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Ayaz Y, Erkan Pota Ç, Başol İ, Doğan ME, Türkoğlu Şen EB, Ünal M. Anterior segment complications after dexamethasone implantations:real world data. Int Ophthalmol 2023; 43:4279-4287. [PMID: 37707746 DOI: 10.1007/s10792-023-02838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE We aim to contribute to the literature in terms of treatment safety with our real world data by examining the anterior segment complications and follow-up results of patients who underwent dexamethasone implants in our clinic. METHODS The records of patients treated with at least one intravitreal dexamethasone implant for various retinal diseases: diabetic macular edema (265 eyes), central retinal vein occlusion (45 eyes), retinal vein branch occlusion (91 eyes), postoperative cystoid macular edema (18 eyes), non-infectious uveitis (37 eyes) and other (14 eyes) between July 2013 and April 2020 were reviewed. RESULTS After 925 injections were applied to 470 eyes of a total of 383 patients, the eyes were controlled during a mean follow-up of 24 months. No complications were detected in 328 eyes. Intraocular pressure (IOP) above 25 mmHg was detected in 97 eyes (20.6%) that had no previous history of ocular hypertension. Of these 97 eyes, 71 (73.1%) eyes with increased IOP were treated with topical monotherapy, 26 (26.8%) eyes were treated with topical combined therapy and 1 (1.03%) patient had glaucoma surgery. Cataracts requiring surgical intervention developed in 55 (%21.73) of 253 phakic eyes. Three patients have anterior chamber dislocation of dexamethasone, 1 patient was hospitalized with sterile endophthalmitis on the 7th day after the injection, and pars plana vitrectomy was performed. CONCLUSION This study is the first long-term follow-up study in our country evaluating the safety of dexamethasone implant injections in various retinal diseases and presenting the first real world data. Cataract progression and increased IOP were found to be the most common side effects. We observed that the patient's diagnosis did not cause a statistically significant change in the observation of side effects. As a result of our findings, close follow-up of IOP after the injection of dexamethasone implants would be appropriate.
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Affiliation(s)
- Yusuf Ayaz
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Çisil Erkan Pota
- Department of Ophthalmology, Antalya Manavgat State Hospital, Antalya, Turkey.
| | - İbrahim Başol
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| | - Mehmet Erkan Doğan
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
| | | | - Mustafa Ünal
- Department of Ophthalmology, Akdeniz University Medical Faculty, Antalya, Turkey
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2
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Chronopoulos A, Chronopoulos P, Hattenbach LO, Ashurov A, Schutz JS, Pfeiffer N, Korb C. Intravitreal fluocinolone acetonide implant for chronic postoperative cystoid macular edema - two years results. Eur J Ophthalmol 2022; 33:11206721221124688. [PMID: 36062617 DOI: 10.1177/11206721221124688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We report visual and anatomical outcomes of chronic postoperative macular edema treated with a fluocinolone acetonide intravitreal implant. METHOD Retrospective study of chronic, post-surgical CME treated with a fluocinolone acetonide intravitreal implant. Best registered visual acuity (BRVA), central retinal thickness (CRT), and Goldmann tonometry intraocular pressure (IOP) were assessed over 24 months. The need for IOP lowering treatment, top-up therapy during follow-up, and complications were also assessed. RESULTS We analyzed 16 consecutive eyes of 16 patients with chronic, post-surgical CME treated with fluocinolone acetonide intravitreal implant. Surgical indications included cataract surgery, vitrectomy plus membrane peeling and combined phaco-vitrectomy. Baseline mean BRVA of 0.8 ± 0.65 logMAR improved to 0.60 ± 0.4 logMAR (p = 0.02) at 12 months and to 0.7 ± 0.5 logMAR (p = 0.32) at 24 months. At month 12, BRVA improved in 11 eyes, stabilized in 4 eyes, and decreased in 1 eye. At month 24, VA remained improved in 5 eyes, remained stabilized in 5 eyes, and decreased in 1 eye. Mean CRT decreased from 524 ± 132 μm at baseline to 389 μm at month 3, 347 μm at month 6, 355 ± 106 μm (p = 0.0003) at month 12, and 313 ± 83 μm (p = 0.0001) at month 24. At 12 months, CRT improved in 13 eyes and remained unchanged in 2 eyes. At 24 months, CRT improved further in 8 eyes, and stabilized in 3 eyes. Increased IOP (≥21 mmHg) was observed only in 4 eyes, all successfully managed with topical medication. No further side effects were observed in any patient. CONCLUSION Visual and anatomic improvements were achieved by a single fluocinolone acetonide implant with few side effects up to 24 months in CME eyes with a long and heavy prior treatment history.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Panagiotis Chronopoulos
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - L O Hattenbach
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Agharza Ashurov
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - James S Schutz
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christina Korb
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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3
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Kucukkomurcu E, Sahin T. Anterior chamber changes assessment by Scheimpflug analysis after intravitreal dexamethasone implantation. Eur J Ophthalmol 2021; 32:336-340. [PMID: 34218720 DOI: 10.1177/11206721211029467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate structural changes in the anterior chamber and intraocular pressure (IOP) changes following intravitreal dexamethasone implantation. METHODS Forty-two eyes of 42 patients that received intravitreal dexamethasone implant for the management of macular edema secondary to diabetic retinopathy or branch retinal vein occlusion (BRVO) were included in the study. IOP was measured by Goldmann applanation tonometry. Anterior chamber depth (ACD) and iridocorneal angle (ICA) was measured by a Scheimflug camera (Sirius, CSO, Italy) the day before the injection of the dexamethasone implant and on postoperative day 1, first week, and first month. RESULTS Mean IOP was 15.14 ± 2.77 mmHg before the procedure and, 15.67 ± 3.70 mmHg, 15.86 ± 3.11 mmHg, 16.21 ± 2.75 mmHg on day 1, first week, and first month following intravitreal dexamethasone implantation, respectively. Mean ICA and ACD were significantly higher in pseudophakic eyes compared to phakic eyes. However, there was no statistically significant change in ICA before and after the procedure (on postoperative day 1, first week, and first month) among both phakic and pseudophakic patients (p = 0.783). Similarly, ACD remained unchanged after the procedure (on postoperative day 1, first week, and first month) compared to the initial measurement (p = 0.802). CONCLUSION This study confirmed that there was an increase in IOP. However, these changes were not accompanied with a change in ACD or ICA.
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Affiliation(s)
| | - Tayfun Sahin
- Department of Ophthalmology, Hitit University School of Medicine, Corum, Turkey
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4
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Han JY, Lee DH, Kim JD, Choi EY, Kim M. Therapeutic Efficacy of Intravitreal Dexamethasone Implant in Korean Patients with Non-infectious Uveitis. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.6.798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yap TE, Husein S, Miralles de Imperial-Ollero JA, Colizzi B, Cordeiro MF, Younis S. The efficacy of dexamethasone implants following anti-VEGF failure for macular oedema in retinal vein occlusion. Eur J Ophthalmol 2020; 31:3214-3222. [PMID: 33356550 DOI: 10.1177/1120672120978355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the efficacy of intravitreal dexamethasone implants (DEX) after anti-VEGF failure in retinal vein occlusion macular oedema. METHODS Retrospective cohort study of DEX implant (0.7 mg) given after anti-VEGF 'failure'. Switch to DEX occurred if a ⩽ +5 ETDRS letter gain and ⩽20% reduction in central subfield thickness was present following ⩾6 consecutive anti-VEGF injections. The primary endpoint was VA change 30 days after DEX. Secondary outcomes were peak VA change, VA change at monthly timepoints, percentage achieving 15-letter gain, central subfield thickness (CST) and intraocular pressure (IOP). RESULTS Sixty-two injections in 62 patients associated with 26% central retinal vein occlusion (CRVO) and 74% branch retinal vein occlusion (BRVO) were eligible. There was a modest, significant improvement in mean VA change at 30 days compared to baseline (+6 letters, 95% CI +2.2 to +9.1 letters, p < 0.01). DEX implant significantly improved mean peak VA change compared to preceding anti-VEGF by +18.1 letters in CRVO (p = 0.002) and +13.2 letters in BRVO (p < 0.0001). IOP peaked between 30 and 60 days following injection, with 31% of CRVO and 11% of BRVO patients experiencing an IOP ⩾ 25 mmHg. CONCLUSION DEX implant provides useful rescue therapy in cases of anti-VEGF 'failure' for macular oedema following retinal vein occlusion, resulting in improved functional outcomes at 30 days.
