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.

Comparison of aflibercept and ranibizumab in diabetic macular edema associated with subretinal detachment

2019 ◽  
Vol 30 (2) ◽  
pp. 363-369 ◽  
Author(s):  
Abdullah Ozkaya ◽  
Gokhan Demir ◽  
Asli Kirmaci
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Secondary Outcome ◽  
Intravitreal Ranibizumab ◽  
Corrected Visual Acuity ◽  
Intravitreal Aflibercept ◽  
Best Corrected Visual Acuity

Purpose: To compare the efficacy of ranibizumab and aflibercept in the treatment of diabetic macular edema associated with subfoveal retinal detachment. Methods: This is a retrospective, comparative study. The treatment-naïve diabetic macular edema patients who had diabetic macular edema associated with subfoveal retinal detachment and underwent intravitreal aflibercept or intravitreal ranibizumab treatment were included. The patients were treated on a pro re nata treatment regimen after a loading dose of 3-monthly injections and the follow-up time was 12 months. The primary outcome measure of this study was the presence of subfoveal retinal detachment after treatment at different time points. The secondary outcome measures were the change in best corrected visual acuity and central retinal thickness. Results: A total of 46 eyes of 46 patients were included. The aflibercept group consisted of 20 and the ranibizumab group consisted of 26 eyes. During the follow-up period of 12 months, subfoveal retinal detachment was completely resolved in 75% versus 57.7% of the eyes at month 3 (p = 0.2), 90% versus 76.9% at month 6 (p = 0.2), 90% versus 65.4% at month 9 (p = 0.05), and 100% versus 80.8% at month 12 (p = 0.03) in the intravitreal aflibercept versus intravitreal ranibizumab groups. The change in best corrected visual acuity was not statistically different between the groups at months 3, 6, 9, and 12, respectively (p > 0.05 for all). Conclusion: Both intravitreal aflibercept and intravitreal ranibizumab were effective in regards to anatomical and functional outcomes of diabetic macular edema patients associated with subfoveal retinal detachment. Interestingly, intravitreal aflibercept seemed more effective than intravitreal ranibizumab in the resolution of subfoveal retinal detachment at month 12.

Dexamethasone Intravitreal Implant at the Time of Cataract Surgery in Eyes with Diabetic Macular Edema

2016 ◽  
Vol 27 (4) ◽  
pp. 433-437 ◽  
Author(s):  
Giacomo A. Panozzo ◽  
Elena Gusson ◽  
Giorgio Panozzo ◽  
Giulia Dalla Mura
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Foveal Thickness ◽  
Dexamethasone Intravitreal Implant ◽  
Positive Effects ◽  
Intravitreal Implant ◽  
A Prospective Study

Purpose To determine the potential role of intraoperative dexamethasone intravitreal implant (DEX-I) in reducing diabetic macular edema (DME) worsening after phacoemulsification. Methods This was a prospective study on 19 eyes of 19 patients with type 2 diabetes mellitus with DME and cataract. Mean preoperative Early Treatment Diabetic Retinopathy Study visual acuity (VA) was 16.7 letters. Mean foveal thickness (FT) was 451 μm. The DME was naive in 11 eyes and refractory in 8 eyes. All eyes underwent a standard phacoemulsification and intraocular lens implantation; DEX-I was injected at the end of surgery. Follow-up was performed at 1 week and then monthly until DME recurrence (up to 8 months). Results At 1 week, mean VA improved by 15 letters (range 0-29 letters) and mean FT decreased by 147 μm (range 69-236 μm). Improvement consolidated at month 1, with a mean VA improvement of 18 letters (range 3-32 letters) and a mean improvement in FT of 193 μm (range 76-304 μm), remaining stable at month 2 after surgery in all eyes. The DME recurred in 1 eye at month 3, in 14 eyes (73.8%) between months 4 and 5, and after month 6 in 4 eyes (21%). Refractory DMEs demonstrated the same benefit but recurred earlier than naive ones (4 months versus 5.8 months, p<0.01). Conclusions Intraoperative DEX-I prevents DME worsening after phacoemulsification. Its positive effects last for at least 3 months.

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.

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.

