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Teixeira C, Pessoa B, Ruão M, Sousa JPC, Penas S, Silva R, Carneiro Â, Meireles A. ILUVIEN ® in diabetic macular edema that persists or recurs despite treatment: Results from the Retina.pt ® RIVER audit. Eur J Ophthalmol 2024; 34:1149-1158. [PMID: 38013451 DOI: 10.1177/11206721231217525] [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] [Indexed: 11/29/2023]
Abstract
PURPOSE Persistent diabetic macular edema (DME) remains a problem in clinical practice, with many patients having a suboptimal response to the standard of care (SOC). Evidence supports the long-term efficacy of intravitreal fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients that have responded sub-optimally, although there is still scarce data from real-world Portuguese practices. We aimed to monitor the current SOC in selected Portuguese practices prior to FAc implantation and then assess the long-term effectiveness and safety of the FAc implant. SETTINGS The study included patient data from five Portuguese public hospitals. DESIGN This was a non-interventional, multicenter audit of data collected from Retina.pt registry from patients with persistent or recurrent DME despite treatment. METHODS Outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP). Results were compared at regular times over 36 months. RESULTS This study included 222 eyes from 152 patients. A significant decrease in BCVA (P < 0.001) and a significant increase in CMT (P = 0.013) were observed prior to FAc. A significant increase in BCVA was registered at 6 months after FAc implant administration (P < 0.001), which was maintained during follow-up. No relevant changes in IOP were observed. Treatment burden was reduced as a result of treatment with FAc (P < 0.001 for anti-VEGF, corticosteroids, or both treatments) in the full population. CONCLUSIONS In Portuguese practice, data showed that pre-FAc implantation, some patients did not respond to SOC treatment and/or they were undertreated. Following FAc implant administration, there were rapid, sustained, long-term visual and anatomical improvements, and a marked reduction in treatment burden.
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Affiliation(s)
- Carla Teixeira
- Department of Ophthalmology of Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Porto, Portugal
| | - Bernardete Pessoa
- Diabetes Ocular Department of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
- Department of Ophthalmology, Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute for the Biomedical Sciences Abel Salazar from University of Porto (UMIB ICBAS - UP), Porto, Portugal
| | - Miguel Ruão
- Department of Ophthalmology of Centro Hospitalar entre Douro e Vouga, Santa Maria da Feira, Portugal
| | | | - Susana Penas
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
- Department of Ophthalmology of Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rufino Silva
- Department of Ophthalmology, Ophthalmology Clinic, Faculty of Medicine of the University of Coimbra (FMUC), Coimbra, Portugal
- Department of Ophthalmology of Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Department of Ophthalmology, Coimbra, Centro Académico Clínico de Coimbra (CACC), Coimbra, Portugal
| | - Ângela Carneiro
- Department of Ophthalmology of Centro Hospitalar Universitário de São João (CHUSJ), E.P.E., Porto, Portugal
| | - Angelina Meireles
- Department of Ophthalmology of Centro Hospitalar e Universitário de Santo António (CHUdSA), Porto, Portugal
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Salvetat ML, Pellegrini F, Spadea L, Salati C, Musa M, Gagliano C, Zeppieri M. The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When. J Clin Med 2024; 13:1327. [PMID: 38592149 PMCID: PMC10932454 DOI: 10.3390/jcm13051327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25-30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy; (M.L.S.)
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy; (M.L.S.)
