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Liang X, Shen B, Ou Z, An H, Li L. Comparison of intravitreal ranibizumab monotherapy vs. ranibizumab combined with dexamethasone implant for macular edema secondary to retinal vein occlusion. Front Med (Lausanne) 2022; 9:930508. [PMID: 36172537 PMCID: PMC9510371 DOI: 10.3389/fmed.2022.930508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the efficacy and the injection number of intravitreal ranibizumab (IVR) monotherapy vs. intravitreal ranibizumab plus dexamethasone (IVR + DEX) implants for macular edema (ME) secondary to retinal vein occlusion (RVO). Methods This prospective, control trial comprised 96 eyes of 96 patients with ME due to non-ischemic RVO divided into two groups. The IVR monotherapy group consisted of 61 patients (29 with CRVO and 32 with BRVO) treated with ranibizumab with three consecutive loading doses at a monthly + pro re nata (three + PRN) regimen. The IVR + DEX implant group consisted of 35 patients (19 with CRVO and 16 with BRVO) treated with intravitreal ranibizumab plus DEX implant. All eyes underwent best-corrected visual acuity (BCVA, log MAR), central foveal thickness (CFT), and intraocular pressure (IOP). In case of recurrence, each group received initial medication. Results At the 12-month visit, the mean log MAR BCVA that was improved from baseline was 0.23 with the IVR group and 0.30 with the IVR + DEX group. CFT decreased on average by 420 ± 292 μm with the IVR group and 393 ± 259 μm with the IVR + DEX implant group. No significant differences were detected in BCVA improvement and CFT reduction between the two groups (p > 0.05). The mean number of injections was 5.4 in the IVR group and 3.9 in the IVR + DEX implant group (p < 0.001). The mean reinjection interval for patients with the IVR + DEX implant was 131.2 ± 8.9 days (range: 98–150). The incidence of high IOP and cataract progression were significantly higher in the IVR + DEX implant group than in the IVR group (both p < 0.001). Conclusion In RVO-ME, the IVR + DEX implant did not have synergistic efficacy, providing further improvement in BCVA and a reduction in CFT. However, the IVR + DEX implant still had an advantage in reducing the number of injections and prolonging the time between injections.
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Kishore K, Bhat PV, Venkatesh P, Canizela CC. Dexamethasone Intravitreal Implant for the Treatment of Macular Edema and Uveitis: A Comprehensive Narrative Review. Clin Ophthalmol 2022; 16:1019-1045. [PMID: 35418744 PMCID: PMC8995179 DOI: 10.2147/opth.s209395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/10/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The purpose of this review article is to provide a comprehensive review of the current applications of intravitreal DEX implant (Ozurdex®, Allergan Inc, Irvine, CA) for a variety of ophthalmic conditions – ranging from FDA approved indications to off-label uses. We have attempted to provide relevant evidence from the literature to help a reader develop an understanding of the biological and pharmacokinetic properties of DEX implant, its uses, and potential side effects. Methods PubMed searches were performed using the terms “Ozurdex”, or “intravitreal DEX implant”, AND “retinal vein occlusion”, or “diabetic macular edema”, or “uveitis”. The search was performed in July of 2021, with an additional search in October 2021. All original English language articles were considered for this review. Results DEX implant has evidence of efficacy in a variety of clinical situations including macular edema associated with retinal vein occlusion, diabetes, uveitis, and others. Safety concerns include cataract formation and progression, intraocular pressure elevation, complications related to intravitreal injection, and opportunistic infections secondary to steroid-induced immune suppression. Conclusion DEX implant is a useful tool in the management of several retinal disorders. Further studies are needed for head-to-head comparison with other treatment modalities and to determine its precise place in clinical practice.
