Effect of dexamethasone intravitreal implant on visual acuity and foveal photoreceptor integrity in macular edema secondary to retinal vascular disease

2020 ◽  
Author(s):  
Verónica Castro-Navarro ◽  
CLARA MONFERRER-ADSUARA ◽  
Catalina Navarro-Palop ◽  
Javier Montero-Hernández ◽  
Enrique Cervera-Taulet
Keyword(s):  
Visual Acuity ◽  
Vascular Disease ◽  
Macular Edema ◽  
Retinal Thickness ◽  
Mean Difference ◽  
External Limiting Membrane ◽  
Dexamethasone Intravitreal Implant ◽  
Intravitreal Implant ◽  
Treatment Naïve ◽  
Retinal Vascular Disease

Purpose: To evaluate the effect of the dexamethasone intravitreal (DEX) implant on the external limiting membrane (ELM) and ellipsoid zone (EZ) integrity in treatment naïve patients with macular edema (ME) secondary to retinal vascular disease (RVD). Methods: Retrospective study conducted on patients with ME secondary to RVD, who underwent a DEX implant. Results: One-hundred eyes were included. Mean age was 70.3±11.1 years. Mean ELM integrity significantly improved from 1575.9±285.9 μm at baseline to 1711.7±244.0 μm at month 3, p<0.0001. Similarly, there was a significant improvement in EZ integrity from baseline to month-3 (1531.5±317.1 μm versus 1694.3±252.8 μm, respectively, p<0.0001). At month 3, mean visual acuity (VA) gain was 9.9±14.1 letters, p<0.0001. Mean central retinal thickness (CRT) significantly decreased by -193.2±185.7 μm from baseline to month-3, p<0.0001. Mean change in VA and CRT were significantly correlated with baseline ELM integrity (p=0.0065 and p=0.0046, respectively) and EZ (p=0.0300 and p=0.0035, respectively) integrity. At month-3, the proportion of eyes who had an intact ELM (mean difference 16.0%, 95% CI: 5.4% to 26.4%, p=0.0033) and EZ (mean difference 12.0%, 95% CI: 1.8% to 22.1%, p=0.0210) was significantly higher than at baseline. Conclusions: DEX implant was able to significantly improve ELM and EZ integrity in naïve patients with ME.

Rapid response to dexamethasone intravitreal implant in diabetic macular edema

2017 ◽  
Vol 28 (1) ◽  
pp. 74-79 ◽  
Author(s):  
Giuseppe Lo Giudice ◽  
Antonio Avarello ◽  
Gianluca Campana ◽  
Alessandro Galan
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Secondary Outcome ◽  
Dexamethasone Intravitreal Implant ◽  
Clinical Series ◽  
Intravitreal Implant ◽  
Early Effects ◽  
Sd Oct

Purpose: To evaluate the early effects of dexamethasone (DEX) intravitreal implants in patients with diabetic macular edema (DME). Methods: This was a prospective, single-arm, interventional clinical series. Eighteen patients (18 eyes) with chronic/recalcitrant or naive DME were included. Patients underwent single DEX intravitreal implant. Clinical assessments, including ophthalmologic examination, central retinal thickness (CRT) measurement by spectral-domain optical coherence tomography (SD-OCT) scan, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were carried out at baseline, 1-3 hours, and then 3, 7, and 30 days after treatment. The main outcome was change in CRT on SD-OCT, while secondary outcome measures included visual acuity (VA) and changes in IOP following implant. Results: Mean CRT significantly decreased from 565 ± 171 µm at baseline to 310 ± 89 µm at end of follow-up (p<0.001), with reduction becoming evident 1-3 hours after injection. Mean BCVA also significantly improved 7 days and 30 days after treatment up to 0.14 logMAR (p<0.05). All patients had a controlled IOP after the injection with only 1/18 eyes having a transient increase in IOP during follow-up. Conclusions: This is the first study showing very early effects of DEX implants on CRT reduction and VA improvement in DME.

scholarly journals Dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes

2021 ◽  
Vol 14 (10) ◽  
pp. 1571-1580
Author(s):  
Pedro Neves ◽  
◽  
Inês Matias ◽  
João Rodrigues ◽  
Margarida Santos ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Demographic Data ◽  
Antiangiogenic Therapy ◽  
Real Life ◽  
Real World Data ◽  
Dexamethasone Intravitreal Implant ◽  
Intravitreal Implant ◽  
Treatment Naïve

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.

