◽  
Author(s):  
Claudio Furino ◽  
Alfredo Niro ◽  
Michele Reibaldi ◽  
Maria Oliva Grassi ◽  
Francesco Boscia ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Serous Retinal Detachment ◽  
Intravitreal Dexamethasone Implant ◽  
The Mean ◽  
Group 2 ◽  
Intravitreal Dexamethasone ◽  
Pattern Group ◽  
Group 1

Purpose: Different patterns of diabetic macular edema (DME) suggest different pathogenesis and drug response. We evaluated the outcomes after intravitreal dexamethasone (DEX) implant for DME with or without serous retinal detachment (SRD). Methods: In this retrospective study, 22 naïve patients (23 eyes) with DME who underwent a single DEX implant were evaluated. Based on the optical coherence tomographic pattern of DME, 12 eyes had a cystoid macular edema pattern (Group 1) and 11 eyes had an SRD pattern (Group 2). The best-corrected visual acuity (BCVA), central retinal thickness (СRТ), central retinal volume (CRV), SRD height (SRDh), and intraocular pressure (IOP) were recorded before and at two and four months after the treatment. Results: There were no significant differences between the groups regarding demographic, clinical data and outcomes at baseline. In Group 1, the CRT and CRV significantly decreased at two months (P = 0.002 and P = 0.01, respectively), while the BCVA significantly improved at four months (P = 0.03). In Group 2, the CRT and CRV significantly improved (P < 0.01 and P ≤ 0.01, respectively) during the follow-up period. At four months, both groups showed a recurrence of DME, Group 1 in particular (two-month CRT reduction, –149 ± 127 μm vs four-month CRT reduction, –72 ± 174 μm; P = 0.04). The mean reduction in CRV was significantly different at four months (Group 1, –0.49 ± 1.7 mm3 vs Group 2, –1.3 ± 1.3 mm3; P = 0.04). In Group 2, the SRDh significantly decreased at two (P = 0.01) and four months (P = 0.01). Four cases with elevated IOP were managed. Conclusion: DEX implants were found to be effective in different patterns of DME. The SRD pattern may predict a longer-lasting morphologic efficacy.

Early treatment with dexamethasone intravitreal implants in diabetic macular edema: Naïve versus refractory patients

2021 ◽  
pp. 112067212110248
Author(s):  
Anna V Bux ◽  
Francesca Fortunato ◽  
Antonio Barone ◽  
Vincenzo Russo ◽  
Nicola Delle Noci ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
First Line ◽  
Corrected Visual Acuity ◽  
Real World Setting ◽  
Treatment Naïve ◽  
Group 2 ◽  
Group 1

Purpose: To assess the efficacy and safety of dexamethasone 0.7 mg implants (DEX-I) in patients with diabetic macular edema (DME) either naïve to therapy or refractory to anti-VEGF treatment, in a single-center, real-world setting. Methods: Patients diagnosed with DME and treated with DEX-I were retrospectively enrolled in the study and split in two groups: naïve (Group 1, n = 64) and refractory (Group 2, n = 64) to treatment. Patients were evaluated at baseline, at 1 month, and every 3 months after each DEX-I implant. Main outcome measures were change in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline to follow-up visits. Results: Significant improvements in BCVA were observed in treatment-naïve patients at 6 months following the first and second DEX-I injection ( p = 0.0023 and p = 0.0063, respectively), with significant reductions in mean CMT at 6 months after all DEX implants. In treatment-refractory patients, mean CMT was significantly reduced from baseline to 6 months ( p < 0.05) after all DEX-I injections, although no changes were observed in BCVA. Conclusions: DEX-I improved visual acuity and macular edema mostly in treatment-naïve patients, suggesting DEX-I may be a viable first-line treatment option in DME.

scholarly journals Real-world outcomes following 12 months of intravitreal aflibercept monotherapy in patients with diabetic macular edema in France: results from the APOLLON study

2020 ◽  
Vol 258 (3) ◽  
pp. 521-528 ◽  
Author(s):  
Jean-François Korobelnik ◽  
Vincent Daien ◽  
Céline Faure ◽  
Ramin Tadayoni ◽  
Audrey Giocanti-Auregan ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Start ◽  
Anti Vegf ◽  
Intravitreal Aflibercept ◽  
Treatment Naïve ◽  
Secondary Endpoints ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Endothelial Growth Factor