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Edo State, Nigeria
| | - Caterina Gagliano
- Faculty of Medicine and Surgery, University of Enna “Kore”, Piazza dell’Università, 94100 Enna, Italy
- Eye Clinic, Catania University, San Marco Hospital, Viale Carlo Azeglio Ciampi, 95121 Catania, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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Capone L, Airaghi P, Aragona P, Castellino N, Cicinelli MV, Ciucci F, Coppola M, Gaetano CD, Lattanzio R, Lorusso M, Maceroni M, Malvasi ME, Marco L, Marraffa M, Martini G, Mastropasqua R, Minnella AM, Nikolopulou E, Ortisi E, Pacella E, Papa V, Pennesi C, Reibaldi M, Rizzo S, Toto L, Trombetta L, Bandello F. Real-world experience with fluocinolone acetonide intravitreal implant in patients with diabetic macular edema. Eur J Ophthalmol 2024:11206721241235266. [PMID: 38396370 DOI: 10.1177/11206721241235266] [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: 02/25/2024]
Abstract
OBJECTIVES to evaluate long-term effectiveness and safety of fluocinolone acetonide (FAc) implant used as second-line treatment in patients with persistent diabetic macular edema (DME). METHODS retrospective data chart review of 241 pseudophakic eyes of 178 patients treated with FAc from July 2017 to December 2021 in 10 medical retinal units in Italy. The primary endpoint was the change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) at 2 years. A Student's paired t-test was used. Additional therapies for DME and intraocular pressure (IOP)-related events were also evaluated. RESULTS efficacy of FAc was assessed in a subset of 111 eyes with at least 24 months of follow-up. Mean BCVA increased at 2 years by 5.1 ETDRS letters (95%CI = 2.6-7.5; p < 0.001) while mean CMT decreased by 189 µm (95% CI 151-227; p < 0.001). Thirty-eight of these eyes (34.2%) needed additional intravitreal treatments, mainly anti-VEGF. Safety was evaluated on the entire cohort of 241 eyes treated with FAc. Overall, 66 eyes (27.4%) required emergent IOP-lowering medications (typically within the first-year post FAc) while 14 eyes (5.8%) underwent trabeculectomy, mostly during the second year of follow-up. CONCLUSION FAc implant provides a substantial long-term functional and anatomical benefit when used as second-line treatment in eyes with DME. IOP rise can be adequately managed with topical agents although some eyes may require IOP-lowering surgery.
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Affiliation(s)
- Luigi Capone
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute-School of Medicine, Vita-Salute San Raffaele University Milan, Milano, Italy
| | - Pietro Airaghi
- Ophthalmology Unit, IRCCS S. Gerardo dei Tintori, Monza, Italy
| | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | | | - Maria Vittoria Cicinelli
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute-School of Medicine, Vita-Salute San Raffaele University Milan, Milano, Italy
| | - Francesco Ciucci
- Ophthalmology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Michele Coppola
- Ophthalmology Unit, IRCCS S. Gerardo dei Tintori, Monza, Italy
| | | | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute-School of Medicine, Vita-Salute San Raffaele University Milan, Milano, Italy
| | - Massimo Lorusso
- Department of Ophthalmology, Ente Ecclesiastico F. Miulli Hospital, Bari, Italy
| | - Martina Maceroni
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore-Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | | | | | - Michele Marraffa
- Department of Ophthalmology, ULSS 9 Scaligera, Orlandi Hospital, Bussolengo, Verona, Italy
| | - Gaia Martini
- Department of Ophthalmology, ULSS 9 Scaligera, Orlandi Hospital, Bussolengo, Verona, Italy
| | - Rodolfo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Angelo Maria Minnella
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore-Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Eleni Nikolopulou
- Department of Ophthalmology, Ente Ecclesiastico F. Miulli Hospital, Bari, Italy
| | - Elina Ortisi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Elena Pacella
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Claudio Pennesi
- Ophthalmology Unit, IRCCS S. Gerardo dei Tintori, Monza, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
| | - Stanislao Rizzo
- Institute of Ophthalmology, Università Cattolica del Sacro Cuore-Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
| | - Lisa Toto
- Ophthalmology Clinic, Department of Medicine and Science of Ageing, University G. D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Luigi Trombetta
- Department of Biomedical Sciences, Ophthalmology Clinic, University of Messina, Messina, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute-School of Medicine, Vita-Salute San Raffaele University Milan, Milano, Italy