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Affiliation(s)
- Timothy E Yap
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial College Ophthalmic Research Group, Imperial College London, London, UK
| | - Salman Husein
- Imperial College Ophthalmic Research Group, Imperial College London, London, UK
| | - Juan Antonio Miralles de Imperial-Ollero
- Imperial College Ophthalmic Research Group, Imperial College London, London, UK.,Department of Ophthalmology, Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Benedetta Colizzi
- Imperial College Ophthalmic Research Group, Imperial College London, London, UK.,Department of Ophthalmology, Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Francesca Cordeiro
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial College Ophthalmic Research Group, Imperial College London, London, UK
| | - Saad Younis
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK.,Imperial College Ophthalmic Research Group, Imperial College London, London, UK
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Pacella E, Loffredo L, Malvasi M, Trovato Battagliola E, Messineo D, Pacella F, Arrico L. Effects of Repeated Intravitreal Injections of Dexamethasone Implants on Intraocular Pressure: A 4-Year Study. Clin Ophthalmol 2020; 14:3611-3617. [PMID: 33154620 PMCID: PMC7605966 DOI: 10.2147/opth.s265691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/11/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Dexamethasone and other corticosteroids are administered intravitreally to treat a variety of retinal diseases. As a side effect, they can alter intraocular pressure (IOP). The purpose of this study is to describe the incidence, severity, and management of ocular hypertension following the administration of multiple intravitreal injections of dexamethasone implants. Materials and Methods A total of 78 eyes of 78 subjects (males 62%; females 38%; mean age 67 ± 13 years SD) received a total of 152 intravitreal injections of 0.7 mg dexamethasone implants over 4 years. Indications included retinal vein occlusion (87%), diabetic macular edema (9%), wet-type age-related macular degeneration (4%). Ocular hypertension was defined as intraocular pressure above 23 mmHg or any pressure increase of 10 mmHg or more from baseline values. IOP was measured by applanation tonometry before the injection (T0), as well as one week (T1), one month (T2), and three months (T3) afterwards. Results Five percent (4/78) of subjects developed ocular hypertension after the 1st injection. On the second and third rounds, additional 7.2% (3/42) and 4.2% (1/24) of subjects developed the same side effect. Among the 8 subjects who received a fourth injection, none was found with OHT. Pressure elevations were detected at T2 and T3. In all patients, topical medical therapy was sufficient to lower the IOP below threshold. Mean pressure variations following the first injection as compared to previous recorded values were +0.97 mmHg (T1), +0.92 mmHg (T2), and -0.41 mmHg (T3) (p < 0.05). Mean pressure variations following the second injection were +0.54 mmHg (T1), +0.23 mmHg (T2) and -0.66 mmHg (T3) (p < 0.05). Conclusion Ocular hypertension is a recognized side effect of intravitreal dexamethasone. Some patients develop it right after the first injection, while others develop it subsequently, on the 2nd or 3rd round. This side effect becomes most apparent 30-90 days following the implantation procedure and responds well to topical pressure-lowering medications.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Lorenzo Loffredo
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome La Sapienza, Rome, Italy
| | | | | | - Daniela Messineo
- Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
| | - Loredana Arrico
- Department of Sense Organs, University of Rome La Sapienza, Rome, Italy
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7
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Pharmacokinetic and pharmacodynamic evaluation of nano-fixed dose combination for hypertension. J Hypertens 2020; 38:1593-1602. [DOI: 10.1097/hjh.0000000000002429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morphological and Functional Outcomes after Intravitreal Dexamethasone Injection for Macular Edema in Patients with Central Vein Occlusion at 48-Week Follow-Up. J Ophthalmol 2020; 2020:6830148. [PMID: 32104595 PMCID: PMC7036098 DOI: 10.1155/2020/6830148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/20/2019] [Accepted: 01/20/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of the study was to assess the efficacy of intravitreal dexamethasone implant (IDI: Ozurdex®) injection in eyes with macular edema due to retinal vein occlusion. Material and Method. A retrospective, nonrandomized study was conducted in patients with macular edema (ME) due to retinal vein occlusion (RVO) who undertook intravitreal Ozurdex® as first-line treatment. We performed a complete ocular exam including macular OCT. Results The mean BCVA (logMar) improved from 0.420.42 ± 0.23 logMar at baseline to 0.21 ± 0.23 logMar at 48 weeks in the BRVO group and from 0.72 ± 0.16 logMar at baseline to 0.31 ± 0.23 logMar at 48 weeks in the CRVO group. In both groups, CFT values decreased significantly compared to baseline (p < 0.0001 at each timepoint). Reinjection for recurrent macular edema after 18 weeks was indicated in five eyes (41.67%) in the BRVO group and in six eyes (25%) in the CRVO group. Cataract developed in two eyes (16.67%) in the BRVO group and in one eye (4.17%) in the CRVO group. The IOP was higher than 25 mmHg in two cases in the BRVO group (16.66%) and in three cases (8.33%) in the CRVO group. Conclusion Ozurdex® injected intravitreally significantly improved the mean CFT and BCVA in eyes with macular edema due to retinal vein occlusion.
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9
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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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10
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Rajesh B, Zarranz-Ventura J, Fung AT, Busch C, Sahoo NK, Rodriguez-Valdes PJ, Sarao V, Mishra SK, Saatci AO, Udaondo Mirete P, Querques G, Farah ME, Lanzetta P, Arevalo JF, Kodjikian L, Chhablani J. Safety of 6000 intravitreal dexamethasone implants. Br J Ophthalmol 2019; 104:39-46. [PMID: 31040132 DOI: 10.1136/bjophthalmol-2019-313991] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the real-life safety profile of intravitreal dexamethasone implant injection for various retinal conditions. METHODS Retrospective multicenter analysis of intravitreal dexamethasone implant injections (700 µg) due to various retinal conditions including central retinal venous occlusion (1861 injections), diabetic macular oedema (3104 injections), post-surgical cystoid macular oedema (305 injections) and uveitis (381 injections). The eyes were evaluated mainly for the occurrence of adverse events such as glaucoma, cataract, retinal detachment and endophthalmitis along during the follow-up period. RESULTS A total of 6015 injections in 2736 eyes of 1441 patients (mean age of 65.7±12.9 years) were in total analysed over an average period of 18 months (range 6 months to 102 months). A total of 576 eyes (32.5% of the phakic eyes) developed cataract requiring surgical intervention. However, visually insignificant cataract progression was observed in another 259 phakic eyes (14.6%) which did not require surgical removal. A total of 727 eyes (26.5%) experienced an intraocular pressure (IOP) rise of >25 mm Hg, with 155 eyes (5.67%) having a prior history of glaucoma and 572 eyes (20.9%) having new onset IOP rise. Overall, more than 90% of eyes with IOP rise were managed medically, and 0.5% eyes required filtering surgery. Endophthalmitis (0.07%), retinal detachment (0.03%) and vitreous haemorrhage (0.03%) were rare. There was no significant change in visual acuity (p=0.87) and central macular thickness (p=0.12) at the last follow-up. CONCLUSION This is the largest real-life study assessing the safety of intravitreal dexamethasone implant injections in various retinal conditions. Cataract progression and intraocular pressure rise are the most common side effects, but are often rather easily manageable.
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Affiliation(s)
| | - Javier Zarranz-Ventura
- Hospital Clínic de Barcelona Insi, Instituto Clinic de Barcelona, Instituto Clinic de Oftalmología (ICOF), Barcelona, Spain
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, Australian Capital Territory, Australia.,Save Sight Institute, Sydney Eye Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Catharina Busch
- Department of Ophthalmology, Universitatsklinikum Leipzig, Leipzig, Germany
| | - Niroj Kumar Sahoo
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
| | - Patricio J Rodriguez-Valdes
- Ophthalmology, Instituto de Oftalmología y Ciencias Visuales, Escuela de Medicina, Tecnológico de Monterrey, San Pedro Garza García, Mexico
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | | | | | | | | | - Michel Eid Farah
- Ophthalmology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - J Fernando Arevalo
- Retina and Vitreous, Clinica Oftalmologica Centro Caracas, Caracas, Venezuela
| | - Laurent Kodjikian
- Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France.,CNRS UMR 5510 Mateis, University of Lyon, Lyon, France
| | - Jay Chhablani
- Vitreo-retina, L V Prasad Eye Institute, Hyderabad, Andhra Pradesh, India
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Arranz-Romera A, Esteban-Pérez S, Garcia-Herranz D, Aragón-Navas A, Bravo-Osuna I, Herrero-Vanrell R. Combination therapy and co-delivery strategies to optimize treatment of posterior segment neurodegenerative diseases. Drug Discov Today 2019; 24:1644-1653. [PMID: 30928691 DOI: 10.1016/j.drudis.2019.03.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022]
Abstract
Neurodegenerative diseases affecting the posterior segment of the eye are one of the major causes of irreversible blindness worldwide. The pathogenesis of these retinal pathologies is characterized by a multifactorial etiology, involving the complex interaction of different apoptotic mechanisms, suggesting that effective treatments will require a multimodal approach. Thus, combination therapy based on the potential synergistic activities of drugs with different mechanisms of action is currently receiving considerable attention. Here, we summarize several kinds of strategy for the co-administration of different drugs to the posterior segment of the eye, highlighting those that involve co-delivery from multiloaded drug delivery systems.
