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Chen C, Wang Z, Yan W, Lan Y, Yan X, Li T, Han J. Anti-VEGF combined with ocular corticosteroids therapy versus anti-VEGF monotherapy for diabetic macular edema focusing on drugs injection times and confounding factors of pseudophakic eyes: A systematic review and meta-analysis. Pharmacol Res 2023; 196:106904. [PMID: 37666311 DOI: 10.1016/j.phrs.2023.106904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE To assess the effectiveness and safety of combining intravitreal endothelial growth factor inhibitor (anti-VEGF) and ocular corticosteroids for diabetic macular edema (DME). METHODS Articles concentrating on the efficacy and safety of combining anti-VEGF and ocular corticosteroids therapy for DME versus anti-VEGF monotherapy was screened systematically. Meta-analysis was conducted on the basis of a protocol registered in the PROSPERO (CRD42023408338) and performed on the extracted continuous variables and dichotomous variables. The outcome was expressed as weighted mean difference (MD) and risk ratio (RR). RESULTS Add up to 21 studies including 1468 eyes were enrolled in this study. The MD for best-corrected visual acuity (BCVA) improvement at 1/3/6/12-month between the combination therapy group and monotherapy group were 2.56 (95% CI [0.43, 4.70]), 2.46 (95% CI [-0.40, 5.32]), - 1.76 (95% CI [-3.18, -0.34]), - 1.94 (95% CI [-3.87, 0.00]), respectively. The MD for central retinal thickness (CMT) reduction at 1/3/6/12-month between two groups were - 66.27 (95% CI [-101.08, -31.47]), - 33.62 (95% CI [-57.55, -9.70]), - 4.54 (95% CI [-16.84, 7.76]), - 26.67 (95% CI [-41.52, -11.82]), respectively. Additionally, the combination group had higher relative risk of high intraocular pressure and cataract progression events. CONCLUSIONS Anti-VEGF combined with ocular corticosteroids had a significant advantage over anti-VEGF monotherapy within 3 months of DME treatment, which reached the maximum with increasing anti-VEGF injection times to 3. However, with the prolongation of the treatment cycle, the effect of combined therapy after 6 months was no better than monotherapy, and the side effects of combined therapy were more severe.
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Affiliation(s)
- Chengming Chen
- Department of Ophthalmology, Tangdu Hospital, The Air Force Military Medical University, Xi'an 710038, China; Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou 350025, China
| | - Zhaoyang Wang
- Department of Thoracic Surgery, Tangdu Hospital, The Air Force Military Medical University, Xi'an 710038, China
| | - Weiming Yan
- Department of Ophthalmology, The 900th Hospital of Joint Logistic Support Force, PLA (Clinical Medical College of Fujian Medical University, Dongfang Hospital Affiliated to Xiamen University), Fuzhou 350025, China
| | - Yanyan Lan
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China
| | - Xiaolong Yan
- Department of Thoracic Surgery, Tangdu Hospital, The Air Force Military Medical University, Xi'an 710038, China.
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.
| | - Jing Han
- Department of Ophthalmology, Tangdu Hospital, The Air Force Military Medical University, Xi'an 710038, China.
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Chiu CY, Huang TL, Chang PY, Chen FT, Hsu YR, Chen YJ, Wang JK. Combined intravitreal ranibizumab and posterior subtenon triamcinolone acetonide injections for patients with diabetic macular edema refractory to intravitreal ranibizumab monotherapy. Taiwan J Ophthalmol 2021; 11:251-258. [PMID: 34703740 PMCID: PMC8493978 DOI: 10.4103/tjo.tjo_31_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/07/2020] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The purpose of this study is to compare the efficacy of intravitreal ranibizumab (IVR) alone and concurrent IVR with posterior subtenon triamcinolone acetonide (PSTA) injection for patients with diabetic macular edema (DME) refractory to IVR monotherapy. MATERIALS AND METHODS We enrolled 43 eyes of 43 patients with DME who received at least three times of IVR, which resulted in poor anatomical responses, with central foveal thickness (CFT) reduction <10% and postinjection CFT >300 μm. All the eyes received initial 3 monthly then pro re nata (PRN) IVR 0.5-mg injections. Twenty eyes continued PRN injections and 23 eyes received combined IVR 0.5 mg and PSTA 40 mg with at least 1-year follow-up. Best-corrected visual acuity (BCVA) and CFT were recorded from 1-month to 1-year follow-up. RESULTS Following switch to combined therapy, the mean BCVA significantly improved from 0.61 ± 0.32 logarithm of the minimum angle of resolution (logMAR) to 0.45±0.39 logMAR at 6 month (P = 0.003), 0.43±0.35 logMAR at 9 months (P < 0.001), and 0.48±0.45 logMAR at 1 year (P = 0.03). In eyes with IVR alone, no significant VA improvement was noted throughout the year. Significantly better BCVA was noted in the combined group at 6-month, 9-month, and 1-year follow-up compared to IVR-alone group. The timing of combined therapy showed a significant association with 1-year BCVA (t = 3.25, P = 0.018). CONCLUSION Concurrent IVR and PSTA resulted in significantly better visual outcomes in 1-year follow-up for those refractory to preceding ranibizumab monotherapy for DME. Early addition of PSTA predicted a better visual outcome.