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Wei J, Shu Y, Wang Y, Liu H. Bibliometric and visualized analysis of diabetic macular edema. Indian J Ophthalmol 2024; 72:S66-S74. [PMID: 38131545 PMCID: PMC10833150 DOI: 10.4103/ijo.ijo_399_23] [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: 02/08/2023] [Revised: 04/10/2023] [Accepted: 07/31/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Our aim was to identify recent research trends on diabetic macular edema (DME) and focus on publications from different countries, institutions, and authors. METHODS We retrieved and analyzed data from January 1, 2003 to December 31, 2022 on the DME research field from the Web of Science Core Collection (WoSCC) database. Microsoft Excel and VOSviewer were applied to perform visualization analysis and evaluate the trends. RESULTS A total of 4482 publications were identified, and the annual global publications increased steadily, from 36 to 390, during this period. The United States (1339 publications, 71,754 citations), Johns Hopkins University (176 publications, 17,015 citations), and Bressler NM (76 publications, 9621 citations) were the most influential and productive countries, institutions, and authors, respectively. The top 100 keywords were classified into five clusters: (1) therapy and adverse effects of DME; (2) clinical biomarkers of DME; (3) mechanistic research on DME; (4) improving bioavailability and efficacy; and (5) early diagnosis of diabetic complications. "Diabetic macular edema," "retinopathy," "ranibizumab," and "optical coherence tomography angiography" were the most frequent keywords. Regarding the average appearing years (AAYs) of the keywords, "deep learning" (AAY:2020.83), "optical coherence tomography angiography" (AAY:2019.59), "intravitreal Aflibercept" (AAY:2019.29), and "dexamethasone implant" (AAY:2019.20) were recognized as the hotspots of the DME research area in the short run. CONCLUSION In the past two decades, the United States was in master status in DME research. Although intravitreal drug injection has been the mainstream therapy for a long time, the effectiveness of different drugs, such as dexamethasone, new solutions for drug delivery, such as intravitreal implantation, and more accurate tools for the classification and follow-up of DME patients, such as deep learning systems, are still research hotspots.
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Affiliation(s)
- Jin Wei
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Yiyang Shu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yimin Wang
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Haiyun Liu
- Department of Ophthalmology, Shanghai General Hospital (Shanghai First People's Hospital), Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
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Taloni A, Coco G, Rastelli D, Buffon G, Scorcia V, Giannaccare G. Safety and Efficacy of Dexamethasone Intravitreal Implant Given Either First-Line or Second-Line in Diabetic Macular Edema. Patient Prefer Adherence 2023; 17:3307-3329. [PMID: 38106365 PMCID: PMC10725633 DOI: 10.2147/ppa.s427209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023] Open
Abstract
Diabetic macular edema (DME) is a common sight-threatening complication of diabetic retinopathy (DR) and the leading cause of severe visual impairment among the working-age population. Several therapeutic options are available for the management of DME, including intravitreal corticosteroids. They have been traditionally used as second-line treatment, due to the risk of intraocular pressure increase and cataract-related adverse events. However, attention has recently been focused on the primary or early use of intravitreal corticosteroids, due to growing evidence of the crucial role of inflammation in the pathogenesis of DME. Furthermore, intravitreal steroid implants offer the additional advantage of a longer duration of action compared to anti-vascular endothelial growth factor agents (anti-VEGF). This review aims to summarize the available evidence on the efficacy and safety profile of dexamethasone (DEX) intravitreal implant, with a specific focus on clinical scenarios in which it might be considered or even preferred as first-line treatment option by adequate selection of patients, considering both advantages and possible adverse events. Patients with contraindications to anti-VEGF, DME with high inflammatory OCT biomarkers, pseudophakic patients and phakic patients' candidates to cataract surgery as well as vitrectomized eyes may all benefit from first-line DEX implant. Additionally, DME not responders to anti-VEGF should be considered for a switch to DEX implant and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent DME.