ONSET AND DURATION OF VISUAL ACUITY IMPROVEMENT AFTER DEXAMETHASONE INTRAVITREAL IMPLANT IN EYES WITH MACULAR EDEMA DUE TO RETINAL VEIN OCCLUSION

Retina ◽  
2014 ◽  
Vol 34 (9) ◽  
pp. 1743-1749 ◽  
Author(s):  
Baruch D. Kuppermann ◽  
Julia A. Haller ◽  
Francesco Bandello ◽  
Anat Loewenstein ◽  
Jenny Jiao ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Dexamethasone Intravitreal Implant ◽  
Vein Occlusion ◽  
Intravitreal Implant

scholarly journals Comparative Efficacy of Intravitreal Triamcinolone and Dexamethasone Intravitreal Implant for Diabetic Macular Edema

2021 ◽  
Author(s):  
Madison Kerley ◽  
Charles C. Barr ◽  
Wei Wang ◽  
Douglas K. Sigford ◽  
Henry J. Kaplan ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Burden ◽  
Intravitreal Triamcinolone ◽  
Dexamethasone Intravitreal Implant ◽  
Intravitreal Implant ◽  
Intravitreal Dexamethasone

Abstract Purpose: To compare the efficacy, adverse effects, and treatment burden of two injectable corticosteroids, triamcinolone acetonide (Kenalog® or Triesence®) and the dexamethasone intravitreal implant (Ozurdex®), for treating diabetic macular edema (DME). Methods: This was a retrospective review at a single tertiary care center. Eyes treated with either intravitreal triamcinolone two mg (IVTA) or the intravitreal dexamethasone 0.7 mg implant for center-involving DME and with follow up of at least six months were included. Main outcomes were visual acuity (VA), intraocular pressure (IOP), IOP medication use, central macular thickness (CMT), and time to next treatment of any kind.Results: There were 24 eyes in the IVTA group and 15 eyes in the dex group. Baseline mean VA was 20/60 (range 20/30-20/800) in the IVTA group and 20/35 (range 20/20-20/100) in the dex group (p=0.0011). Only the subgroup of pseudophakic IVTA patients experienced a statistically significant increase in vision early on (+2 letters at month 1, +3 letters at month three), though not at month six. Mean IOP increased by 2.5 and 0.20 mmHg at month one in the IVTA and dex groups, respectively (p=0.27). Mean CMT decreased by 143 mm with IVTA and 39 mm with dex at month one (p=0.00025). Mean time to next treatment of any kind was 19 weeks for IVTA and 20.3 weeks for dex (p=0.41). Conclusions: Intravitreal triamcinolone and the intravitreal dexamethasone implant both show similar efficacy at reducing DME and its treatment burden, but neither significantly affected visual acuity over six months.

Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: Systematic review and meta-analysis

2020 ◽  
pp. 112067212094759
Author(s):  
Raymond Pranata ◽  
Amelinda Vania ◽  
Rachel Vania ◽  
Andi Arus Victor
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Mean Difference ◽  
Cataract Formation ◽  
Intravitreal Ranibizumab ◽  
Dexamethasone Intravitreal Implant ◽  
Vein Occlusion ◽  
Intravitreal Implant

Purpose: Intravitreal ranibizumab (RNB) and dexamethasone intravitreal implant (DII) were developed in the recent past and has been widely used for macular edema secondary to BRVO. We aimed to assess the efficacy and safety of intravitreal ranibizumab (RNB) compared to dexamethasone intravitreal implant (DII) in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: We performed a comprehensive search on topics that assess RNB and DII in patients with macular edema secondary to BRVO from several electronic databases. Results: There were 678 subjects from five studies. Ranibizumab was associated with a greater increase in best-corrected visual acuity (BCVA; mean difference 9.13, I2: 0%) compared to DII. Ranibizumab also demonstrated a greater ⩾10 (OR 2.76, I2: 0%) and ⩾15 letters (OR 2.78, I2: 0%) gain. RNB has better BCVA (logMAR scale) improvement at 6 months’ follow up (mean difference −0.15, I2: 64%) in favor of RNB. Higher IOP was found in DII group on follow-up (mean difference −2.92, I2: 89%) and RNB has lesser IOP ⩾10 mmHg increase compared to DII (OR 0.08, I2: 0%). Cataract formation and/or progression was less in RNB (OR 0.53, I2: 75%). The need for rescue laser was similar the two groups. Conclusion: Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.