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Affiliation(s)
- Alicia Arranz-Romera
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal), Research Group (UCM 920415), Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain; Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared) e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Sergio Esteban-Pérez
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal), Research Group (UCM 920415), Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain; Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared) e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - David Garcia-Herranz
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal), Research Group (UCM 920415), Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain; Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared) e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Alba Aragón-Navas
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal), Research Group (UCM 920415), Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain; Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared) e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Irene Bravo-Osuna
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal), Research Group (UCM 920415), Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain; Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared) e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Rocio Herrero-Vanrell
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal), Research Group (UCM 920415), Pharmaceutics and Food Technology, Faculty of Pharmacy, Complutense University, Madrid, Spain; Red Temática de Investigación Cooperativa Sanitaria en Enfermedades Oculares (Oftared) e Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain.
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Kwon S, Wykoff CC, Brown DM, van Hemert J, Fan W, Sadda SR. Changes in retinal ischaemic index correlate with recalcitrant macular oedema in retinal vein occlusion: WAVE study. Br J Ophthalmol 2018; 102:1066-1071. [PMID: 29699979 DOI: 10.1136/bjophthalmol-2017-311475] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 11/04/2022]
Abstract
AIM To evaluate changes in the ischaemic index (ISI) after targeted retinal photocoagulation (TRP) and to investigate the correlation between these changes and macular oedema (ME). METHOD Twenty-four eyes of 24 patients with retinal vein occlusion (RVO) with recurrent ME were included. Ultra-widefield fluorescein angiography (UWFFA; Optos 200Tx) was obtained at baseline and every 4 months. The regions of retinal non-perfusion and the total gradable retina were manually segmented on UWFFA images for calculating the global ISI. ISI was also computed for specific regions defined by a standardised grid: perimacular area (PMA), near-peripheral area (NPA), mid-peripheral area (MPA) and far-peripheral area (FPA). Global and regional ISIs and change in ISI over time were correlated with central macular thickness (CMT). RESULTS The ISIs of entire retina, PMA, NPA, MPA and FPA at baseline were 30.5%±23.3, 17.7%±20.6, 21.9%±19.0, 33.0%±27.9 and 48.0%±32.9, respectively. The ISIs at final follow-up were 23.5%±19.9, 15.7%±22.2, 16.5%±16.7, 24.7%±24.7 and 24.7%±24.7, respectively. A significant correlation was found between CMT and global ISI during follow-up (r=0.22, p=0.03). Among the different retinal zones, PMA showed a correlation with CMT (r=0.27, p=0.007). The change in ISI for the total retina (Δtotal), PMA (ΔPMA) and NPA (ΔNPA) retinal regions was positively correlated with the change in CMT (ΔCMT) (r=0.45, 0.42 and 0.50, respectively, p=0.006, 0.009 and 0.002, respectively). CONCLUSION The severity of ME was correlated with the ISIs of the entire retina and the PMA. The reduction in ME was correlated with the reduction in ISI of the entire retina as well as the ISIs for the NPA and PMA following TRP. The role of TRP, particularly to these regions (NPA, PMA), warrants further investigation in recalcitrant RVO-associated ME.
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Affiliation(s)
- Soonil Kwon
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA.,Department of Ophthalmology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi, South Korea
| | - Charles Clifton Wykoff
- Retina Consultants of Houston and Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | - David M Brown
- Retina Consultants of Houston and Blanton Eye Institute, Houston Methodist Hospital, Weill Cornell Medical College, Houston, Texas
| | | | - Wenying Fan
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA
| | - SriniVas R Sadda
- Doheny Image Reading Center, Doheny Eye Institute, Los Angeles, California, USA.,Department of Ophthalmology, David Geffen School of Medicine at UCLA, Stein Eye Institute, Los Angeles, California, USA
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13
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Bandello F, Augustin A, Tufail A, Leaback R. A 12-month, multicenter, parallel group comparison of dexamethasone intravitreal implant versus ranibizumab in branch retinal vein occlusion. Eur J Ophthalmol 2018; 28:697-705. [PMID: 29631435 PMCID: PMC6210573 DOI: 10.1177/1120672117750058] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose: Dexamethasone intravitreal implant and intravitreal ranibizumab are indicated for the treatment of macular edema secondary to retinal vein occlusion. This non-inferiority study compared dexamethasone with ranibizumab in patients with branch retinal vein occlusion. Methods: In this randomized, 12-month head-to-head comparison, subjects with branch retinal vein occlusion were assigned to dexamethasone 0.7 mg at day 1 and month 5 with the option of retreatment at month 10 or 11, or ranibizumab 0.5 mg at day 1 and monthly through month 5 with subsequent as-needed injections at month 6–month 11. The primary efficacy outcome was the mean change from baseline in best-corrected visual acuity at month 12; secondary outcomes included average change in best-corrected visual acuity, proportion of eyes with ≥10- and ≥15-letter gain/loss, change in central retinal thickness, and change in Vision Functioning Questionnaire-25 score. Results: In all, 307 of a planned 400 patients were enrolled in the study and received (mean) 2.5 dexamethasone injections (n = 154) and 8.0 ranibizumab injections (n = 153) over 12 months. The mean change from baseline in best-corrected visual acuity at month 12 was 7.4 letters for dexamethasone versus 17.4 letters for ranibizumab (least-squares mean difference (dexamethasone minus ranibizumab), −10.1 letters; 95% confidence interval, −12.9, −7.2; p = 0.0006). Conclusion: Dexamethasone and ranibizumab improved best-corrected visual acuity and anatomical outcomes; however, dexamethasone did not show non-inferiority to ranibizumab in this under-powered study. Dexamethasone was associated with an increased risk of intraocular pressure elevation and cataract progression, but a lower injection burden, compared to ranibizumab.
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Affiliation(s)
- Francesco Bandello
- 1 Department of Ophthalmology, University Vita-Salute, Scientific Institute San Raffaele, Milan, Italy
| | - Albert Augustin
- 2 Department of Ophthalmology, Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
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14
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Abstract
PURPOSE To analyze the outer retinal layer changes on spectral-domain optical coherence tomography after dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusions (CRVO). METHODS Thirty patients affected by macular edema related to CRVO (8 patients less than 50 years of age with nonischemic CRVO [<50-niCRVO], 12 patients more than 50 years with niCRVO [>50-niCRVO], and 10 patients with ischemic CRVO [iCRVO]) were included in a prospective study. After a comprehensive ophthalmologic examination, including best-corrected visual acuity, fluorescein angiography, and spectral-domain optical coherence tomography, each patient received a first implant. Further retreatments were performed on the basis of macular edema detection from the fourth month. Main outcome measure was the change in outer retinal layers at the 12-month examination. RESULTS The retinal layers of interest (external limiting membrane; ellipsoid zone; and retinal pigment epithelium) were classified as absent, disrupted, or present. The best baseline optical coherence tomography profile was found in <50-niCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium layers in no patients; present and disrupted external limiting membrane in 25% and 75% of cases, respectively; disrupted ellipsoid zone and retinal pigment epithelium in 100% of cases), whereas the worst was detected in the iCRVO group (absent external limiting membrane, ellipsoid zone, and retinal pigment epithelium in 40%, 40%, and 10% of cases, respectively). A significant recovery of the retinal layers was observed in all CRVO subgroups; the greatest improvement was found in <50-niCRVO group. Median best-corrected visual acuity in the whole group improved from 0.85 to 0.45 (P = 0.0001). It is noteworthy that a significant best-corrected visual acuity gain was achieved only in eyes showing present or disrupted layers at baseline regardless of the CRVO subgroup examined, whereas eyes with absent layers at baseline were unable to attain any improvement. CONCLUSION Dexamethasone implant can promote the resolution of macular edema in patients affected by any CRVO subform, but a beneficial functional outcome could be achieved by eyes showing no absence of outer retinal layers on spectral-domain optical coherence tomography at baseline.