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Affiliation(s)
- Andrea Taloni
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Davide Rastelli
- Department of Ophthalmology, Policlinico Casilino, Rome, Italy
| | - Giacinta Buffon
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Billant J, Douma I, Agard E, Levron A, Bouvarel H, Leroux P, Badri Y, Dot C. [Late steroid-induced ocular hypertension after intravitreal dexamethasone implants: A series of 20 cases]. J Fr Ophtalmol 2023; 46:1039-1046. [PMID: 37758545 DOI: 10.1016/j.jfo.2023.03.041] [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: 02/27/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Steroid-induced ocular hypertension (OHT) occurs in approximately one third of cases after dexamethasone implant (DEXi) injection. Among these, more than one fifth occur after the third DEXi intravitreal injection (IVI). Our goal was to analyze the clinical profiles of these late responders. MATERIAL AND METHODS A real-life, retrospective, observational study was conducted to assess demographic characteristics and intraocular pressure (IOP) responses in late responders (IOP ≥ 21mmHg, n DEXi ≥ 4). The following parameters were analyzed: IOP 2 months after IVI and number of glaucoma medications needed. The IOP response compared to baseline was defined as low (< +6mmHg), moderate (≤ +15mmHg) or high (> 15mmHg). RESULTS Late steroid-induced OHT occurred in 20.8% of cases. Twenty eyes (18 patients) were included. The mean duration of follow-up was 3.8±1.9 years. They received a mean number of 9.5±4.2 IVI. The first OHT peak, measured at 25.3±3.2mmHg (21-31), occurred after 6.8±2.3 IVI. Approximately 65% of OHT spikes occurred between the fourth and sixth IVI; 35% occurred later. At maximum, 1.7±1.0 glaucoma medications and 0.75±0.79 SLT procedures were required to control the OHT, with no filtering surgery required. The ratio of "low," "moderate," and "high" responders was 5%, 85% and 10% respectively. CONCLUSION Late steroid-induced OHT occurs after at least 3 DEXi in one fifth of multi-injected patients, requiring long-term IOP monitoring. This case series identifies mostly moderate responder profiles, whose IOP rise often remains well-controlled with medical management or laser treatment (SLT).
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Affiliation(s)
- J Billant
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France.
| | - I Douma
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - E Agard
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - A Levron
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - H Bouvarel
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - P Leroux
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - Y Badri
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France
| | - C Dot
- Service d'ophtalmologie, hôpital d'instruction des Armées Desgenettes, Lyon, France; École du Val-de-Grâce, Paris, France; Service d'ophtalmologie, hôpital Édouard-Herriot, hospices civils de Lyon, Lyon, France
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Rousseau N, Lebreton O, Masse H, Maucourant Y, Pipelart V, Clement M, Le Lez ML, Khanna RK, Pepin M, Eude Y, Le Meur G, Weber M, Ducloyer JB. Fluocinolone Acetonide Implant Injected 1 Month after Dexamethasone Implant for Diabetic Macular Oedema: the ILUVI1MOIS Study. Ophthalmol Ther 2023; 12:2781-2792. [PMID: 37369907 PMCID: PMC10441852 DOI: 10.1007/s40123-023-00749-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION The aim of this study was to assess the efficacy and safety of fluocinolone acetonide implant (FAci) injected 1 month after the last dexamethasone intravitreal implant (DEXi) in chronic diabetic macular oedema (DME) patients. METHODS Retrospective multicentric study conducted in pseudophakic patients with chronic DME frequently treated with dexamethasone intravitreal implant (DEXi; time to DME recurrence ≤ 6 months), receiving FAci 1 month after the last DEXi, with at least a 6-month follow-up. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure (IOP) and additional treatments were assessed on the day of FAci injection (M0), 1 (M1) and 3 months (M3) later and then every 3 months. RESULTS A total of 41 eyes from 34 patients were included. At M0, patients' mean age was 68.7 ± 9.8 years, the mean DME duration was 63.9 ± 22.9 months, the mean interval between two DEXi was 14.2 ± 3.3 weeks. M12 data were available for 71% of patients. At baseline, the mean BCVA, CMT and IOP were 63.2 ± 16.6 letters, 299.4 ± 103.3 µm, and 16.2 ± 4.5 mmHg, respectively, and remained stable during the follow-up. At M12, 14% of patients required additional intravitreal treatments. CONCLUSION In pseudophakic patients with chronic DME showing good response to DEXi but requiring repeated injections every < 6 months, switching to FAci 1 month after the last DEXi was effective and safe. Further prospective randomized controlled studies are needed to confirm these findings, and to determine the best interval between the last DEXi and the first FAci.