scholarly journals Comparative Efficacy of Pharmacotherapy for Macular Edema Secondary to Retinal Vein Occlusion: A Network Meta-analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Sheng Gao ◽  
Yun Zhang ◽  
Xun Li ◽  
Ge Ge ◽  
Jianan Duan ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Randomized Controlled Trials ◽  
Macular Edema ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Dexamethasone Intravitreal Implant ◽  
Randomized Controlled ◽  
Vein Occlusion ◽  
Intravitreal Implant ◽  
The Mean

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 &gt; 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.

scholarly journals Risk factors for repeated dexamethasone intravitreal implant therapy for macular edema due to treatment-naïve branch retinal vein occlusion

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yu-Te Huang ◽  
Chun-Ju Lin ◽  
Huan-Sheng Chen ◽  
Peng-Tai Tien ◽  
Chun-Ting Lai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Older Age ◽  
Repeated Treatment ◽  
Dexamethasone Intravitreal Implant ◽  
Vein Occlusion ◽  
Intravitreal Implant ◽  
Treatment Naïve

Abstract Background This study evaluated the effects of dexamethasone intravitreal implant on treatment-naïve branch retinal vein occlusion (BRVO)-induced macular edema (ME), and the risk factors for earlier repeated treatment. Methods Patients treated from 2013 to 2016 were enrolled. The patients’ demographics, medical history, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) were recorded. Risk factors for repeated treatment were identified using a Cox proportional hazard model and logistic regression. Results 29 patients (mean age: 58.64 ± 13.3 years) were included; 44.8% received only one injection, while 55.2% received two or more. The mean initial CRT was 457.8 ± 167.1 μm; the peak CRT and final CRT improved significantly to 248.9 ± 57.9 μm and 329.2 ± 115.1 μm, respectively. The peak BCVA improvement and final improvement were 29.5 ± 23.5 approximate ETDRS letters and 19.8 ± 24.4 letters, respectively, with 62.1% of patients improving by more than 15 letters. Older age, higher initial CRT, and diabetes were the risk factors for multiple injections. Conclusion Dexamethasone intravitreal implant results in significant peak CRT and BCVA improvements, while older age, higher initial CRT, and diabetes are risk factors for repeated injections. The optimal retreatment schedule for these patients should be further explored.

scholarly journals Micropulse laser in patients with refractory and treatment-naïve center–involved diabetic macular edema: short terms visual and anatomic outcomes

2021 ◽  
Vol 13 ◽  
pp. 251584142097911
Author(s):  
Diego Alejandro Valera-Cornejo ◽  
Marlon García-Roa ◽  
Jaime Quiroz-Mendoza ◽  
Alejandro Arias-Gómez ◽  
Paulina Ramírez-Neria ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Macular Thickness ◽  
Thickness Change ◽  
Macular Volume ◽  
Naive Group ◽  
Micropulse Laser ◽  
Refractory Diabetic Macular Edema ◽  
Treatment Naïve

Purpose: The purpose of the study is to describe visual and anatomic outcomes of 5774nm micropulse laser photocoagulation in eyes with either treatment-naïve or refractory diabetic macular edema (DME) at 3 months. Methods: This was a prospective case series that recruited 23 consecutive patients (33 eyes) with center-involved DME that was either treatment-naïve or had not responded to prior treatment. Micropulse therapy was performed with the Easy Ret 577 (Quantel Medical, Cournon d’Auvergne, France) diode laser in a high-density manner in eyes with treatment-naïve or refractory DME. The primary outcome was the change of best-corrected visual acuity (BCVA; logMAR) at 1 and 3 months. Secondary outcomes were changes in the central macular thickness (CMT), thickness area, macular volume, and macular capillary leakage at 1 and 3 months. Results: There were no significant changes in BCVA at 3 months, with mean ± standard deviation (SD) of −0.08 ± 0.01 ( p = 0.228) and + 0.01 ± 0.01 ( p = 0.969) for treatment-naïve and refractory groups, respectively. The change in CMT at 3 months was statistically but not clinically significant in the treatment-naïve group only (mean ± SD; –30 ± 130 µm; p = 0.011). The macular volume and area thickness change were not statistically significant ( p = 0.173 and p = 0.148 for macular volume and area thickness, respectively) in the treatment-naïve group. There was no difference concerning the leakage area in both groups. No adverse events were reported. Conclusion: We concluded that micropulse 577nm laser therapy maintained the visual acuity and macular thickness at 3 months in both treatment-naïve and refractory DME.

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