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Hattenbach LO, Feltgen N, Bertelmann T, Schmitz-Valckenberg S, Berk H, Eter N, Lang GE, Rehak M, Taylor SR, Wolf A, Weiss C, Paulus EM, Pielen A, Hoerauf H. Head-to-head comparison of ranibizumab PRN versus single-dose dexamethasone for branch retinal vein occlusion (COMRADE-B). Acta Ophthalmol 2018; 96:e10-e18. [PMID: 28251811 DOI: 10.1111/aos.13381] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/08/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE To compare the efficacy and safety of ranibizumab 0.5 mg versus dexamethasone 0.7 mg according to their European labels in macular oedema secondary to branch retinal vein occlusion (BRVO) in a 6-month, phase IIIb, randomized trial. METHODS Patients received either monthly ranibizumab for 3 months followed by Pro re nata (PRN) treatment (n = 126) or a sustained-release dexamethasone implant followed by PRN sham injections (n = 118). Main outcomes were mean average change in best-corrected visual acuity (BCVA) from baseline to month 1 through month 6, mean changes in BCVA and foveal centre point thickness (FCPT), and adverse events (AEs). RESULTS There was no difference in BCVA gains between the treatments prior to month 3. Best-corrected visual acuity (BCVA) gain with dexamethasone declined thereafter. From month 3 to month 6, mean BCVA change from baseline was significantly higher with ranibizumab than with dexamethasone [raw means (standard deviation):+16.2 (±11) letters versus +9.3 (±10.1) letters]. At month 6, the difference in BCVA gains from baseline was +17.3 letters in the ranibizumab versus +9.2 letters in the dexamethasone group. Patients in the ranibizumab group received a mean of 2.94 loading injections and 1.74 PRN retreatment injections, while those in the dexamethasone group received a single loading injection. Elevated intraocular pressure (IOP) and AEs were more frequent with dexamethasone than ranibizumab treatment. CONCLUSION Ranibizumab PRN resulted in greater visual acuity (VA) gains in macular oedema following BRVO compared with single-dose dexamethasone over a 6-month study period, observed from month 3, when administered according to their European label. In clinical practice, retreatment with dexamethasone may be required prior to this point.
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Affiliation(s)
| | - Nicolas Feltgen
- Department of Ophthalmology; Georg-August-University Göttingen; Göttingen Germany
| | - Thomas Bertelmann
- Department of Ophthalmology; Georg-August-University Göttingen; Göttingen Germany
- Novartis Pharma GmbH; Nuremberg Germany
| | | | - Hüsnü Berk
- Department of Ophthalmology; St. Elisabeth-Hospital; Koeln-Hohenlind Germany
| | - Nicole Eter
- Department of Ophthalmology; University of Münster Medical Center; Münster Germany
| | | | - Matus Rehak
- Department of Ophthalmology; University of Leipzig; Leipzig Germany
- Department of Ophthalmology; Charité - Universitätsmedizin; Berlin Germany
| | - Simon R. Taylor
- Department of Ophthalmology; University of Surrey; Guildford UK
| | - Armin Wolf
- Department of Ophthalmology; Ludwig-Maximilians University; Munich Germany
| | | | | | - Amelie Pielen
- Department of Ophthalmology; Medizinische Hochschule Hannover; Hannover Germany
| | - Hans Hoerauf
- Department of Ophthalmology; Georg-August-University Göttingen; Göttingen Germany
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Nagpal M, Mehrotra N, Juneja R, Jain H. Dexamethasone implant (0.7 mg) in Indian patients with macular edema: Real-life scenario. Taiwan J Ophthalmol 2018; 8:141-148. [PMID: 30294527 PMCID: PMC6169328 DOI: 10.4103/tjo.tjo_62_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Context: Role of Ozurdex in macular edema due to various posterior segment pathologies. AIM: The aim of this study is to report outcome of Ozurdex implant in macular edema (ME) secondary to various posterior segment pathologies. SETTINGS AND DESIGN: This was a single-center, retrospective, interventional study. SUBJECTS AND METHODS: Patients of ME were treated with one or more Ozurdex implants (0.7 mg). Data collection included demographic details, best-corrected visual acuity (BCVA), central foveal thickness (CFT), duration of efficacy, and record of adverse events (if any) within 24 weeks. STATISTICAL ANALYSIS USED: Paired sample t-test, Stata data analysis, and statistical software, version 12.1, StataCorp, College Station, TX, USA, were used in the study. RESULTS: One hundred and sixteen eyes of 104 patients were studied which had a diagnosis of diabetic ME (n = 46), retinal vein occlusion (n = 40), and uveitis (n = 30). The average age of patients (mean ± standard deviation) was 50.2 ± 21.9 years. Baseline mean ± SD (standard deviation) logMAR BCVA, CFT, and intraocular pressure (IOP) were 0.636 ± 0.4, 527.8 ± 210.1 μm, and 15.3 ± 3.8 mmHg, respectively. The reinjection interval was around 12–18 weeks. Ozurdex proved its efficacy in improving mean logMAR visual acuity and reduction of CFT from baseline till 12 weeks' follow-up period (0.414 ± 0.5 and 301.5 ± 278.5, respectively; P < 0.05), and after 12 weeks' follow-up, it started worsening (0.530 ± 0.9 and 444.8 ± 375.2, respectively; P > 0.05). The most common reported adverse event was significant rise of IOP (>5 mmHg), with a total of 12 cases followed by cataract 9 cases. CONCLUSION: Ozurdex implant leads to a significant improvement in BCVA and CFT values till 12 weeks, followed by a gradual decline for all the pathologies studied together. No new safety concerns were observed with the Ozurdex implant. The duration of efficacy was found to be <24 weeks.
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Affiliation(s)
- Manish Nagpal
- Department of Vitreo-Retina, Retina Foundation, Ahmedabad, Gujarat, India
| | - Navneet Mehrotra
- Department of Vitreo-Retina, Retina Foundation, Ahmedabad, Gujarat, India
| | - Rakesh Juneja
- Department of Vitreo-Retina, Retina Foundation, Ahmedabad, Gujarat, India
| | - Hardik Jain
- Department of Vitreo-Retina, Retina Foundation, Ahmedabad, Gujarat, India
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Laine I, Lindholm JM, Ylinen P, Tuuminen R. Intravitreal bevacizumab injections versus dexamethasone implant for treatment-naïve retinal vein occlusion related macular edema. Clin Ophthalmol 2017; 11:2107-2112. [PMID: 29225460 PMCID: PMC5708292 DOI: 10.2147/opth.s144688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose To compare the short-term effects of three monthly intravitreal bevacizumab (IVB) injections to single dexamethasone (DEX) implantation in treatment-naïve patients with cystoid macular edema (CME) secondary to branch (BRVO) and central retinal vein occlusion (CRVO). Design A retrospective single-center study. Subjects A total of 135 eyes of 135 patients with BRVO (n=83) and CRVO (n=52). Methods Changes in clinical parameters were recorded before treatment and at the first and third month after commencement of IVB (n=121) and DEX (n=14). Main outcome measures Central retinal thickness (CRT), intraocular pressure (IOP), and best-corrected visual acuity (BCVA). Results The baseline parameters were comparable between IVB and DEX groups. After the first month, CRT decreased by 131.3±42.9 μm in IVB and by 266.9±48.3 μm in DEX (mean ± SEM; p=0.047). IOP change was –0.29±0.39 mmHg in IVB and +3.70±2.34 mmHg in DEX (p=0.005). IOP elevation to ≥25 mmHg and ≥5 mmHg from the baseline was observed in two of the DEX- and in none of the IVB-treated eyes (p=0.010). After the third month, no differences regarding CRT and IOP were observed between the treatment modalities. Moreover, BCVA gain was comparable between IVB (0.37±0.05 logarithm of minimum angle of resolution [logMAR] units) and DEX (0.33±0.30 logMAR units) groups. Conclusion DEX was associated with faster resolution of CME, but had greater probability for short-term IOP elevation when compared to IVB. After the third month, treatments were comparably effective. Anatomical outcomes and adverse drug reactions of IVB versus DEX should be considered case specifically in patients having CME secondary to BRVO/CRVO.
