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Chacun S, Kodjikian L, Ricard C, Elbany S, Marthelot V, Akesbi J, Devin F, Burillon C, Denis P, Mathis T. Dexamethasone Implant under a Proactive Treatment Regimen in a Clinical Setting: The ProDEX Study. Ophthalmol Retina 2024; 8:889-897. [PMID: 38555008 DOI: 10.1016/j.oret.2024.03.019] [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: 10/16/2023] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE To assess the effectiveness of switching intravitreal dexamethasone implants (DEX-implant) from pro re nata (PRN) treatment regimen to a proactive regimen in patients with macular edema of diverse etiologies. DESIGN An observational, retrospective, uncontrolled, multicenter, national case series. PARTICIPANTS Eighty-one eyes from 68 patients treated between October 2015 and June 2023 were included. METHODS This study included consecutive eyes treated with DEX-implant who were switched from a PRN regimen to a proactive regimen for diabetic macular edema (DME), retinal vein occlusion (RVO), noninfectious uveitis macular edema (UME; including postsurgical macular edema), and radiation maculopathy (RM). MAIN OUTCOME MEASURES The main outcome measures were change in the best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) at each visit. RESULTS According to the etiology, DME represented 49.4% of eyes, UME 24.3%, RVO 21.0%, and RM 6.2%. The mean (standard deviation [SD]) duration of follow-up under the PRN and proactive regimens was 20.6 (13.3) and 14.2 (10.3) months, respectively. Switching from a PRN to a proactive regimen significantly improved mean (SD) BCVA by 3.7 (12.9) ETDRS letters (P = 0.01) with a mean (SD) decrease in CMT of 108.0 (151.4) μm (P < 0.001). The proportion of visits with significant anatomic recurrence (> 50 μm) also decreased from 40.1% to 6.0% after switching to a proactive regimen (P < 0.001). The number of DEX-implant injections significantly increased during the proactive treatment period (P < 0.001), but the change in the number of visits was not significantly different (P = 0.2). The proactive treatment period was not associated with a significant increase in IOP (P = 0.6). CONCLUSIONS Switching to a proactive regimen in patients already treated with DEX-implant seems to significantly improve BCVA and CMT while maintaining stable IOP. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Samuel Chacun
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Service d'Ophtalmologie, Hôpital universitaire d'Édouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Villeurbanne, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Villeurbanne, France; Laboratoire MATEIS, UMR-CNRS 5510, INSA, Université Lyon, Villeurbanne, France
| | - Cécile Ricard
- StatMed74, Épidémiologiste indépendant, Annecy, France
| | - Sandra Elbany
- Service d'Ophtalmologie, Hôpital universitaire d'Édouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Villeurbanne, France
| | | | - Jad Akesbi
- L'Institut Parisien d'Ophtalmologie, Paris, France
| | - François Devin
- Centre Monticelli Paradis, Marseille, France; Groupe Almaviva santé, Clinique Juge, Marseille, France
| | - Carole Burillon
- Service d'Ophtalmologie, Hôpital universitaire d'Édouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Villeurbanne, France
| | - Philippe Denis
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Villeurbanne, France
| | - Thibaud Mathis
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Villeurbanne, France; Laboratoire MATEIS, UMR-CNRS 5510, INSA, Université Lyon, Villeurbanne, France.
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Singh RP, Albini TA, Baumal CR, Chang PY, Eichenbaum D, Holekamp N, Sharma S, Singer M. Development of a Consensus Guideline for the Diagnosis and Management of Chronic Noninfectious Uveitis Affecting the Posterior Segment. Ophthalmic Surg Lasers Imaging Retina 2024:1-7. [PMID: 39254498 DOI: 10.3928/23258160-20240625-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND AND OBJECTIVE A consensus exercise was carried out to address unmet needs in the classification, diagnosis, and management of patients with chronic noninfectious uveitis affecting the posterior segment (NIU-PS), with a focus on chronic postoperative inflammation/cystoid macular edema. METHODS Eight experts participated in roundtable discussions and consensus-building exercises to develop clear guidelines for the diagnosis and management of chronic NIU-PS. The group addressed questions surrounding clinical features, diagnostic tests, and treatment considerations. RESULTS Clinicians agreed that chronic uveitis/intraocular inflammation should be defined as having persistence or recurrence for 3 or more months. Diagnosis is informed by evaluation of signs and symptoms, use of imaging, and exclusion of infectious etiologies. Management should be initiated with the least invasive therapies, proceeding to intraocular injections, and/or long-term intravitreal or systemic therapies, as necessary. CONCLUSION This manuscript offers an up-to-date consensus guideline based on clinical experience. Future clinical trials may help to test and reevaluate these recommendations. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Zhu D, Zhang W, Qiu D, Zhang D, Li Y, Li J. Relationship Between Asymmetry of Transverse Sinus and Difference in Intraocular Pressure. Neurol India 2024; 72:797-800. [PMID: 39216036 DOI: 10.4103/neurol-india.ni_446_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/15/2021] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE This study used two-dimensional time-of-flight magnetic resonance venography (2D TOF MRV) to show the shape of the transverse sinus and to determine whether there is a correlation between the asymmetry of the transverse sinus morphology and the intraocular pressure (IOP) of the two eyes. METHODS In this study, 63 male and 42 female volunteers were included. Those with obvious neurological diseases and eye diseases were excluded. According to the morphology of the transverse sinus scanned with 2D TOF MRV, subjects were divided into five groups. The IOP of the volunteers was measured separately. RESULTS The difference between group I and group V is statistically significant (Z = 6.78, P < 0.01). Statistically, significant differences also existed among the IOP of each group, including the mean values of both eyes and the difference between the right eye and the left eye. The asymmetry of the transverse sinus maintained a negative correlation with the right IOP (r = 0.51, P < 0.01) and the difference between the right eye and the left eye (r = 0.79, P < 0.01). The asymmetry and the left IOP had no statistical correlation. CONCLUSION The preliminary conclusion of this study is that if one side of the transverse sinus is thicker, the drainage-related ocular veins are relatively coarser, and the IOP is relatively lower. The 2D TOF MRV examination can be used as an examination to show the shape of the transverse sinus. It is a display method to provide a feasible means of inspection for a reasonable interpretation.