Abstract Purpose To report the effectiveness of intravitreal aflibercept (IVT-AFL) treatment for diabetic macular edema (DME) in French clinical practice. Methods APOLLON (NCT02924311) was a prospective, observational cohort study of patients with DME. Effectiveness was evaluated by change from baseline in best-corrected visual acuity (BCVA) at 12 months in treatment-naïve patients (i.e., had not received any anti-vascular endothelial growth factor [anti-VEGF] agent, laser, or steroid at IVT-AFL treatment start) and previously treated patients (i.e., previously treated with anti-VEGF agents other than IVT-AFL, laser, or steroids at IVT-AFL treatment start). Secondary endpoints included change in central retinal thickness (CRT) over 12 months, frequency of injections, and proportion of patients with safety events. Results Of the 147 patients followed for at least 12 months and included in the effectiveness analysis, 52.4% (n = 77) were treatment-naïve and 47.6% (n = 70) were previously treated. Mean (standard deviation [SD]) BCVA score at baseline was 62.7 (14.3) Early Treatment Diabetic Retinopathy Study (ETDRS) letters in treatment-naïve patients and 60.0 (13.7) ETDRS letters in previously treated patients. At month 12, mean (SD) change in BCVA was + 7.8 (12.3) letters in treatment-naïve patients and + 5.0 (11.3) letters in previously treated patients. Mean CRT decreased in both patient cohorts. The mean (SD) number of IVT-AFL injections at month 12 was 7.6 (2.5) for treatment-naïve patients and 7.6 (2.3) for previously treated patients. Of 388 patients included in the safety analysis, ocular treatment-emergent adverse events occurred in 54.1% (n = 210) of patients. Conclusion IVT-AFL treatment was associated with improvements in functional and anatomic outcomes in both treatment-naïve and previously treated patients with DME in France.

scholarly journals 3-year follow-up of half-dose verteporfin photodynamic therapy for central serous chorioretinopathy with OCT-angiography detected choroidal neovascularization

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yu-Chen Hu ◽  
Yi-Ling Chen ◽  
Yen-Chih Chen ◽  
San-Ni Chen
Keyword(s):  
Photodynamic Therapy ◽  
Choroidal Neovascularization ◽  
Central Serous Chorioretinopathy ◽  
Subretinal Fluid ◽  
Anti Vegf ◽  
Half Dose ◽  
The Mean ◽  
Group 2 ◽  
Endothelial Growth Factor ◽  
Group 1

AbstractTo assess the 3-year outcome of half-dose verteporfin photodynamic therapy (PDT) in central serous chorioretinopathy (CSC) with optical coherence tomography angiography (OCT-A) detected choroidal neovascularization (CNV), we performed a retrospective, interventional study. Patients were divided into 2 groups according to the fluorescein angiography: point source leakage in group 1 and diffuse oozing in group 2. Data were collected from patients including changes of best-corrected visual acuity (BCVA), size of CNV, central macular thickness (CMT), choroidal thickness (CT), reabsorption of subretinal fluid (SRF), sessions of half-dose PDT, and the number of intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF). There was a total of 34 eyes in 32 patients included. The mean sessions of half-dose PDT was 1.50 ± 0.75. The mean number of IVI of anti-VEGF was 1.38 ± 3.34. BCVA improved from 0.38 ± 0.33 to 0.20 ± 0.22 (p < 0.001). Mean CMT was significantly reduced along with reduced CT and increased size of CNV. SRF was totally reabsorbed in 31 eyes. Patients in group 1 had significant less sessions of PDT and better final BCVA. In conclusion, half-dose PDT treatment was effective for CSC with CNV. Patients with diffuse oozing in FA may fare less well with half-dose PDT.

scholarly journals Effects of Switching from Anti-VEGF Treatment to Triamcinolone Acetonide in Eyes with Refractory Macular Edema Associated with Diabetic Retinopathy or Retinal Vein Occlusion