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Affiliation(s)
- Nicolas Rousseau
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Olivier Lebreton
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Hélène Masse
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Yann Maucourant
- Centre Hospitalier Universitaire de Rennes, Service d'ophtalmologie, Rennes, France
| | - Valentin Pipelart
- Centre Hospitalier Le Mans, Service d'ophtalmologie, Le Mans, France
| | - Manon Clement
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Marie-Laure Le Lez
- Hôpital Universitaire Bretonneau, Service d'ophtalmologie, Tours, France
| | - Raoul Kanav Khanna
- Hôpital Universitaire Bretonneau, Service d'ophtalmologie, UMR 1253, iBrain, Tours, France
| | - Maxime Pepin
- Centre Hospitalier Universitaire d'Angers, Service d'ophtalmologie, Angers, France
| | - Yannick Eude
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Guylène Le Meur
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Michel Weber
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Jean-Baptiste Ducloyer
- Nantes Université, CHU Nantes, Service d'ophtalmologie, 1 Place Alexis Ricordeau, 44093, Nantes, France.
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Dot C, Poli M, Aptel F, Labbe A, Kodjikian L, Baillif S, Bodaghi B, Denis P. Ocular hypertension and intravitreal steroids injections, update in 2023. French guidelines of the French glaucoma society and the French ophthalmology society. J Fr Ophtalmol 2023; 46:e249-e256. [PMID: 37302867 DOI: 10.1016/j.jfo.2023.05.001] [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: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
These guidelines are a consensus of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in a third of the cases after corticosteroid implant intravitreal injections. They update the first guidelines published in 2017. Two implants are marketed in France: the dexamethasone implant (DEXi) and the fluocinolone acetonide implant (FAci). It is essential to assess the pressure status before injecting a patient with a corticosteroid implant. A molecule-specific monitoring of the intraocular pressure is needed throughout the follow-up and at the time of reinjections. Real-life studies have allowed optimizing the management algorithm by significantly increasing the safety of these implants. Corticosteroid testing with DEXi should be performed before switching to FAci to optimize pressure tolerance of FAci. Beyond topical hypotensive treatments, selective laser trabeculoplasty may be considered in the therapeutic arsenal for the management of steroid-induced OHT and subsequent injections.
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Affiliation(s)
- C Dot
- HIA Desgenettes/CHU E. Herriot, Lyon, France.
| | - M Poli
- Pôle vision, Ecully, France
| | | | - A Labbe
- CHNO des XV-XX, Paris, France
| | | | | | - B Bodaghi
- CHU de Pitié Salpétrière, Paris, France
| | - P Denis
- CHU de Croix-Rousse, Lyon, France
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Dot C, Poli M, Aptel F, Labbe A, Kodjikian L, Baillif S, Bodaghi B, Denis P. [Intraocular pressure elevation and intravitreal steroid implant injection: State of the art in 2023. Recommendations of the French Glaucoma Society and French Ophthalmology Society [French version]]. J Fr Ophtalmol 2023; 46:803-810. [PMID: 37481449 DOI: 10.1016/j.jfo.2023.05.003] [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: 04/03/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
These are the recommendations of French glaucoma and retina experts on the management of ocular hypertension (OHT) observed in 1/3 of cases after intravitreal steroid implant injections. They are an update to the recommendations first published in 2017. There are two implants on the French market: the dexamethasone (DEXi) and fluocinolone acetonide (FAci) implants. It is important to know the pressure status before injecting a patient with a steroid implant. Monitoring of the IOP adapted to the specific drug is necessary throughout follow-up and reinjections. Real-life studies have made it possible to optimize the management algorithm by significantly increasing the safety of use of these implants. A corticosteroid test with DEXi is necessary before switching to FAci to optimize the pressure tolerance of the latter. In addition to topical glaucoma medications, SLT laser can be considered in the therapeutic arsenal for the management of steroid-induced OHT and future injections.