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Affiliation(s)
- Kamal Kishore
- Illinois Retina and Eye Associates, Peoria, IL, USA
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
- Correspondence: Kamal Kishore, Illinois Retina and Eye Associates, 4505 N Rockwood Drive, Suite 1, Peoria, IL, 61615, USA, Tel +1 3095891880, Fax +1 3095891885, Email
| | - Pooja V Bhat
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Cecilia C Canizela
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
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Arrigo A, Bandello F. Retinal vein occlusion: drug targets and therapeutic implications. Expert Opin Ther Targets 2021; 25:847-864. [PMID: 34775882 DOI: 10.1080/14728222.2021.2005026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The pathogenesis of retinal vein occlusion (RVO) is extremely complex and includes several mediators. These mediators represent potential drug targets that can be used in the development of intravitreal drugs. AREAS COVERED PubMed/MEDLINE databases were accessed between April-May 2021 to find the most relevant scientific papers regarding drug targets and therapeutic implications in RVO, focusing on current therapeutic options and potential cornerstones of future advances in treatment. EXPERT OPINION Before the introduction of intravitreal therapies, the visual outcome following a diagnosis of RVO was extremely poor. Anti-VEGF and corticosteroid treatments have radically changed RVO prognosis, helping to preserve patients' visual function and their quality of life. According to current clinical data, anti-VEGF and corticosteroid drugs are associated with both pros and cons; the present recommendation is to employ anti-VEGF molecules as a first-line treatment. Advances in our understanding of the biomolecular characteristics of RVO offer a solid basis for the development of new therapeutic targets and treatments.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Narayanan R, Kelkar A, Abbas Z, Goel N, Soman M, Naik N, Sudhalkar A, Walinjkar J, Shah U, Maksane N. Sub-optimal gain in vision in retinal vein occlusion due to under-treatment in the real world: results from an open-label prospective study of Intravitreal Ranibizumab. BMC Ophthalmol 2021; 21:33. [PMID: 33435908 PMCID: PMC7805171 DOI: 10.1186/s12886-020-01757-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022] Open
Abstract
Background Macular edema secondary to retinal vein occlusion (RVO) is an important cause of loss of vision. Intravitreal injections (IVI) of anti-vascular endothelial growth factor (VEGF) are the standard of care in this disease, as shown in numerous randomized controlled trials. The purpose of this study was to study the efficacy and safety of ranibizumab, an anti-VEGF agent, in the real-world setting. Methods This was 48 weeks, open-label, prospective, multicentre, observational study. Patients diagnosed with ME secondary to RVO were treated with IVI of Ranibizumab 0.5 mg in real-world conditions. Efficacy was measured by improvement seen in best-corrected visual acuity (BCVA) in terms of Early Treatment of Diabetic Retinopathy Study (ETDRS) Letter Scores and change in central retinal thickness (CRT) measured by optical coherence tomography. Results One hundred eyes of 100 patients (79 with branch retinal vein occlusion and 21 with central retinal vein occlusion) were recruited in the study. The mean (standard deviation, SD) BCVA was 52.8 (21.99) letters at baseline and 62.3 (24.40) letters at week 48. From baseline, there was a significant improvement in BCVA by 7.7 letters (p = 0.001) at 48 weeks. The mean (SD) of CRT was 479.9 (216.25) μm at baseline and it decreased significantly to 284.9 (171.35) μm at week 48 (p < 0.001). During the study period, the average number of intravitreal injections was 3.5 per patient. There was no report of endophthalmitis in any eye. Conclusions Ranibizumab is well tolerated and effective in treating macular edema secondary to RVO in real-world clinical settings. However, there is under-treatment compared to controlled clinical trials, and the gain in vision is sub-optimal with under-treatment. Trial registration Clinical Trials Registry - India: CTRI/2015/07/005985.
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Affiliation(s)
- Raja Narayanan
- L V Prasad Eye Institute, Hyderabad Eye Research Foundation, Hyderabad, Telangana, India.