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Affiliation(s)
- Ilkka Laine
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,Department of Automation and Electrical Engineering, Aalto University, Helsinki, Finland
| | - Juha-Matti Lindholm
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
| | - Petteri Ylinen
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, Helsinki.,Unit of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.,The Insurance Centre, Patient Insurance Centre, Helsinki, Finland
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18
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Lin CJ, Chen HS, Su CW, Tien PT, Lin JM, Chen WL, Kuo CY, Lai CT, Tsai YY. The Effect of Age and Initial Central Retinal Thickness on Earlier Need of Repeat Ozurdex Treatment for Macular Edema Due to Retinal Vein Occlusion: A Retrospective Case Series. J Ocul Pharmacol Ther 2017; 33:763-772. [PMID: 28949790 DOI: 10.1089/jop.2017.0070] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chun-Ju Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Huan-Sheng Chen
- An-Shin Dialysis Center, NephroCare Ltd., Fresenius Medical Care, Taichung, Taiwan
| | - Cheng-Wen Su
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Peng-Tai Tien
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Jane-Ming Lin
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Lu Chen
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Yuan Kuo
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Ting Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung, Taiwan
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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19
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Real-Life Management of Patients with Retinal Vein Occlusion Using I-Macula Web Platform. J Ophthalmol 2017; 2017:5601786. [PMID: 28811936 PMCID: PMC5546074 DOI: 10.1155/2017/5601786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022] Open
Abstract
Aim Real-life evaluation in the management of patients affected by macular edema secondary to retinal vein occlusion. Material and Methods A retrospective, observational study using the I-Macula Web platform. Results Thirty-five patients (37 eyes; 15 females and 20 male) affected by RVO were analysed. At 12 months, there was a statistically significant improvement of best-corrected visual acuity (p = 0.0235) and central macular thickness (p < 0.0001). The mean change in visual acuity was 8.9 letters. Twenty-seven eyes underwent DEX implant (n = 62; mean: 2.29) only. Of these, 8, 4, 14, and 1 eyes underwent 1, 2, 3, and 4 DEX implants, respectively. The remaining 10 eyes were also injected with ranibizumab (n = 49; mean: 4.9). At 12 months, 12 eyes (32.5%) presented a dry macula, whereas the remaining 25 eyes (67.5%) still had macular edema. Mean interval between the first and second treatment (T1) and between the second and third treatment (T2) were 5.15 and (T2) 3.7 months, respectively. Where only DEX implants were received, T1 and T2 was 5.1 and 4.9 months, respectively. Conclusions This study confirms that DEX implants and/or anti-VEGF drugs improve visual acuity and central macular thickness in patients affected by RVO.
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Bikbov MM, Fayzrakhmanov RR, Gil'manshin TR. [Selective symptomatic therapy of macular edema due to occlusive processes in retinal venous system]. Vestn Oftalmol 2017; 133:18-21. [PMID: 28524135 DOI: 10.17116/oftalma2017133218-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM to evaluate the effect of dexamethasone intravitreal implant on the functional state of the eye in macular edema associated with central retinal vein occlusion. MATERIAL AND METHODS The study included two groups of patients: group 1 (control group) - 8 patients (16 eyes) without ocular pathology and group 2 (study group) - 8 patients (8 eyes) with macular edema on the background of newly diagnosed thrombosis of the central retinal vein. All the patients from the study group underwent insertion of an intravitreal dexamethasone implant - Ozurdex. Best corrected visual acuity (BCVA) and retinal light sensitivity of the central visual field were followed up. The maximum follow-up period was 12 months. RESULTS In group 1 (controls), BCVA averaged 0.93±0.2 and retinal light sensitivity of the central visual field - 19.01±1.18 dB. In group 2, baseline BCVA and retinal light sensitivity were 0.08±0.02 and 4.23±0.2 dB, 1 month after Ozurdex implantation - 0.21±0.04 and 11.77±0.98 dB, at 12 months - 0.23±0.17 and 5.2±0.78 dB, respectively. CONCLUSION Macular edema associated with central retinal vein thrombosis has a strong deteriorating effect on the functional state of the eye. The dexamethasone intravitreal implant in patients with postthrombotic macular edema contributes to functional improvement, including BCVA and light sensitivity of the central retina, over the first year. At that, different functional parameters show different dynamics after dexamethasone treatment. Light sensitivity values, in contrast to BCVA, change unevenly and significantly during the year. Intravitreal implantation of a dexamethasone implant in patients with postthrombotic macular edema is an effective symptomatic treatment of occlusive processes within the retinal venous system.
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Affiliation(s)
- M M Bikbov
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
| | - R R Fayzrakhmanov
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
| | - T R Gil'manshin
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
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21
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Morphological changes in the macular area at post-thrombotic maculopathy after intravitreal injection of a dexamethasone implant (evidence from 5 clinical cases). OPHTHALMOLOGY JOURNAL 2016. [DOI: 10.17816/ov9490-97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose. To evaluate the effect of intravitreal implant with dexamethasone on the morphological changes of macular area in patients with central retinal vein occlusion.Materials and methods. Results of optical coherence tomography of the central retinal area of 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema (ME) are presented. All the patients underwent single intravitreal injection of dexamethasone implant. Maximal follow-up period – 12 months.Results. In 1 month after dexamethasone implant injection, we observed a decrease of foveal retinal thickness from 425.36 ± 57.87 to 273.75 ± 36.65 µm. In 1 year after treatment, foveal retinal thickness increased by 1.2 times compared to results got in 1 month after dexamethasone implant injection. The transformation of the macular area under the implant action was mainly due to changes in thickness and structure in the outer and inner nuclear and plexiform retinal layers.Conclusion. Intravitreal injection of dexamethasone implant provides a decrease in post-thrombotic macular edema in 1 month since implantation. Retinal layers transform selectively at various pathological conditions of the retina, including macular edema. Retinal thickness changes in post-thrombotic ME, including those occurring under the dexamethason implant action are mainly related to changes in the outer and inner nuclear and plexiform retinal layers. The duration of morpho-functional effect persists not less than 12 months after treatment.
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Mante A, Heider M, Zlomke C, Mäder K. PLGA nanoparticles for peroral delivery: How important is pancreatic digestion and can we control it? Eur J Pharm Biopharm 2016; 108:32-40. [PMID: 27553262 DOI: 10.1016/j.ejpb.2016.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/31/2016] [Accepted: 08/18/2016] [Indexed: 02/01/2023]
Abstract
Biodegradable nanoparticles made of Poly(lactide-co-glycolide) are increasingly proposed for the improvement of oral drug absorption, but also as carriers for the treatment of colonic diseases. Unfortunately, our knowledge of the digestibility of PLGA-NPs is rather limited. Therefore, we investigated the impact of pancreatin on the digestibility of PLGA-NPs stabilized with different emulsifiers. The pancreatin induced degradation was monitored by the pH-stat method and an enzymatic l-lactic acid assay. A high digestibility was found for poloxamer 188 and polysorbate 80 stabilized PLGA-NPs. The digestion could be blocked by Orlistat, indicating a major role of pancreatic lipase. PLGA-NPs stabilized with Poly(vinyl alcohol) (=PVA) were not digested at comparable surfactant concentrations (0.6%). However, PLGA-NPs stabilized with very low amounts of PVA (0.1%) were digestible. In conclusion, PLGA-NPs are substrates for the pancreatic lipase. The digestibility can be enhanced or blocked by the proper selection of the surfactant composition and concentration.
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Affiliation(s)
- Anika Mante
- Institute of Pharmacy, Faculty of Biosciences, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, D-06120 Halle (Saale), Germany.
| | - Martha Heider
- Institute of Pharmacy, Faculty of Biosciences, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, D-06120 Halle (Saale), Germany.
| | - Christin Zlomke
- Institute of Pharmacy, Faculty of Biosciences, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, D-06120 Halle (Saale), Germany.
| | - Karsten Mäder
- Institute of Pharmacy, Faculty of Biosciences, Martin Luther University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, D-06120 Halle (Saale), Germany. http://pharmtech.pharmazie.uni-halle.de
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Shah AR, Xi M, Abbey AM, Yonekawa Y, Faia LJ, Hassan TS, Ruby AJ, Wolfe JD. Short-term Efficacy of Intravitreal Dexamethasone Implant in Vitrectomized Eyes with Recalcitrant Diabetic Macular Edema and Prior Anti-VEGF Therapy. J Ophthalmic Vis Res 2016; 11:183-7. [PMID: 27413499 PMCID: PMC4926566 DOI: 10.4103/2008-322x.183928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose: To determine the efficacy of an intravitreal dexamethasone implant (IDI) for diabetic macular edema (DME) in vitrectomized eyes. Methods: This interventional retrospective consecutive case series included vitrectomized eyes undergoing IDI placement for treatment of recalcitrant DME between June 2011 and June 2014. All patients had previously received anti-VEGF therapy (ranibizumab or bevacizumab). Primary endpoints were changes in visual acuity (VA) and central retinal thickness (CRT) from baseline values one month after device implantation. Secondary endpoints were VA and CRT changes at 3 months. Results: A total of 8 eyes of 8 patients met the inclusion criteria. One month after IDI placement, there was a significant (p = 0.01) improvement in VA from 0.79 ± 0.52 logMAR (20/123 Snellen equivalent) to 0.64 ± 0.55 logMAR (20/88), meanwhile CRT improved from 455.75 ± 123.19 to 295.00 ± 90.39 μm (p = 0.02). These findings persisted at 3 months. Conclusion: In vitrectomized eyes previously treated with anti-VEGF agents for recalcitrant DME, implantation of the IDI appears to be efficacious in improving VA and CRT at 1-month with the observed benefits persisting for at least for 3 months.