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Affiliation(s)
- C Dot
- HIA Desgenettes, CHU É.-Herriot, Lyon, France.
| | - M Poli
- Pôle vision, Écully, France
| | | | - A Labbe
- CHNO des XV-XX, Paris, France
| | | | | | - B Bodaghi
- CHU Pitié-Salpêtrière, Paris, France
| | - P Denis
- CHU Croix-Rousse, Lyon, France
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Mathis T, El Ameen B, Vartin C, Serrar Y, Matonti F, Sudhalkar A, Bilgic A, Rezkallah A, Kodjikian L. Relevance of Visual Acuity Measurement for Therapeutic Decisions in Diabetic Macular Edema. Pharmaceutics 2023; 15:1607. [PMID: 37376056 DOI: 10.3390/pharmaceutics15061607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
This study aimed to determine the validity of basing retreatment decisions on anatomical criteria alone (captured using optical coherence tomography (OCT)-OCT-guided strategy) rather than the gold standard (combined visual acuity (VA) and OCT) in patients with diabetic macular edema (DME). This cross-sectional study included 81 eyes undergoing treatment for DME from September 2021 to December 2021. An initial therapeutic treatment decision based on OCT results was made on inclusion. Subsequently, in light of the patient's VA score, this initial decision was upheld or adjusted, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. In 67 out of the 81 eyes included in the study (82.7%), the OCT-guided strategy produced equivalent results to the gold standard. In this study, the OCT-guided retreatment decision strategy yielded sensitivity and specificity of 92.3% and 73.8%, respectively, and PPV and NPV of 76.6% and 91.2%, respectively. These findings differed according to the patient's treatment regimen: the sensitivity and specificity for eyes under a treat and extend regimen was higher, 100% and 88.9%, respectively, than eyes under a Pro Re Nata regimen, 90% and 69.7%, respectively. These findings show that VA testing could be omitted from the follow-up of certain patients with DME treated with intravitreal injections without impacting the quality of care.
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Affiliation(s)
- Thibaud Mathis
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France
| | - Batoul El Ameen
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Cristina Vartin
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Yasmine Serrar
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Frédéric Matonti
- Centre Monticelli Paradis, 13008 Marseille, France
- Groupe Almaviva Santé, Clinique Juge, 13008 Marseille, France
| | | | - Alper Bilgic
- Alphavision Augenarztpraxis, 27568 Bremerhaven, Germany
| | - Amina Rezkallah
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, 69100 Villeurbanne, France
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Gonzalez-Cortes JH, Martinez-Pacheco VA, Gonzalez-Cantu JE, Bilgic A, de Ribot FM, Sudhalkar A, Mohamed-Hamsho J, Kodjikian L, Mathis T. Current Treatments and Innovations in Diabetic Retinopathy and Diabetic Macular Edema. Pharmaceutics 2022; 15:pharmaceutics15010122. [PMID: 36678750 PMCID: PMC9866607 DOI: 10.3390/pharmaceutics15010122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 01/01/2023] Open
Abstract
Diabetic retinopathy (DR) is one of the leading causes of blindness worldwide. Multiple treatment options have been used over time to attempt to modify the natural progression of the disease in both proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). These two retinal complications are the result of microvascular occlusions and vascular hyperpermeability and are considered one of the leading causes of irreversible blindness in patients of working age. It is now well demonstrated that PDR and DME are associated with increased levels of inflammatory and pro-angiogenic factors in the ocular compartment. To date, laser photocoagulation, vascular endothelial growth factor (VEGF) inhibitors, and corticosteroids have demonstrated efficacy in their treatment in large randomized controlled trials and in real-life observational studies. This manuscript aims to provide a comprehensive review of current treatments, including the main drugs used in diabetic pathologic manifestations, as well as new therapeutic alternatives, such as extended-release intraocular devices.