| | - Aditya Kelkar
- National Institute of Ophthalmology, Pune, Maharashtra, India
| | - Zahir Abbas
- Apollo Gleneagles Heart Centre, Kolkata, West Bengal, India
| | - Neha Goel
- ICARE Research Center, Noida, Uttar Pradesh, India
| | - Manoj Soman
- Chaithanya Eye Hospital, Trivendrum, Kerala, India
| | - Naveen Naik
- Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Aditya Sudhalkar
- Iladevi Cataract & IOL Research Centre, Ahmedabad, Gujarat, India
| | | | - Utkarsh Shah
- Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
| | - Nitin Maksane
- Novartis Healthcare Private Limited, Mumbai, Maharashtra, India
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Mishra SK, Sinha S, Chauhan R, Kumar A. Intravitreal Dexamethasone Implant versus Intravitreal Ranibizumab Injection for Treatment of Non-Proliferative Diabetic Macular Edema: A Prospective, Randomized and Blinded Trial. Curr Drug Deliv 2020; 18:825-832. [PMID: 33267762 DOI: 10.2174/1567201817666201202093637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In the working age population, Diabetic Macular Edema (DME) is the most common cause of visual loss. PURPOSE The present study is aimed to assess the safety and efficacy of intravitreal injection of Ranibizumab (IVR) versus intravitreal Dexamethasone implant (IVD) in patients with DME in a tertiary care centre upto 4 months. METHODS This is a comparative, prospective, randomized study that was done on 140 patients with macular edema confirmed on optical coherence tomography (OCT). IVD group received Ozurdex® (Allergan, Inc, Ireland) while the IVR group received Lucentis® (Novartis, Basel, Switzerland); the groups were followed up at day-1 and weeks 4, 8, 12, 16. Patients were divided into Group A, in which patients were given 3 doses (monthly) of IVR 0.3 mg in 0.05 ml (n=70). Group B patients were given a single dose of IVD implant 0.7 mg (n=70). RESULTS The mean number of injections given was 1 Ozurdex® per patient vs. 3 Lucentis® per patient. The maximum reduction in central macular thickness (CMT) with IVD was 167.8 μm and 138.8μm in the 2nd and 3rd months, respectively, with IVR. The mean best-corrected visual acuity (BCVA) in the 4th month was 0.34 logMAR and 0.33 logMAR, in IVD and IVR groups, respectively, with consistent improvement. Patients with 0-5 letters, 6-10 letters and 10-15 letters, and >15 letters visibility in IVD group were 9.5, 20.6, 4.8, 6.4%, and 20.4, 18.8, 20.3 20.3% in IVR groups, respectively. The maximum intraocular pressure (IOP) rise with IVD was found to be 16 mmHg in 2 patients (3.17%). IOP rise >10 mmHg was observed in 14/63 patients (22.22%); the majority of patients indicated a high rise at 2nd month with all returning to baseline by 4th month. No reports of infectious endophthalmitis or new cataracts were detected in either of the treated groups. CONCLUSION Both intravitreal Ranibizumab injection and Dexamethasone implants were found to be safe and effective in lowering CMT and improving BCVA at the 4-month follow up in patients with DME. Since there was no recurrence of CMT in the Dexamethasone implant group, we suggest that early administration before the 4th month may indicate superior efficacy over the ranibizumab injection. Further randomized trials in a large sample size with a longer period follow- up would be performed to justify the obtained results in the present study.
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Affiliation(s)
- Sanjay Kumar Mishra
- Department of Ophthalmology, Army Base Hospital and Army College of Medical Sciences, Delhi Cantonment, New Delhi, India
| | - Shruti Sinha
- Department of Ophthalmology, Army Base Hospital and Army College of Medical Sciences, Delhi Cantonment, New Delhi, India
| | - Ravi Chauhan
- Department of Ophthalmology, Command Hospital, Lucknow Cantonment, India
| | - Ashok Kumar
- Department of Ophthalmology, Armed Forces Medical College, Pune, India
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Iovino C, Mastropasqua R, Lupidi M, Bacherini D, Pellegrini M, Bernabei F, Borrelli E, Sacconi R, Carnevali A, D’Aloisio R, Cerquaglia A, Finocchio L, Govetto A, Erba S, Triolo G, Di Zazzo A, Forlini M, Vagge A, Giannaccare G. Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature. Pharmaceutics 2020; 12:pharmaceutics12080703. [PMID: 32722556 PMCID: PMC7466091 DOI: 10.3390/pharmaceutics12080703] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.