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Tomoaki Tatsumi ◽  
Toshiyuki Oshitari ◽  
Takayuki Baba ◽  
Yoko Takatsuna ◽  
Shuichi Yamamoto
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Retinal Vein Occlusion ◽  
Medical Records ◽  
Retinal Thickness ◽  
Vein Occlusion ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
The Mean ◽  
Endothelial Growth Factor

Purpose. To evaluate the efficacy of switching from intravitreal antivascular endothelial growth factor (VEGF) agents to triamcinolone acetonide (TA) in eyes with diabetic macular edema (DME) or with retinal vein occlusion-associated macular edema (RVO-ME) on the resolution of the macular edema (ME). Methods. The medical records of 11 eyes of 11 patients with DME and 9 eyes of 9 patients with RVO-ME whose MEs were refractory to anti-VEGF treatment were reviewed. The central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the mean interval of the recurrences were measured during the anti-VEGF treatment and after switching to the TA injections. Results. Switching to TA injections significantly increased the mean interval for recurrences from 9.2 ± 2.7 weeks to 22.3 ± 12.9 weeks in eyes with DME ( P = 0.006 ). In eyes with RVO-ME, the mean period of recurrence was 12.3 ± 5.6 weeks before and 11.6 ± 4.4 weeks after the switch ( P = 0.44 ). The mean interval for recurrence was extended to more than 8 weeks in 7 of 11 eyes with DME, but none of the eyes with RVO-ME had a prolongation of more than 4 weeks. An elevation of the IOP was observed in 3 of the 20 eyes after the TA injection. Conclusions. These findings indicate that switching to TA injections can be a good option for DME eyes refractory to anti-VEGF injections but not for the RVO-ME eyes.

scholarly journals Triamcinolone as an adjunct to the combination of anti-VEGF for the management of diabetic macular edema

2021 ◽  
Vol 14 (6) ◽  
pp. 869-874
Author(s):  
Ying-Ying Yu ◽  
◽  
Li-Bin Chang ◽  
Hui-Ka Xia ◽  
Xiao-Xin Li ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Cost Effective ◽  
Treatment Burden ◽  
Intravitreal Triamcinolone ◽  
Anti Vegf ◽  
Significant Difference ◽  
The Mean ◽  
Endothelial Growth Factor ◽  
Mean Cost

AIM: To assess the efficacy of intravitreal triamcinolone (IVTA) as an adjunct to the combination of anti-vascular endothelial growth factor (VEGF) for the management of diabetic macular edema (DME). METHODS: A total of 51 patients with visual disabilities causing by DME from two sites were retrospectively collected and assigned to two groups according to the therapeutic method: intravitreal conbercept (IVC) combined with focal laser (24 eyes) and IVC combined with focal laser and IVTA (27 eyes). Best-corrected visual acuity (BCVA), the required number of IVCs, central retinal thickness (CRT), the mean costs of treatment burden and safety were compared over 12mo. RESULTS: From baseline to month 1 through month 12, IVC combined with focal laser and IVTA improved the mean average change in BCVA superior to IVC combined with focal laser (+5.20 vs +2.71 letters). At month 12, 20.83% of the IVC combined with focal laser and 37.04% of IVC combined with focal laser and IVTA arms gained more than 10 BCVA letters. During the period, the mean CRT decreased significantly in the IVC combined with focal laser and IVTA arm (-245.9 μm) compared to the IVC combined with focal laser arm (-98.45 μm). The average of 6.45 and 1.25 conbercept injections performed in the IVC combined with focal laser and IVC combined with focal laser and IVTA arms, respectively. The mean cost of treatment burden for 12mo was $6247.44±4069.18 in the IVC combined with focal laser arm and $1679.19±542.73 in the IVC combined with focal laser and IVTA arm, with a statistically significant difference. Apart from occasional minor subconjunctival hemorrhage, no other significant ocular adverse events (AEs) were observed in either group during the12-month period. CONCLUSION: It is effective and cost-effective to treat DME by utilizing triamcinolone as an adjunct to the combination of anti-VEGF.

scholarly journals CENTRAL MACULAR THICKNESS AFTER COMBINED THERAPY OF BEVACIZUMAB INTRAVITREAL INJECTION AND TOPICAL DICLOFENAC COMPARED WITH BEVACIZUMAB INTRAVITREAL INJECTION ALONE IN DIABETIC MACULAR EDEMA