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Affiliation(s)
- Chiung-Yi Chiu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Tzu-Lun Huang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Pei-Yao Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taiwan
| | - Fang-Ting Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taiwan
| | - Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taiwan
| | - Yun-Ju Chen
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Medicine, National Taiwan University, Taiwan
| | - Jia-Kang Wang
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan.,Department of Medicine, National Taiwan University, Taiwan.,Department of Medicine, National Yang Ming University, Taiwan.,Department of Healthcare Administration, New Taipei City, Taiwan.,Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
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Effect of intravitreal or sub-tenon triamcinolone acetonide injection at completion of vitrectomy on peripheral retinochoroidal thickness in eyes with proliferative diabetic retinopathy. Sci Rep 2019; 9:171. [PMID: 30655586 PMCID: PMC6336773 DOI: 10.1038/s41598-018-37220-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/28/2018] [Indexed: 12/31/2022] Open
Abstract
The effect of triamcinolone acetonide (TA) on the peripheral retinochoroidal thickness was determined after pars plana vitrectomy (PPV) with scatter photocoagulation in eyes with proliferative diabetic retinopathy. The peripheral retinochoroidal thickness was measured at 5 mm from the limbus in the four quadrants using anterior segment optical coherence tomography before, and 3 days, and 1 and 2 weeks after the surgery. The total peripheral thickness was significantly thicker than the baseline thickness after PPV alone (P < 0.001; 18 eyes), PPV combined with intravitreal TA injection (IVTA; P = 0.011; 19 eyes), and PPV combined with sub-tenon TA injection (STTA; P = 0001; 23 eyes). The total peripheral thickness in the PPV group at 3 days after surgery was significantly thicker than that of the PPV + IVTA (P = 0.015) and of the PPV + STTA groups (P = 0.016). Multiple linear regression analyses showed that the injection of TA by the two routes and the number of photocoagulation burns were significantly correlated with the total peripheral thicknesses at 3 days after the surgery. The results indicate that the PPV with large number of intraoperative scatter photocoagulation burns caused an increase in the total peripheral thickness and an administration of either IVTA and STTA can reduced the degree of thickening.
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Yamada Y, Takamura Y, Matsumura T, Morioka M, Gozawa M, Inatani M. Posterior subtenon infusion of triamcinolone acetonide as adjunctive treatment to panretinal photocoagulation using pattern scan laser for diabetic retinopathy. Jpn J Ophthalmol 2018; 62:686-692. [PMID: 30328560 DOI: 10.1007/s10384-018-0628-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 08/31/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the effect of sub-Tenon's capsule triamcinolone acetonide injection (STTA) combined with panretinal photocoagulation (PRP) using pattern scan laser (PSL) for high risk non-proliferative diabetic retinopathy (NPDR), in terms of the inflammation and the progression of diabetic macular edema (DME). STUDY DESIGN Retrospective comparative analysis. METHODS NPDR patients who underwent PRP using PSL with (STTA+PSL group, n=24) or without (PSL group, n=19) pretreatment of STTA were enrolled. We measured anterior flare intensity (AFI) and central retinal thickness (CRT) at day of STTA (day 0), and at 1, 3, 7, 11 and 15 weeks. RESULTS The CRT of the STTA+PSL group was significantly lower than that of the PSL group at 7 (308.15±69.16 μm versus 340.21±77.91 μm, p = 0.04), 11 (283.8±60.75 μm versus 335.7±67.70 μm, p = 0.01) and 15 weeks (281.13±35.29 μm versus 316.58±54.89 μm, p = 0.02). AFI levels in the STTA+PSL group were significantly lower than those in the PSL group at 11 (10.47±3.40 versus 15.85±8.38, p = 0.007) and 15 weeks (11.38±3.31 versus 14.37±3.85, p = 0.009). The significant improvement in CRT from baseline was noticed through the observational periods in STTA+PSL group, but not in the PSL group. CONCLUSION Pretreatment of STTA has the potential to not only prevent the worsening of DME, but also reduce the CRT and AFI of eyes with NPDR after PRP using PSL.