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Affiliation(s)
- Claudio Iovino
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy
- Correspondence: ; Tel.: +39-070-609-2319
| | - Rodolfo Mastropasqua
- Institute of Ophthalmology, University of Modena and Reggio Emilia, 41121 Modena, Italy;
| | - Marco Lupidi
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
- Fondazione per la Macula Onlus, DINOMGI., University Eye Clinic, 16132 Genova, Italy
- Centre de l’Odéon, 113 Boulevard St Germain, 75006 Paris, France
| | - Daniela Bacherini
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
| | - Marco Pellegrini
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Federico Bernabei
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (M.P.); (F.B.)
| | - Enrico Borrelli
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Riccardo Sacconi
- Department of Ophthalmology, Hospital San Raffaele, University Vita Salute San Raffaele, 20132 Milan, Italy; (E.B.); (R.S.)
| | - Adriano Carnevali
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
| | - Rossella D’Aloisio
- Department of Medicine and Science of Ageing, Ophthalmology Clinic, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy;
| | - Alessio Cerquaglia
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, 06129 Perugia, Italy; (M.L.); (A.C.)
| | - Lucia Finocchio
- Department of Neurosciences, Psychology, Drug Research and Child Health, Eye Clinic, University of Florence, AOU Careggi, 50139 Florence, Italy; (D.B.); (L.F.)
- Moorfields Eye Hospital NHS Foundation Trust, London EC1V2PD, UK
| | - Andrea Govetto
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol BS12LX, UK
| | - Stefano Erba
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Giacinto Triolo
- Fatebenefratelli-Oftalmico Hospital, ASST-Fatebenefratelli-Sacco, 63631 Milan, Italy; (A.G.); (S.E.); (G.T.)
| | - Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Campus Bio Medico University Hospital, 00128, Rome, Italy;
| | | | - Aldo Vagge
- University Eye Clinic, DINOGMI, Polyclinic Hospital San Martino IRCCS, 16132 Genoa, Italy;
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University “Magna Graecia,” 88100 Catanzaro, Italy; (A.C.); (G.G.)
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Ming S, Xie K, Yang M, He H, Li Y, Lei B. Comparison of intravitreal dexamethasone implant and anti-VEGF drugs in the treatment of retinal vein occlusion-induced oedema: a meta-analysis and systematic review. BMJ Open 2020; 10:e032128. [PMID: 32595145 PMCID: PMC7322510 DOI: 10.1136/bmjopen-2019-032128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To compare the efficacy and safety of intravitreal dexamethasone (DEX) implant and anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of macular oedema secondary to retinal vein occlusion (RVO). DESIGN Systematic review and meta-analysis based on Grading of Recommendations Assessment, Development and Evaluation (GRADE). DATA SOURCES PubMed, Cochrane Library and ClinicalTrials.gov registry were searched from inception to 10 December 2019, without language restrictions. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) and real-world observation studies comparing the efficacy of DEX implant and anti-VEGF agents for the treatment of patients with RVO, naïve or almost naïve to both arms, were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data for mean changes in best-corrected visual acuity (BCVA), central subfield thickness (CST) and product safety. Review Manager V.5.3 and GRADE were used to synthesise the data and validate the evidence, respectively. RESULTS Four RCTs and 12 real-world studies were included. An average lower letter gain in BCVA was determined for the DEX implant (mean difference (MD) = -6.59; 95% CI -8.87 to -4.22 letters) administered at a retreatment interval of 5-6 months. Results were similar (MD6 months=-12.68; 95% CI -21.98 to -3.37 letters; MD12 months=-9.69; 95% CI -12.01 to -7.37 letters) at 6 and 12 months. The DEX implant resulted in comparable or marginally less CST reduction at months 6 and 12 but introduced relatively higher risks of elevated intraocular pressure (RR=3.89; 95% CI 2.16 to 7.03) and cataract induction (RR=5.22; 95% CI 1.67 to 16.29). Most real-life studies reported an insignificant numerical gain in letters for anti-VEGF drugs relative to that for DEX implant. However, the latter achieved comparable efficacy with a 4-month dosage interval. CONCLUSION Compared with anti-VEGF agents, DEX implant required fewer injections but had inferior functional efficacy and safety. Real-life trials supplemented the efficacy data for DEX implant.