2021 ◽  
Vol 4 (2) ◽  
pp. 106
Author(s):  
Melvina Nidya Sandra ◽  
Yumni Shabrina ◽  
Tri Wahyu Widayanti ◽  
Retno Ekantini ◽  
Agus Supartoto ◽  
...  
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Diabetic Macular Edema ◽  
Macular Thickness ◽  
Combination Group ◽  
Central Macular Thickness ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Introduction: To evaluate whether the combination of diclofenac eye drops and bevacizumab intravitreal injection would provide additional benefits over bevacizumab alone in the treatment of naïve diabetic macular edema (DME). Methods: A total of 43 patients were enrolled consecutively and randomized into two groups to receive combination treatment with intravitreal bevacizumab and topical diclofenac (group 1) or bevacizumab alone (group 2). Group 1 patients received single bevacizumab intravitreal injection and got self-administered diclofenac eye drop four times daily for one month. Group 2 patients received single bevacizumab intravitreal injection alone. Outcome data were obtained from patient visits at baseline and at 1 month after bevacizumab intravitreal injection. All patients underwent measurement of best corrected visual acuity (BCVA), a complete eye examination, and measurement of central macular thickness (CMT). Result: The mean reduction in CMT in the combination group was 130.42±32.57 µm (p<0.01), while in the bevacizumab alone group the reduction was 141.38±45.27 µm (p<0.01), there is no significant difference between the two groups (p=0.866). The mean improvement of BCVA was 0.32±0.10 log Mar in the combination group and 0.26±0.12 in group 2, there is no significant difference between the two groups (p=0.691). There was no adverse ocular event in the two groups. Conclusion: In patients with naïve DME, adding diclofenac eye drop as adjuvant of bevacizumab intravitreal injection are less likely to have a meaningful effect on reducing the central macular thickness. Keywords: Diabetic macular edema, NSAID, diclofenac, anti-VEGF, bevacizumab, central macular thickness

scholarly journals Interdigitation and ellipsoid zones disruption correlate with visual outcomes among treatment naive patients with diabetic macular edema

2020 ◽  
Author(s):  
Nardine Sharef ◽  
Rabea Kassem ◽  
Idan Hecht ◽  
Asaf Bar ◽  
Idit Maharshak ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Automatic Measurement ◽  
Defect Size ◽  
Anti Vegf ◽  
Snellen Visual Acuity ◽  
Treatment Naïve ◽  
The Mean

Introduction: We have recently shown that defects in interdigitation and ellipsoid zones (IZ and EZ) can predict response to anti-VEGF therapy in a small group of treatment-naïve diabetic macular edema (DME) patients. The aim of the current study is to further evaluate this association in a larger study group of patients over a longer follow-up time. Methods: Thirty eyes of 30 treatment-naïve DME patients were analyzed in this retrospective study. The integrity of foveal IZ and EZ was evaluated using OCT at the diagnosis of DME and following anti-VEGF injections. The defect size was correlated with best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: The mean patients' age at baseline was 63.0±10.0 years. Patients underwent 3.9±2.9 anti-VEGF injections for a mean of 9.1±4.8 months. Following treatment, the mean Snellen visual acuity improved from 20/52 to 20/44 (p=0.05), CMT decreased from 432.5±141.4 m to 375.2±121.4 µm (p=0.05) and IZ/EZ defect size decreased from 259.83±375.94 µm to 65.34±143.97 µm (p=0.001). In patients with no IZ/EZ defects at baseline the mean Snellen visual acuity was better when compared to those with IZ/EZ defects (20/36 vs. 20/70, p=0.031). The number of eyes with IZ/EZ defects decreased from 17 (57%) at baseline to 6 (20%) at end of follow-up (p<0.01). BCVA gain correlated with IZ/EZ defect size reduction (r=0.41, p=0.02) but not with improvement in CMT (r=0.28, p=0.121). Conclusions: IZ/EZ defect size correlated not only with baseline BCVA, but also predicted the change in BCVA after anti-VEGF treatment. Possible future automatic measurement of IZ/EZ defect size might prove helpful for evaluation of treatment response.