Switching to intravitreal fluocinolone acetonide implant for refractory diabetic macular edema: 12- and 24-month results

2021 ◽  
pp. 112067212199298
Author(s):  
Argyrios Chronopoulos ◽  
Panagiotis Chronopoulos ◽  
Agharza Ashurov ◽  
Christina Korb ◽  
Norbert Pfeiffer ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Fluocinolone Acetonide ◽  
Additional Treatment ◽  
Multicentric Study ◽  
Goldmann Tonometry ◽  
Refractory Diabetic Macular Edema ◽  
Intravitreal Implant ◽  
Fluocinolone Acetonide Implant

Purpose: To report visual and anatomical outcomes of chronic/refractory diabetic macular edema (DME) treated with intravitreal fluocinolone acetonide implant. Setting: Retrospective, one arm, multicentric study. Method: Between 2013 and 2018, 27 consecutive eyes of 25 patients with chronic/refractory DME were treated with a fluocinolone acetonide intravitreal implant. Best registered visual acuity (BRVA), central retinal thickness (CRT), and Goldmann tonometry intraocular pressure (IOP) were assessed at 12 and 24 months. The need for IOP lowering treatment as well as top-up therapy during the follow-up were also assessed. Results: The duration of DME prior to treatment in our study was 54 ± 24 months. The baseline mean BRVA of 0.7 ± 0.34 logMAR improved to 0.5 ± 0.3 ( p = 0.01) at 12 months and 0.46 ± 0.3 ( p = 0.04) at 24 months. At 12 months, BRVA improved in 14 eyes (52%), stabilized in 5 eyes (20%), and decreased in 3 eyes (11%). At 24 months, BRVA improved further in 6 eyes (24%), stabilized in 3 eyes (12%), and decreased in 6 eyes (24 %). Mean CRT decreased from 497 ± 176 to 349 ± 186 μm at 12 months ( p = 0.0005) and to 267 ± 104 μm at 24 months ( p = 0.001). Only five eyes required additional treatment for DME and only three eyes required treatment for raised IOP. Discussion: Our results show that the visual and the anatomical improvements achieved by a single injection of a fluocinolone acetonide implant were maintained up to 24 months with minimal additional therapy even in eyes with a long and heavy history; however, IOP monitoring remains essential.

Dexamethasone Intravitreal Implant in Combination with Laser Photocoagulation for the Treatment of Diffuse Diabetic Macular Edema

Ophthalmology ◽  
2013 ◽  
Vol 120 (9) ◽  
pp. 1843-1851 ◽  
Author(s):  
David G. Callanan ◽  
Sunil Gupta ◽  
David S. Boyer ◽  
Thomas A. Ciulla ◽  
Michael A. Singer ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Laser Photocoagulation ◽  
Dexamethasone Intravitreal Implant ◽  
Intravitreal Implant ◽  
Diffuse Diabetic Macular Edema

scholarly journals EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE FOR DIABETIC MACULAR EDEMA

2016 ◽  
Vol 3 (2) ◽  
pp. 30-34
Author(s):  
Prachand Gautam ◽  
Koshal Shrestha ◽  
Gyanendra Lamichhane ◽  
Sushila Patel
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Diabetic Macular Edema ◽  
Intravitreal Triamcinolone ◽  
Hard Exudates ◽  
Intravitreal Triamcinolone Acetonide ◽  
Diffuse Diabetic Macular Edema

INTRODUCTION: Diabetic retionopathy is a microangilpathy. The present study was done to investigate results of Intravitreal Triamcinolone Acetonide injection for the treatment diffuse diabetic macular edema. MATERIAL AND METHODS: The study included 40 eyes of 40 patients with clinically significant diffuse diabetic macular edema. Eyes were diagnosed with diabetic macular edema according to Early Treatment Diabetic Retinopathy Study guidelines. An Intravitreal injection of Triamcinolone Acetonide at the dose of 4 mg/0.2 ml was administered. Best corrected visual acuity was measured as the logarithm of the minimum angle of resolution (logMAR) and snellen vision drum and size of macular edema (hard exudates) was obtained by slit lamp biomicroscopy using +90 D Volk lens at each visit. Intraocular pressure (IOP) and other complications related with steroid and injection related complications were also evaluated. Subsequently patients were followed up on 1st day, 2nd week and 3rd month. RESULTS: All patients were completed second follow up at 3 months. The mean size of macular edema, which obtained at 3 months postoperatively, was significantly different from the baseline measurement from 1.4125 to 0.9474 DD. Mean visual acuity improved significantly from baseline at 3 months of follow up was 0.7421 LogMAR (≈ 6/30 in Snellen chart). Eleven eyes developed intraocular pressure higher than 21 mmHg at 2nd week postoperatively. Other drug and injection related complications were not developed. Increased IOP were controlled with anti glaucoma drugs. CONCLUSIONS: Intravitreal Triamcinolone was a promising therapeutic method for diabetic macular edema. TriamcinoloneAcetonide effectively reduces size of macular edema and improves visual acuity in the short term.Journal of Universal College of Medical Sciences (2015) Vol.03 No.02 Issue 10 Page: 30-34