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Affiliation(s)
- Shuai Ming
- Department of Ophthalmology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Provincial Clinical Research Center for Eye Disease, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Kunpeng Xie
- Henan Provincial Clinical Research Center for Eye Disease, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Mingzhu Yang
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Huijuan He
- Henan Provincial Clinical Research Center for Eye Disease, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Ya Li
- Henan Provincial Clinical Research Center for Eye Disease, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Bo Lei
- Department of Ophthalmology, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Henan Provincial Clinical Research Center for Eye Disease, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Key Laboratory of Ophthalmology and Visual Science, Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
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Callizo J, Ziemssen F, Bertelmann T, Feltgen N, Vögeler J, Koch M, Eter N, Liakopoulos S, Schmitz-Valckenberg S, Spital G. Real-World Data: Ranibizumab Treatment For Retinal Vein Occlusion In The OCEAN Study. Clin Ophthalmol 2019; 13:2167-2179. [PMID: 31806930 PMCID: PMC6847987 DOI: 10.2147/opth.s209253] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The non-interventional OCEAN study (NCT02194803) evaluated frequency and monitoring of ranibizumab injections for retinal vein occlusion (RVO) in routine practice in Germany. Methods RVO patients (including branch and central RVO (BRVO/CRVO)) receiving ranibizumab were included. Best-corrected visual acuity (BCVA) testing, imaging and treatment were performed at the investigators’ discretion and documented over 24 months. Results Overall, 744 RVO patients (27% BRVO, 16% CRVO, remaining unspecified RVO) were included. For 74% of patients, data were available for the 12-month visit and for 56% for the 24-month visit. Mean baseline BCVA was 52.0 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (BRVO: 55.9, CRVO: 43.9). BCVA improved rapidly within the first 3 months, reaching 64.3 letters at 12 months and 64.7 at 24 months. CRVO patients showed less improvement than those with BRVO. Patients received a median of 4 (5) injections over 12 (24) months, with 100% of patients receiving injections at baseline, 70% at Month 1 and 81% at Month 2. Overall, 40% of patients demonstrated a ≥15 letter increase within the first 3 months (42% BRVO, 46% CRVO). Patients with low initial BCVA (<50 letters) showed greater improvement than patients with higher baseline BCVA. Due to considerable loss to follow-up, the number of injections and optical coherence tomography (OCT) examinations were not associated with the change in BCVA. Conclusion Patients with RVO in routine practice in Germany received fewer injections and fewer OCT examinations than in clinical trials. CRVO patients showed less and later improvement compared to BRVO patients.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, Georg-August University, Goettingen, Germany
| | - Focke Ziemssen
- Center for Ophthalmology, Eberhard Karl University of Tuebingen, Tuebingen, Germany
| | - Thomas Bertelmann
- Georg-August-University Goettingen, University Eye Hospital, Goettingen, Germany
| | - Nicolas Feltgen
- Georg-August-University Goettingen, University Eye Hospital, Goettingen, Germany
| | | | - Mirja Koch
- Novartis Pharma GmbH, Clinical Research, Nuremberg, Germany
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, Muenster, Germany
| | - Sandra Liakopoulos
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | | | - Georg Spital
- Augenzentrum Am St. Franziskus Hospital, Muenster, Germany
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Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS, Midena E, Sivaprasad S, Tadayoni R, Wolf S, Loewenstein A. Guidelines for the Management of Retinal Vein Occlusion by the European Society of Retina Specialists (EURETINA). Ophthalmologica 2019; 242:123-162. [PMID: 31412332 DOI: 10.1159/000502041] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022]
Abstract
The high prevalence of cardiovascular disease particularly in the elderly population is associated with retinal vascular disease. Retinal vein occlusions represent severe disturbances of the hypoxia-sensitive neurosensory retina. Acute and excessive leakage leads to the diagnostic hallmarks of retinal hemorrhage and edema with substantial retinal thickening. Advanced diagnostic tools such as OCT angiography allow to evaluate retinal ischemia and identify the risk for late complications and will soon reach clinical routine besides fluorescein angiography. Accordingly, the duration of non-perfusion is a crucial prognostic factor requiring timely therapeutic intervention. With immediate inhibition of vascular leakage, anti-VEGF substances excel as treatment of choice. Multiple clinical trials with optimal potential for functional benefit or a lesser regenerative spectrum have evaluated aflibercept, ranibizumab, and bevacizumab. As retinal vein occlusion is a chronic disease, long-term monitoring should be individualized to combine maintenance with practicability. While steroids may be considered in patients with systemic cardiovascular risk, surgery remains advisable only for very few patients. Destructive laser treatment is an option if reliable monitoring is not feasible. Ophthalmologists are also advised to perform a basic systemic workup to recognize systemic concomitants. The current edition of the EURETINA guidelines highlights the state-of-the-art recommendations based on the literature and expert opinions in retinal vein occlusion.