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Affiliation(s)
- Ankoor R Shah
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Mengqiao Xi
- Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Ashkan M Abbey
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Yoshihiro Yonekawa
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Lisa J Faia
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Tarek S Hassan
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Alan J Ruby
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
| | - Jeremy D Wolfe
- Associated Retinal Consultants, Royal Oak, MI, USA; Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Beaumont Eye Institute, Royal Oak, MI, USA
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24
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Wallsh J, Sharareh B, Gallemore R. Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy. Clin Ophthalmol 2016; 10:947-54. [PMID: 27307697 PMCID: PMC4888726 DOI: 10.2147/opth.s105412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments. Methods A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points. Results All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P<0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P<0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 μm at 4 months (P<0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P<0.05) in this patient population and partially limited analysis of other end points. Conclusion DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.
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Bikbov MM, Fayzrakhmanov RR, Gil'manshin TR, Gilyazova II. [Foveolar effects of dexamethasone intravitreal implant in central retinal vein occlusion]. Vestn Oftalmol 2016; 132:21-25. [PMID: 27213793 DOI: 10.17116/oftalma2016132221-25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To evaluate functional and morphometric parameters of the central retina in patients with postocclusive macular edema treated with dexamethasone intravitreal implant injection. MATERIAL AND METHODS We examined 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema, including 4 men and 1 woman aged 55.8±3.65 years (experimental group). All the patients received a single injection of dexamethasone intravitreal implant. The maximum follow-up period was 12 months. The control group consisted of 5 presbiopic patients (10 eyes) aged 59.14±3.14 years. RESULTS One month after injection, the best corrected visual acuity (BCVA) and central retinal light sensitivity improved (from 0.09±0.03 to 0.19±0.05 and from 3.18±0.19 to 11.07±0.97 dB, correspondingly), while foveolar thickness decreased from 425.36±57.87 to 273.75±36.65 µm. One year after the treatment, BCVA remained high and averaged 0.21±0.14. The total light sensitivity also remained higher than that at baseline, however, decreased down to 4.8±0.76 dB. Optical coherence tomography showed some flatness of the fovea. Foveolar thickness appeared 1.5 times higher than that in the control group and 1.2 times higher than that at the 1-month follow-up after dexamethasone intravitreal implant injection. Over the whole follow-up period, IOP has never significantly exceeded the baseline, optical media remained clear. CONCLUSION 1. Dexamethasone intravitreal implant has been shown effective in resolving postocclusive macular edema, improving visual functions, and increasing central retinal light sensitivity within the first month after injection. 2. Positive changes in morphometric parameters of the central retina induced by the injection involve inner segments of photoreceptors as well as the outer nuclear, outer plexiform and inner nuclear layers. The morphofunctional effect persists for no less than 12 months after injection. 3. Over the 1-year follow-up period, there has been no negative influence of the implant on either intraocular pressure level, or lens transparency.
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Affiliation(s)
- M M Bikbov
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
| | - R R Fayzrakhmanov
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
| | - T R Gil'manshin
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
| | - I I Gilyazova
- Ufa Eye Research Institute, 90 Pushkina St., Ufa, Russian Federation, 450008
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Garweg JG, Zandi S. Retinal vein occlusion and the use of a dexamethasone intravitreal implant (Ozurdex®) in its treatment. Graefes Arch Clin Exp Ophthalmol 2016; 254:1257-65. [PMID: 27178087 PMCID: PMC4917582 DOI: 10.1007/s00417-016-3350-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 02/23/2016] [Accepted: 04/12/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To review published data pertaining to the clinical experience with a dexamethasone intravitreal implant (Ozurdex®) with a view to establishing a clinically based therapeutic regime. Methods A PubMed search using the MeSH terms “retinal vein occlusion” and either “pathophysiology” or “dexamethasone intravitreal implant” was undertaken for manuscripts published until August 2015. The analysis included studies involving minimally 15 patients under a prospective design or 30 under a retrospective design, a minimal follow up of 6 months, and at least 2 intravitreal Ozurdex® injections per eye. Results In the vast majority of eyes, satisfactory outcomes were achieved with retreatment intervals of between 3 and 5 months. Initial evidence indicates a similar efficacy compared to anti-VEGF therapies as a first-line treatment. Safety concerns associated with the long-term and repeated use of Ozurdex® are not borne out by clinical findings: its implantation is not associated with a sustained increase in intraocular pressure (IOP) over time or with the number of applications. Conclusion Compared with anti-VEGF therapies, the burden of retreatment is reduced. In patients with chronic macular edema not responsive to repetitive anti-VEGF therapies, the outcome after dexamethasone implant treatment is encouraging. However, these results are achieved at the expense of side effects typically associated with steroids: in up to 20 % of the Ozurdex®-treated patients, an elevation in IOP, which could be medically controlled in the majority of cases, and cataract formation or progression was observed.
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Affiliation(s)
- Justus G Garweg
- Berner Augenklinik am Lindenhofspital, University of Bern, Swiss Eye Institute, Luzerner Strasse 1, CH-6343, Rotkreuz, Bern, Switzerland.
| | - Souska Zandi
- Berner Augenklinik am Lindenhofspital, University of Bern, Swiss Eye Institute, Luzerner Strasse 1, CH-6343, Rotkreuz, Bern, Switzerland
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Efficacy and Safety in Retinal Vein Occlusion Treated with at Least Three Consecutive Intravitreal Dexamethasone Implants. J Ophthalmol 2016; 2016:6016491. [PMID: 27022479 PMCID: PMC4789055 DOI: 10.1155/2016/6016491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the effects of repeated intravitreal dexamethasone implant (DI) (Ozurdex®) in eyes with macular edema (ME) due to retinal vein occlusion (RVO). Methods. Multicenter observational study including patients who received more than three consecutive DI on an "as-needed" basis for the treatment of ME in RVO. Results. A total of 18 eyes were included for analysis. Mean interval of retreatment with DI was 5.1 months between the first and second DI and 5.4 months following the second DI. Baseline BCVA was 0.74 ± 0.08 log-Mar; it significantly improved to 0.45 ± 0.04 2 months after the 3rd DI. There was no significant difference between the 3 first postinjection BCVA. CMT decreased from 617 μm ± 120 μm (baseline) to 330 ± 109 μm two months after the third DI. Elevated intraocular pressure occurred in 50% and was controlled medically. Cataract progression leading to cataract surgery occurred in 69% of phakic eyes after a mean interval of 17 months. Conclusion. Repeated DI on an "as-needed" basis, with a retreatment interval <6 months, are effective in the long term in the management of ME due to RVO. Rates of increased intraocular pressure and cataract surgery seem to be higher than previously described when eyes were followed during a longer period.
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Comparison of Choroidal Thickness Changes following Intravitreal Dexamethasone, Ranibizumab, and Triamcinolone in Eyes with Retinal Vein Occlusion. Eur J Ophthalmol 2016; 26:627-632. [DOI: 10.5301/ejo.5000734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate short-term choroidal thickness changes following intravitreal dexamethasone implant (DEX), ranibizumab (RAN), and triamcinolone acetonide (TA) in eyes with retinal vein occlusion (RVO) and macular edema (ME). Methods In this prospective study, 35 eyes of 35 patients with RVO and ME who were treated with intravitreal injections of DEX, RAN, and TA were included. Choroidal thickness was measured using semiautomated segmentation of enhanced depth imaging with optical coherence tomography at fovea and parafoveal areas. Changes in choroidal thickness following treatment were compared statistically. Results Choroidal thickness decreased following DEX, RAN, and TA treatments (all p>0.05). In the DEX group, at the first month nasal 1,500 µm (N11,500) and at the third month subfoveal (SF3) and nasal 500 µm (N3500) choroidal thickness revealed a significant reduction compared to RAN and TA groups (all p<0.05). In the TA group, choroidal thickness showed a significant reduction only at nasal 1,500 µm (N31,500) at the third month (p<0.05). Conclusions Choroidal thickness was decreased in all 3 groups. The DEX and TA groups showed a significant reduction at some areas. Ranibizumab had the smallest effect on choroidal thickness after 3 months among all groups.