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Affiliation(s)
- Yutaka Yamada
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Fukui-ken, 910-1193, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Fukui-ken, 910-1193, Japan.
| | - Takehiro Matsumura
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Fukui-ken, 910-1193, Japan
| | - Masakazu Morioka
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Fukui-ken, 910-1193, Japan
| | - Makoto Gozawa
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Fukui-ken, 910-1193, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Sciences, University of Fukui, Eiheiji-cho, Yoshida-gun, Fukui, Fukui-ken, 910-1193, Japan
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Demircan A, Ozkaya A, Alkin Z, Kemer B, Yesilkaya C, Demir G. Comparison of the effect of ranibizumab and dexamethasone implant on serous retinal detachment in diabetic macular edema. J Fr Ophtalmol 2018; 41:733-738. [PMID: 30213609 DOI: 10.1016/j.jfo.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/08/2018] [Accepted: 03/15/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) on neurosensory retinal detachment (SRD) associated with diabetic macular edema (DME) in the early treatment period. METHODS This was a retrospective, interventional, case-control study. After three monthly loading doses of IVR or an initial IDI injection, the changes in best-corrected visual acuity (BCVA), central macular thickness (CMT) on OCT, and presence and height of SRD were evaluated. RESULTS The IVR and IDI groups consisted of 101 and 35 eyes, respectively. The mean changes in CMT in the IVR and IDI groups were 204.4±176.6 and 311.4±163, respectively (P<0.001). The mean changes in SRD height in the IVR and IDI groups were 133.6±92.1 and 168.6±103.9μm, respectively. The decrease in SRD height was significantly greater in the IDI group than in the IVR group (P=0.002). The SRD resolved completely in 72.2% and 71.4% of the patients in the IVR and IDI groups, respectively (P=0.9). CONCLUSION The mean reduction in CMT and SRD height was greater in the IDI group than in the IVR group. There was a negative correlation between baseline best-corrected visual acuity (BCVA) and SRD height and also between BCVA and CMT.
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Affiliation(s)
- A Demircan
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey.
| | - A Ozkaya
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - Z Alkin
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - B Kemer
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - C Yesilkaya
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
| | - G Demir
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Bereketzade Cami Sok. No. 2 Beyoglu, Istanbul, Turkey
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Sato S, Shinoda H, Nagai N, Suzuki M, Uchida A, Kurihara T, Kamoshita M, Tomita Y, Iyama C, Minami S, Yuki K, Tsubota K, Ozawa Y. Predictive factors of better outcomes by monotherapy of an antivascular endothelial growth factor drug, ranibizumab, for diabetic macular edema in clinical practice. Medicine (Baltimore) 2017; 96:e6459. [PMID: 28422835 PMCID: PMC5406051 DOI: 10.1097/md.0000000000006459] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Intravitreal ranibizumab (IVR) has been approved for treating diabetic macular edema (DME), and is used in daily clinical practice. However, the treatment efficacies of IVR monotherapy in real-world clinical settings are not well known.The medical records of 56 eyes from 38 patients who received their first IVR for DME between April 2014 and March 2015, and were retreated with IVR monotherapy as needed with no rescue treatment, such as laser photocoagulation, were retrospectively reviewed. The clinical course, best-corrected visual acuity (BCVA), and fundus findings at baseline, before the initial IVR injection, and at 12 months, were evaluated.Twenty-five eyes from 25 patients (16 men; mean age 68.7 ± 9.8 years) who received IVR in the first eye, or unilaterally, without any other treatments during follow-up were included. After 12 months, mean central retinal thickness (CRT), which includes edema, was reduced (P = .003), although mean BCVA remained unchanged. There was a negative correlation between individual changes in BCVA (r = -0.57; P = .003) and CRT (r = -0.60; P = .002) at 12 months compared with baseline values. BCVA changes were greater in individuals with a history of pan-retinal photocoagulation at baseline (P = .026). After adjusting for age and sex, CRT improvement >100 μm at 12 months was associated with a greater CRT at baseline (OR 0.87 per 10 μm [95% CI 0.72-0.97]; P = .018) according to logistic regression analyses; however, better BCVA and CRT at 12 months were associated with a better BCVA (r = 0.77; P < .001) and lower CRT (r = 0.41; P = .039) at baseline, respectively, according to linear regression analyses.IVR monotherapy suppressed DME, and the effects varied according to baseline conditions. Eyes that had poorer BCVA or greater CRT, or a history of pan-retinal photocoagulation at baseline, demonstrated greater improvement with IVR monotherapy. In contrast, to achieve better outcome values, DME eyes should be treated before the BCVA and CRT deteriorate. These findings advance our understanding of the optimal use of IVR for DME in daily clinical practice, although further study is warranted.
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Affiliation(s)
| | | | - Norihiro Nagai
- Department of Ophthalmology
- Laboratory of Retinal Cell Biology, Keio University, School of Medicine, Tokyo, Japan
| | - Misa Suzuki
- Department of Ophthalmology
- Laboratory of Retinal Cell Biology, Keio University, School of Medicine, Tokyo, Japan
| | | | | | - Mamoru Kamoshita
- Department of Ophthalmology
- Laboratory of Retinal Cell Biology, Keio University, School of Medicine, Tokyo, Japan
| | | | | | | | | | | | - Yoko Ozawa
- Department of Ophthalmology
- Laboratory of Retinal Cell Biology, Keio University, School of Medicine, Tokyo, Japan
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