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Affiliation(s)
| | | | - Bianca S Gerendas
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Edoardo Midena
- Department of Ophthalmology, University of Padua, Padua, Italy
| | - Sobha Sivaprasad
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Ramin Tadayoni
- Department of Ophthalmology, Lariboisière Hospital Paris, Paris, France
| | - Sebastian Wolf
- Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
| | - Anat Loewenstein
- Department of Ophthalmology Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wei Q, Chen R, Lou Q, Yu J. Intravitreal corticosteroid implant vs intravitreal ranibizumab for the treatment of macular edema: a meta-analysis of randomized controlled trials. Drug Des Devel Ther 2019; 13:301-307. [PMID: 30666092 PMCID: PMC6333386 DOI: 10.2147/dddt.s184520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this meta-analysis was to compare the efficacy and safety of corticosteroid implant and intravitreal ranibizumab for the treatment of macular edema (ME). MATERIALS AND METHODS PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were comprehensively searched for studies comparing dexamethasone implant with ranibizumab in patients with ME. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and adverse events were extracted from the final eligible studies. RevMan 5.3 software was used to analyze the data, and the modified Jadad assessment tool was used to access the quality of outcomes. RESULTS Three randomized controlled trials (RCTs) were included in our analysis. The types of causes of ME include central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and diabetic retinopathy (DR). The ranibizumab treatment group had significantly better BCVA compared with the corticosteroid treatment group (standard mean difference [SMD] -0.80; 95% CI -1.08, -0.53; P<0.00001). The ranibizumab treatment group also had higher CST reduction compared with the corticosteroid treatment group, and there was a significant difference (weighted mean difference [WMD] 167.58; 95% CI 125.21-209.95; P<0.00001). There was no significant difference in serious adverse effects between the two groups (SMD 1.67; 95% CI 0.69, 4.05; P=0.26). However, the use of corticosteroid implant had a higher risk of intraocular pressure (IOP) (OR 6.88; 95% CI 4.53-10.44; P<0.00001) elevation and cataract (OR 3.98; 95% CI 1.89-8.37; P=0.0003) than ranibizumab treatment and fewer injections. CONCLUSIONS Compared with ranibizumab, corticosteroid implant did not have greater improved BCVA, but corticosteroid implant had less CST reduction. The advantages of corticosteroids are fewer injections, while the advantages of ranibizumab include fewer side effects.
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Affiliation(s)
- Qingquan Wei
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
| | - Rui Chen
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
| | - Qiyang Lou
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
| | - Jing Yu
- Department of Ophthalmology, Ninghai First Hospital, Zhejiang 315600, People's Republic of China, ;
- Department of Ophthalmology, Shanghai Tenth People's Hospital Affiliated with Tongji University, Shanghai 200072, People's Republic of China, ;
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Chatziralli I, Theodossiadis G, Kabanarou SA, Theodossiadis P. Ranibizumab versus dexamethasone implant for central retinal vein occlusion: special remarks of the RANIDEX study. Graefes Arch Clin Exp Ophthalmol 2017; 255:2077-2078. [DOI: 10.1007/s00417-017-3750-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022] Open
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Călugăru D, Călugăru M. Ranibizumab versus dexamethasone implant for central retinal vein occlusion: the Ranidex study. Graefes Arch Clin Exp Ophthalmol 2017; 255:2073-2075. [PMID: 28744657 DOI: 10.1007/s00417-017-3749-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 01/25/2023] Open
Affiliation(s)
- Dan Călugăru
- Department of Ophthalmology, University of Medicine Cluj-Napoca/Romania, Cluj-Napoca, Romania
| | - Mihai Călugăru
- Department of Ophthalmology, University of Medicine Cluj-Napoca/Romania, Cluj-Napoca, Romania.
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