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Affiliation(s)
- Jesus H. Gonzalez-Cortes
- Ophthalmology Department, School of Medicine, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
- Correspondence: ; Tel.: +52-8182545652
| | - Victor A. Martinez-Pacheco
- Retina and Vitreous Department, Hospital de Nuestra Señora de la Luz, Universidad Nacional Autónoma de México, Mexico City 06030, Mexico
| | - Jesus E. Gonzalez-Cantu
- Ophthalmology Department, Instituto Avalos, University Galileo, Guatemala City 01010, Guatemala
| | - Alper Bilgic
- Alphavision Augenarztpraxis, 27568 Bremerhaven, Germany
| | - Francesc March de Ribot
- Department of Ophthalmology, Otago University, Dunedin 9016, New Zealand
- Department of Ophthalmology, Girona University, 17004 Girona, Spain
| | | | - Jesus Mohamed-Hamsho
- Ophthalmology Department, School of Medicine, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France
- Unité Mixte de Recherche—Centre National de la Recherche Scientifique 5510, Matéis, Villeurbanne, 69004 Lyon, France
| | - Thibaud Mathis
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 69004 Lyon, France
- Unité Mixte de Recherche—Centre National de la Recherche Scientifique 5510, Matéis, Villeurbanne, 69004 Lyon, France
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Lebrize S, Arnould L, Bourredjem A, Busch C, Rehak M, Massin P, Barbosa-Breda J, Lupidi M, Mariotti C, Hamza M, Grise-Dulac A, Gabrielle PH, Baillif S, Creuzot-Garcher C. Intraocular Pressure Changes After Intravitreal Fluocinolone Acetonide Implant: Results from Four European Countries. Ophthalmol Ther 2022; 11:1217-1229. [PMID: 35426623 PMCID: PMC9114211 DOI: 10.1007/s40123-022-00504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/21/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction The 0.19 mg fluocinolone acetonide (FAc) intravitreal implant delivers a continuous intravitreal corticosteroid dose for the treatment of refractory diabetic macular oedema (DMO). The aim of this study was to assess the impact of an FAc intravitreal implant on intraocular pressure (IOP). Methods We retrospectively collected anonymised data on the patients’ characteristics, DMO treatment, and IOP and IOP-lowering treatments before and after the FAc intravitreal implant between September 2013 and March 2020 in several European centres. Results A total of 221 eyes from 179 patients were included. The mean follow-up duration was 13.4 (± 12.5, range 2.4–33.5) months. Overall, 194 eyes (88.2%) had received an intravitreal dexamethasone injection before the FAc intravitreal implant. For 25 eyes (11.3%) there was a history of glaucoma, and 52 eyes (23.5%) had previous IOP-lowering treatment. Mean IOP before injection was 14.7 (3.4) mmHg and increased to 16.9 (3.7) mmHg 12 months after injection (P < 0.0001). During follow-up, 55 eyes (24.9%) required the addition or initiation of topical IOP-lowering medication, only one patient (0.5%) had laser trabeculoplasty and one patient (0.5%) a minimally invasive glaucoma surgery, and no patient required incisional IOP-lowering surgery. Conclusion The FAc intravitreal implant led to substantial IOP elevation. This elevation was monitored most of the time with addition or initiation of topical IOP-lowering medication. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00504-z.