scholarly journals Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

2018 ◽  
Vol 2018 ◽  
pp. 1-16 ◽  
Author(s):  
Laurent Kodjikian ◽  
David Bellocq ◽  
Thibaud Mathis
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Observational Studies ◽  
Real Life ◽  
Pharmacological Management ◽  
Anti Vegf ◽  
Pubmed Database ◽  
Baseline Visual Acuity

Objectives of the Study. Summary of observational studies concerning the pharmacological management of diabetic macular edema (DME). Methods. A literature review was conducted using the PubMed database on 1 February 2018 to identify studies evaluating the efficacy of anti-VEGF and dexamethasone (DEX) implants for DME. Studies with more than 10 patients and follow-up of more than 6 months were selected. Analyses were carried out on the overall population and on subgroups defined according to baseline visual acuity (BVA) and the patients’ naïve or non-naïve status. Results. Thirty-two studies evaluating the efficacy of anti-VEGF and 31 studies evaluating the efficacy of DEX-implants were retained, concerning 6,842 and 1,703 eyes, respectively. A mean gain of +4.7 letters for a mean of 5.8 injections (mean follow-up: 15.6 months) and +9.6 letters for a mean of 1.6 injections (10.3 months) was found in the anti-VEGF and DEX-implant studies, respectively. Final VA appears to be similar for both treatment (62 letters for anti-VEGF, 61.2 letters for DEX-implant), and BVA appears lower for DEX-implant, which may partially explain the greater visual gain. The DEX-implant studies show greater gains in VA compared to the anti-VEGF studies, especially for higher BVA. Indeed, mean gains for the subgroups of patients with BVA<50 letters, 50<BVA<60 letters, and BVA>60 letters are +4.3, +5.8, and +3.1 letters, respectively, in the anti-VEGF studies and +10.5, +9.3, and +8.8 letters, respectively, in the DEX-implant studies. Regarding the patient’s initial status, only naïve status appears to confer the best functional response in DEX-implant studies. Conclusion. Observational studies investigating DEX-implant report clinically similar final VA when compared to anti-VEGF, but superior visual gains in real-life practice. This latter difference could be due to the better BVA, but also to the fact that less injections were administered in the anti-VEGF observational studies than in the interventional studies.

Long-Term Efficacy of Dexamethasone Intravitreal Implant in the Treatment of Vogt-Koyanagi-Harada (VKH) Disease Relapsing Posterior Uveitis

2021 ◽  
Author(s):  
Tarek Roshdy Elhamaky
Keyword(s):  
Visual Acuity ◽  
Posterior Uveitis ◽  
Systemic Steroid ◽  
Foveal Thickness ◽  
Dexamethasone Intravitreal Implant ◽  
Central Foveal Thickness ◽  
Intravitreal Implant ◽  
The Mean ◽  
Vkh Disease

Abstract Purpose: To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent VKH disease.Methods: This is a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including BCVA (log MAR), IOP, FFA, and SD-OCT. All patients underwent intravitreal injection with sustained-release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in best corrected visual acuity (BCVA) and central foveal thickness (CFT) at 24 months follow-up compared to baseline. Results: At 24 months follow-up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06logMAR (P <0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P <0.0001). The mean IOP changed from 15.1±2.2 to16.9±3.1 mmHg with no significant value. Twenty-one eyes (72.4%) received one injection, while eight eyes (27.6%) required two injections. The mean number of injections was 1.2± 0.60. The mean follow-up time was 24.75± 0.9months. No serious ocular or systemic adverse events were noted during the follow-up period. Ocular hypertension was recorded in there (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes.Conclusions: Our cohort highlights the beneficial effects of the Dexamethasone implant 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroid in this sample study.

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