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Hattenbach LO, Kuhli-Hattenbach C, Springer C, Callizo J, Hoerauf H. Intravitreales Dexamethason-Implantat zur Behandlung des persistierenden postoperativen Makulaödems nach Vitrektomie. Ophthalmologe 2016; 113:581-8. [DOI: 10.1007/s00347-016-0223-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Alagöz N, Alagöz C, Yılmaz I, Yıldırım Y, Baz Ö, Altan Ç, Yazıcı AT, Taşkapılı M. Immediate Intraocular Pressure Changes Following Intravitreal Dexamethasone Implant. J Ocul Pharmacol Ther 2016; 32:44-9. [DOI: 10.1089/jop.2015.0087] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Neşe Alagöz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cengiz Alagöz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ihsan Yılmaz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yıldırım
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ökkeş Baz
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
| | - Çiğdem Altan
- Beyoğlu Eye Training and Research Hospital, Istanbul, Turkey
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Landré C, Zourdani A, Gastaud P, Baillif S. [Treatment of postoperative cystoid macular edema (Irvine-Gass syndrome) with dexamethasone 0.7 mg intravitreal implant]. J Fr Ophtalmol 2015; 39:5-11. [PMID: 26520410 DOI: 10.1016/j.jfo.2015.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the efficacy of dexamethasone 0.7 mg intravitreal implant in patients with postoperative cystoid macular edema. MATERIALS AND METHODS Fourteen patients' charts with postoperative cystoid macular edema were retrospectively reviewed. The main outcome measures were best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT). RESULTS Patients' mean age was 72.1 years old. Five patients were diabetic. All patients had previously been treated with non-steroidal anti-inflammatory drops. Four patients had received a previous treatment with intravitreal ranibizumab. The mean follow-up period was 8.7 months. Mean BCVA before intravitreal dexamethasone was 0.72 logMAR. After injection, it improved to 0.50 at month 1, was 0.47 at month 3, and 0.60 logMAR at month 12. The pre-injection mean CRT was 598 μm. It improved to 286 μm at month 1, 338 μm at month 3, and was 441 μm at month 12. Eight patients received 2 intravitreal injections of dexamethasone. Five patients presented with elevated intraocular pressure during follow-up, which was treated with drops. CONCLUSIONS Intravitreal dexamethasone injection improved visual acuity and macular thickness at month 1 and month 3 in patients with postoperative cystoid macular edema. A second injection was necessary after a mean period of 5 months.
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Affiliation(s)
- C Landré
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - A Zourdani
- Cabinet Nice-Retina, 5, rue Eugène-Emmanuel, 06000 Nice, France
| | - P Gastaud
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - S Baillif
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France.
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Receiver operating characteristic curve to predict anti-VEGF resistance in retinal vein occlusions and efficacy of Ozurdex. Eur J Ophthalmol 2015; 26:168-73. [PMID: 26428221 DOI: 10.5301/ejo.5000686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Current treatment paradigms for macular edema associated with retinal vein occlusions (RVO) often involve initial treatment with anti-vascular endothelial growth factor (VEGF) agents, then switching to intravitreal dexamethasone implant (IDI; Ozurdex, Allergan, Parsippany, NJ) for poor responders. However, many patients undergo multiple injections prior to being declared a nonresponder. We devised a method for prediction of poor anti-VEGF response after one injection, and show that these patients subsequently respond well to IDI. METHODS This study is a retrospective consecutive interventional case series of patients with RVO receiving anti-VEGF agents that were switched to IDI. Patients were categorized as nonresponders to anti-VEGF agents (edema did not improve) or responders (edema improved, but switched to IDI for longer treatment duration). Receiver operating characteristics (ROC) curve analysis was used to determine cutoffs of reduction in central retinal thickness (CRT) to predict poor response to anti-VEGF treatment. RESULTS Twenty-three patients met inclusion criteria. There were 14 nonresponders and 9 responders. The ROC curve analysis found that the maximal sensitivity and specificity in correctly identifying responders to anti-VEGF therapy was those with >25% reduction in CRT 1 month after 1 anti-VEGF treatment (sensitivity 0.89, specificity 0.79, area under the curve 0.93). After IDI placement, anti-VEGF nonresponders showed significant improvement in visual acuity (VA) (p = 0.02) and CRT (p = 0.01). CONCLUSIONS In patients with macular edema secondary to RVOs, a reduction in CRT by ≤25%, 1 month after 1 anti-VEGF injection, is predictive of poor response to anti-VEGF treatment. These patients may benefit from earlier conversion to IDI treatment, which in our study, resulted in improved VA and CRT.
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Unsal E, Eltutar K, Sultan P, Gungel H. The Efficiency of Intravitreal Dexamethasone Implants in the Treatment of Macular Edema Secondary to Retinal Vein Occlusion. J Ocul Pharmacol Ther 2015; 31:350-6. [DOI: 10.1089/jop.2014.0141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Erkan Unsal
- Ophthalmology Department, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Kadir Eltutar
- Ophthalmology Department, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Pınar Sultan
- Ophthalmology Department, Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Hulya Gungel
- Ophthalmology Department, Istanbul Research and Training Hospital, Istanbul, Turkey
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Early results of dexamethasone implant, ranibizumab, and triamcinolone in macular edema due to branch retinal vein occlusion. Eur J Ophthalmol 2015; 26:54-9. [PMID: 26109021 DOI: 10.5301/ejo.5000637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE To compare the short-term results of the efficacy and safety of dexamethasone intravitreal implant (DEX), ranibizumab (RAN), and intravitreal triamcinolone acetonide (IVTA) in macular edema secondary to branch retinal vein occlusion (BRVO). METHODS One eye each of 32 patients who were treated with intravitreal injections for macular edema secondary to BRVO was studied. This retrospective study included 3 groups. The patients received DEX in group 1 (n = 11), RAN in group 2 (n = 11), and IVTA in group 3 (n = 10). Data were collected before and after the injections at the first and third months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were analyzed statistically. RESULTS The median duration of the follow-up was 3.0 months in overall groups. The BCVA increased significantly in all groups (p = 0.018, p = 0.034, p = 0.014, respectively). The CMT increased significantly in groups 1 and 3 (p = 0.02, p<0.001, respectively), but not in group 2 (p = 0.14). The IOP increased significantly in groups 1 and 3 (p = 0.05, p<0.001, respectively). Antiglaucomatous treatment was required only in group 3. Cataract developed in 2 patients (20%) in group 3 and surgery was required. CONCLUSIONS Although RAN was the safest among the 3 agents, DEX and IVTA reduced CMT more than RAN, while significant improvement was achieved in BCVA in all groups. All 3 agents can be effectively used in the treatment of macular edema due to BRVO.
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Fortoul V, Denis P, Kodjikian L. Anatomical and functional recurrence after dexamethasone intravitreal implants: a 6-month prospective study. Eye (Lond) 2015; 29:769-75. [PMID: 25853447 DOI: 10.1038/eye.2015.36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/03/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficacy, safety, and delay of anatomical and functional recurrence after a first intravitreal injection of dexamethasone implant in eyes with cystoid macular edema (CME) secondary to retinal vein occlusion (RVO). METHODS A 6-month prospective, monocentric and noncomparative case-series of 26 eyes of 26 patients. Best-corrected visual acuity (BCVA) and central subfield thickness (CST) were measured at baseline and each visit at 1 week, and months 1, 2, 3, 4, 5, and 6 after a first treatment. Primary efficacy outcome was the proportion of eyes with a minimum three-line improvement from baseline BCVA at each visit and at 6 months. We also defined different patterns of recurrence: qualitative anatomical recurrence, quantitative anatomical recurrence and functional recurrence. A P-value <5% was considered statistically significant. RESULTS Mean population age was 69.3 years (SD=12.2; range=42-94 years). Mean ME duration before treatment was ~9.2 months (SD=11.43; range=0.4-40 months). Eighty eight percent of eyes achieved a three-line improvement from baseline at 2 months (P=0.02). The mean delay from baseline until qualitative anatomical, functional, or quantitative anatomical recurrence was 4.11 months (±0.86), 4.31 months (±1.33), and 4.40 months (±1.14), respectively. Qualitative anatomical recurrence occurred on average 14.4 days (SD=42.18) before a minimum of one-line BCVA impairment (functional recurrence). CONCLUSION Dexamethasone intravitreal treatment seems to be effective for ME after RVO even with long-duration ME or poor visual acuity before treatment. Other longer studies should assess the delay of recurrence after second and further treatments with DEX implants or combined therapies for ME after RVO.
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Affiliation(s)
- V Fortoul
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon 1, Lyon, France
| | - P Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon 1, Lyon, France
| | - L Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon 1, Lyon, France
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[Management of macular edema secondary to retinal vein occlusion]. J Fr Ophtalmol 2015; 38:253-63. [PMID: 25683131 DOI: 10.1016/j.jfo.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In recent years, intravitreal injections have added to the treatment modalities available for macular edema (ME) secondary to retinal vein occlusion (RVO). This article aims to provide an update regarding the management of ME secondary to RVO. METHODS A work group met in order to analyze the literature available on Embase/PubMed, regarding treatments for venous occlusion that have received market approval and are reimbursed in France. In total, 33 articles were selected. Consensus within the group for recommendations was based on this data from the literature review and clinical experience and was reported in this article. RESULTS The management of ME secondary to branch retinal vein occlusion (BRVO) or central vein occlusion of the retina (CRVO) differs on a number of points. Methods of best practice were discussed separately for BRVO and CRVO, taking into account various ocular and associated parameters. DISCUSSION Ranibizumab and dexamethasone implant are the first-line treatments for visual impairment due to ME secondary to RVO. The choice of either of these drugs may take into account various ocular and extraocular parameters. A change of treatment to one or the other or to laser may also be considered during follow-up.