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Affiliation(s)
- Sarah Lebrize
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
| | | | - Catharina Busch
- Department of Ophthalmology, University Hospital, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology, University Hospital, Leipzig, Germany
| | | | - Joao Barbosa-Breda
- Department of Ophthalmology, São João University Hospital, Porto, Portugal
- Cardiovascular R&D Center, Faculty of Medicine of the University of Porto, Porto, Portugal
- Research Group Ophthalmology, Department of Neurosciences, KULeuven, Leuven, Belgium
| | - Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Mahmoud Hamza
- Department of Ophthalmology, Le Raincy-Montfermeil Hospital, Montfermeil, France
| | - Alice Grise-Dulac
- Department of Ophthalmology, Fondation A. de Rothschild, Paris, France
| | - Pierre-Henry Gabrielle
- Department of Ophthalmology, Dijon University Hospital, 14 Rue Gaffarel, 21000, Dijon, France
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Mathis T, Papegaey M, Ricard C, Rezkallah A, Matonti F, Sudhalkar A, Vartin C, Dot C, Kodjikian L. Efficacy and Safety of Intravitreal Fluocinolone Acetonide Implant for Chronic Diabetic Macular Edema Previously Treated in Real-Life Practice: The REALFAc Study. Pharmaceutics 2022; 14:pharmaceutics14040723. [PMID: 35456557 PMCID: PMC9025285 DOI: 10.3390/pharmaceutics14040723] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/15/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients and a chronic disease requiring long-term treatments. The fluocinolone acetonide (FAc) implant has recently been approved to treat DME in patients considered insufficiently responsive to available therapies. This study evaluates the functional and anatomical efficacy of the FAc implant in real-life practice. A total of 62 eyes with chronic DME were included and followed for a mean of 13.9 (+7.5) months. Previous treatment included at least anti-vascular endothelial growth factor (VEGF) in 83.9% of eyes, dexamethasone implant (DEX-I) in 100% of eyes, vitrectomy in 29.0% of eyes, and laser photocoagulation (either panretinal or focal photocoagulation) in 75.8% of eyes. The mean baseline best corrected visual acuity (BCVA) was 64.0 (+/−17.2) letters (median: 67.5 letters) with a mean DME duration of 60.3 (+/−30.6) months. The maximum BCVA gain occurred at 21 months with a mean gain of 5.0 (+/−12.7) letters. A total of 50.0% of eyes gained ≥5 letters during follow-up. Patients with lower BCVA at baseline had the lowest final BCVA (p < 0.001) but the highest BCVA gain (p = 0.02). The best overall improvement in mean central macular thickness (CMT) occurred at 18 months (p < 0.0001). The improvement in BCVA was inversely associated with the decrease in CMT and showed a decrease when CMT increased (DME recurrence). According to the history of vitrectomy, we did not find any significant difference in mean final BCVA (p = 0.1) and mean BCVA gain (p = 0.2) between eyes previously vitrectomized or not. A total of 23 eyes (37.1%) required additional treatment for DME, and 17.7% required an IOP-lowering procedure during follow-up. In conclusion, this real-life observational study demonstrated the efficacy and safety of the FAc implant in patients with chronic DME already treated with other available therapies.
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Affiliation(s)
- Thibaud Mathis
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
- Correspondence: (T.M.); (L.K.)
| | - Maxence Papegaey
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
| | | | - Amina Rezkallah
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
| | - Frédéric Matonti
- Centre Monticelli Paradis, 13008 Marseille, France;
- Institut Neuroscience Timone, Univeristé Aix Marseille, CNRS, INT, 13005 Marseille, France
- Groupe Almaviva Santé, Clinique Juge, 13008 Marseille, France
| | | | - Cristina Vartin
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
| | - Corinne Dot
- Service d’Ophtalmologie, Hôpital Militaire Desgenettes, 69003 Lyon, France;
- Hôpital D’instruction des Armées, Val-de-Grâce, 75005 Paris, France
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France; (M.P.); (A.R.); (C.V.)
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
- Correspondence: (T.M.); (L.K.)
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