Evaluation of retinal inflammatory biomarkers after intravitreal steroid implant and Ranibizumab injection in diabetic macular edema

2021 ◽  
pp. 112067212110294
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Ecem Onder Tokuc ◽  
Fatma Sümer ◽  
V Levent Karabas
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Outer Nuclear Layer ◽  
Plexiform Layer ◽  
Retinal Layer ◽  
Treatment Naïve ◽  
The Mean ◽  
The Individual ◽  
Inflammatory Component

Purpose: To compare the efficacy of intravitreal (IV) ranibizumab (IVR) injection with IV dexamethasone implant (IVDEX) in treatment naive diabetic macular edema (DME) patients with inflammatory component. Materials and methods: Treatment naive DME eyes with subfoveal neurosensorial detachment (SND) and hyperreflective spots (HRS) were treated either three loading doses of IVR (18 eyes) or one dose of IVDEX (19 eyes). Central macular thickness (CMT), height of SND, the number of HRSs scattered on the individual retinal layers and photoreceptor integrity were assessed using spectral domain- optical coherence tomography scans over 3-months follow-up. Results: The mean change in best-corrected visual acuity (BCVA) was −0.11 ± 0.08 logMAR in IVDEX group and −0.04 ± 0.06 logMAR in IVR group at 1-month ( p = 0.011). IVDEX group showed statistically significant more increase in BCVA compared to those receiving IVR injections at 2-months ( p = 0.004) and 3-months ( p = 0.017) visits. Compared to baseline, the number of total HRSs and the number of HRSs at each individual inner retinal layer significantly decreased in both groups at all follow-up visits. However, IVDEX group showed more decrease in the total number of HRSs at 2- and 3-months ( p < 0.001 at 2-months, and p = 0.006 at 3-months) and in the mean number of HRSs located at inner nuclear layer–outer plexiform layer level ( p = 0.016 at 1-month, p < 0.001 at 2-months, and p < 0.001 at 3-months). After treatment, the number of HRSs on the outer nuclear layer showed some non-significant increase in both groups. Conclusion: HRSs tended to migrate from inner retina to the outer retina in DME eyes by treatment. Dexamethasone seemed to be more effective option in such cases with inflammatory component.

scholarly journals Evaluation of the Response to Ranibizumab Therapy following Bevacizumab Treatment Failure in Eyes with Diabetic Macular Edema

2015 ◽  
Vol 6 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Joel Hanhart ◽  
Itay Chowers
Keyword(s):  
Treatment Failure ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Median Number ◽  
Vascular Endothelial ◽  
Spectral Domain Oct ◽  
Bevacizumab Treatment ◽  
Central Subfield Thickness ◽  
The Mean ◽  
Endothelial Growth Factor

Background/Aims: Bevacizumab and ranibizumab are routinely used to treat diabetic macular edema (DME). We aim to evaluate the usefulness of switching to ranibizumab therapy following bevacizumab treatment failure in eyes with DME. Methods: We performed a retrospective analysis of a consecutive group of patients with DME who received ranibizumab injections following the failure of bevacizumab injections. The injections were delivered following a pro re nata protocol every 4-6 weeks. The data collected included demographics, systemic and ophthalmic findings, as well as the central subfield thickness according to spectral-domain OCT. Results: Eight eyes (5 patients) were included in the study. The median number of bevacizumab injections prior to the switch to ranibizumab was 4, and the median number of ranibizumab injections during the study was 2. The mean follow-up period was 541 ± 258 days. The mean central retinal thickness (CRT) (±SEM) was 539 ± 75 μm before the initiation of bevacizumab treatment, and 524 ± 43 μm after the last bevacizumab injection (p = 0.7). It reduced to 325 ± 26 μm following the ranibizumab injections (p = 0.0063). The best-corrected visual acuity (BCVA) improved in 4 eyes and remained stable in 4 eyes following the ranibizumab injections. Conclusion: A ranibizumab therapy was effective in reducing the CRT in eyes that failed bevacizumab therapy. A BCVA improvement can also occur in these eyes. Switching between anti-vascular endothelial growth factor compounds may be beneficial in eyes with DME.

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