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Kwon SH, Shin JP, Kim IT, Park DH. Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.8.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Soo Hyun Kwon
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Pil Shin
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - In Taek Kim
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Dong Ho Park
- Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea
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Maggio E, Polito A, Guerriero M, Pertile G. Intravitreal Dexamethasone Implant for Macular Edema Secondary to Retinal Vein Occlusion: 12-month Follow-Up and Prognostic Factors. Ophthalmologica 2014; 232:207-15. [DOI: 10.1159/000364956] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 05/28/2014] [Indexed: 11/19/2022]
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Nghiem-Buffet S, Fajnkuchen F, Buffet M, Ayrault S, Le Gloahec-Lorcy A, Grenet T, Delahaye-Mazza C, Quentel G, Cohen SY. Intravitreal Ranibizumab and/or Dexamethasone Implant for Macular Edema Secondary to Retinal Vein Occlusion. Ophthalmologica 2014; 232:216-22. [DOI: 10.1159/000365639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 06/28/2014] [Indexed: 11/19/2022]
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Wang C, Hou H, Nan K, Sailor MJ, Freeman WR, Cheng L. Intravitreal controlled release of dexamethasone from engineered microparticles of porous silicon dioxide. Exp Eye Res 2014; 129:74-82. [PMID: 25446320 DOI: 10.1016/j.exer.2014.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
Dexamethasone is a glucocorticoid that is widely used in the ophthalmic arena. The recent FDA approved dexamethasone implant can provide a three month efficacy but with high rate of drug related cataract and high intraocular pressure (IOP). It seems that higher steroid in aqueous humor and around lens may be associated with these complications based on clinical fact that higher IOP was observed with intravitreal triamcinolone acetonide (TA) than with subtenon TA. We hypothesize that placing a sustained dexamethasone release system near back of the eye through a fine needle can maximize efficacy while mitigate higher rate of IOP rise and cataract. To develop a sustained intravitreal dexamethasone delivery system, porous silicon dioxide (pSiO2) microparticles were fabricated and functionalized with amines as well as carboxyl groups. Dexamethasone was conjugated to pSiO2 through the Steglich Esterification Reaction between hydroxyl of dexamethasone and carboxyl groups on the pSiO2. The drug loading was confirmed by Fourier transform infrared spectroscopy (FTIR) and loading efficiency was quantitated using thermogravimetric analysis (TGA). In vitro release was conducted for three months and dexamethasone was confirmed in the released samples using liquid chromatography-tandem mass spectrometry (LC/MS/MS). A pilot ocular safety and determination of vitreous drug level was performed in rabbit eyes. The drug loading study demonstrated that loading efficiency was from 5.96% to 10.77% depending on the loading reaction time, being higher with longer loading reaction time before reaching saturation around 7 days. In vitro drug release study revealed that dexamethasone release from pSiO2 particles was sustainable for over 90 days and was 80 days longer than free dexamethasone or infiltration-loaded pSiO2 particle formulation in the same setting. Pilot in vivo study demonstrated no sign of ocular adverse reaction in rabbit eyes following a single 3 mg intravitreal injection and free drug level at 2-week was 107.23 ± 10.54 ng/mL that is well above the therapeutic level but only around 20% level of dexamethasone released from OZURDEX(®) (dexamethasone intravitreal implant) in a rabbit eye model. In conclusion, dexamethasone is able to covalently load to the pSiO2 particles and provide sustained drug release for at least 3 months in vitro. Intravitreal injection of these particles were well tolerated in rabbit eyes and free drug level in vitreous at 2-week was well above the therapeutic level.
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Affiliation(s)
- Chengyun Wang
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA 92037, USA; Department of Chemistry and Biochemistry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Key Laboratory for Advanced Materials and Institute of Fine Chemicals, East China University of Science and Technology, 130 Meilong Road, Shanghai 200237, China
| | - Huiyuan Hou
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Kaihui Nan
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Michael J Sailor
- Department of Chemistry and Biochemistry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - William R Freeman
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA 92037, USA
| | - Lingyun Cheng
- Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, CA 92037, USA.
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Evaluation of pain during intravitreal Ozurdex injections vs. intravitreal bevacizumab injections. Eye (Lond) 2014; 28:980-5. [PMID: 24924442 DOI: 10.1038/eye.2014.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 05/11/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The purpose was to evaluate the pain associated with intravitreal Ozurdex injections, and to compare it with that associated with intravitreal bevacizumab injections. METHODS The study included 57 eyes of 57 patients who received an intravitreal Ozurdex injection at our institution. Pain was measured by the visual analog scale (VAS). Additional parameters recorded included age, sex, indication for the injection, number of previous Ozurdex injections in the study eye, presence of diabetes mellitus, and lens status. Data were compared with a 2 : 1 sex- and age-matched control group of 114 patients who received intravitreal bevacizumab injections. RESULTS Indications for injection included diabetic macular edema (40.4%) and macular edema secondary to central and branch retinal vein occlusion (28% and 31.6%, respectively). Pain scores on the VAS ranged from 0 to 90, with a mean of 20.8±20.3. There was no significant difference in pain between Ozurdex and bevacizumab injections. Pseudophakia was correlated with increased pain in Ozurdex injections. CONCLUSIONS This is the first series evaluating the pain associated with intravitreal Ozurdex injections. Despite a larger needle gauge and tunneled injection technique, intravitreal injection of Ozurdex is not associated with increased pain compared with bevacizumab. This finding may be a potential advantage for Ozurdex, and may serve to improve patient compliance with future long-term treatment protocols.
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Five-month observation of persistent diabetic macular edema after intravitreal injection of Ozurdex implant. Mediators Inflamm 2014; 2014:364143. [PMID: 24659860 PMCID: PMC3934699 DOI: 10.1155/2014/364143] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 12/21/2013] [Accepted: 12/26/2013] [Indexed: 02/08/2023] Open
Abstract
Aims. This retrospective analysis was aimed at evaluating the
effectiveness of treatment of persistent diabetic macular edema with
intravitreal injections of 0.7 mg dexamethasone implant Ozurdex.
The study comprised three male patients (6 eyes). Results. The
average thickness of the retina at baseline was 632 μm, the medial
BCVA was 0.8 logMAR, and corrected intraocular pressure was 13.7 mmHg.
The maximum decrease in mean retinal thickness was observed at four weeks following the
treatment and was 365 μm (−267 μm) and visual acuity
improved by an average of two lines and was 0.6 logMAR. The largest increase in mean retinal
thickness to average of 528 μm (+164 μm) occurred at 16
weeks and the average BCVA was 0.614 lines BCVA logMAR. In one eye, there was a steroid
cataract development after the third dose of dexamethasone implant of 0.7 mg. Conclusions.
The intravitreal dexamethasone implant treatment of patients with persistent diabetic
macular edema in whom laser photocoagulation proved to be ineffective and as a result
they required a monthly injection of anti-VEGF factors (Ranibizumab, Bevacizumab) may
be a good alternative to extending the interval of injections. However, reinjections involve
a high risk of developing poststeroid cataracts, which is not without significance in middle-aged patients.
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Response to Hernández-Martínez et al. Eye (Lond) 2013; 28:362. [PMID: 24357846 DOI: 10.1038/eye.2013.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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MacDonald D. The ABCs of RVO: a review of retinal venous occlusion. Clin Exp Optom 2013; 97:311-23. [PMID: 24256639 DOI: 10.1111/cxo.12120] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/22/2013] [Indexed: 12/21/2022] Open
Abstract
Retinal vein occlusions are important causes of loss of vision; indeed, they are the second most common retinal vascular disease, following diabetic retinopathy. For this reason alone, primary eye-care providers must be well versed in diagnosis and management. Risk factors, though not universally agreed upon, include but are not limited to advancing age, systemic hypertension, arteriolarsclerosis, diabetes, hyperlipidaemia, blood hyperviscosity, thrombophilia, ocular hypertension and glaucoma. Typically, visual loss is secondary to macular oedema and/or retinal ischaemia. Treatment modalities have included observation, systemic thrombolysis and haemodilution, radial optic neurotomy, chorioretinal anastomosis, vitrectomy, laser photocoagulation and intravitreal injection of anti-inflammatory and, most recently, anti-vascular endothelial growth factors.
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Sun C, Li XX, He XJ, Zhang Q, Tao Y. Neuroprotective effect of minocycline in a rat model of branch retinal vein occlusion. Exp Eye Res 2013; 113:105-16. [PMID: 23748101 DOI: 10.1016/j.exer.2013.05.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/01/2013] [Accepted: 05/21/2013] [Indexed: 01/06/2023]
Affiliation(s)
- Chuan Sun
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China
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