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Affiliation(s)
- Dan Zhu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Zhang T, Liu Z, Li N. The application of dexamethasone implants in uveitis treatment. Front Med (Lausanne) 2024; 11:1402396. [PMID: 39005654 PMCID: PMC11239344 DOI: 10.3389/fmed.2024.1402396] [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: 03/17/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Uveitis refers to a group of ocular inflammatory diseases that can significantly impair vision. Although systemic corticosteroid therapy has shown substantial efficacy in treating uveitis, extensive use of corticosteroids is associated with significant adverse effects. Recently, a biodegradable, sustained-release implant, namely dexamethasone intravitreal implant (Ozurdex), has been reported for treating non-infectious and infectious uveitis. This review aims to summarize the experiences with Ozurdex treatment across various forms of uveitis and to assist readers in understanding the appropriate timing and potential side effects of Ozurdex in uveitis treatment, thereby maximizing patient benefits in uveitis management.
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Affiliation(s)
- Tian Zhang
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Zhutao Liu
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
| | - Na Li
- Affiliated Hospital of Shandong Second Medical University, School of Clinical Medicine, Shandong Second Medical University, Weifang, China
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Garay-Aramburu G, Hunt A, Arruabarrena C, Mehta H, Invernizzi A, Gabrielle PH, Guillaumie T, Wolff B, Gillies MC, Zarranz-Ventura J. Initial response and 12-month outcomes after commencing dexamethasone or vascular endothelial growth factor inhibitors for retinal vein occlusion in the FRB registry. Sci Rep 2024; 14:6122. [PMID: 38480837 PMCID: PMC10937938 DOI: 10.1038/s41598-024-56581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024] Open
Abstract
To compare baseline characteristics, initial response and 12-month efficacy and safety outcomes in eyes with branch and central retinal vein occlusion (BRVO and CRVO) treated with dexamethasone implants (DEX) or anti-vascular endothelial growth factor (anti-VEGF) we performed a multi-centre, retrospective and observational study using Fight Retinal Blindness! Registry. Of 725 eligible eyes, 10% received DEX initially with very frequent adjunctive anti-VEGF (BRVO-DEX 49%, CRVO-DEX 60%). The primary outcome of mean adjusted change in VA at 12 months with DEX and anti-VEGF initiated groups were not statistically significantly different (BRVO: DEX + 6.7, anti-VEGF + 10.6 letters; CRVO: DEX + 2.8, anti-VEGF + 6.8 letters). DEX initiated eyes had fewer injections and visits than anti-VEGF initiated eyes. The BRVO-DEX eyes had greater initial mean changes in VA and central subfield thickness (CST) and achieved inactivity sooner than BRVO-anti-VEGF eyes. The mean CST after the first three months was above 350 μm in all but the BRVO-anti-VEGF group, suggesting undertreatment. In routine care DEX is uncommonly used when available as initial treatment of BRVO and CRVO requiring supplemental anti-VEGF within the first year. The 12-month outcomes were similar, but DEX initiated eyes had fewer injections and visits but more episodes of raised IOP Vs those starting anti-VEGF.
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Affiliation(s)
- Gonzaga Garay-Aramburu
- Begiker-Ophthalmology Research Group, Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, OSI Bilbao Basurto, Facultad de Medicina, Campus de Basurto, University of the Basque Country, UPV/EHU, Avenida Montevideo 18, 48013, Bilbao, Spain.
| | - Adrian Hunt
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Ophthalmology, Westmead Hospital, Westmead, NSW, Australia
| | | | - Hemal Mehta
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Ophthalmology, Royal Free London NHS Foundation Trust, London, UK
| | - Alessandro Invernizzi
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Eye Clinic, Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Tremeur Guillaumie
- Department of Ophthalmology, Saint Brieuc Hospital, 22000, Saint Brieuc, France
| | - Benjamin Wolff
- 55659 Ophthalmological Center Maison Rouge, Strasbourg, France
| | - Mark C Gillies
- The Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Kang EYC, Shao SC, Chang KC, Garg SJ, Lin TY, Chen KJ, Wu WC, Lai CC, Hwang YS, Lai ECC. Real-world effectiveness of intravitreal dexamethasone implants - Comparison between eyes eligible and ineligible for clinical trials and their associated outcomes. Biomed J 2024; 47:100607. [PMID: 37196877 PMCID: PMC10826172 DOI: 10.1016/j.bj.2023.100607] [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: 01/18/2023] [Revised: 04/04/2023] [Accepted: 05/13/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Concerns about the generalizability of pivotal randomized controlled trials (pRCTs) findings have been raised. We aimed to compare intravitreal dexamethasone implants' (IDIs) effectiveness for diabetic macular edema (DME) and central retinal vein occlusion (CRVO), between eyes eligible and ineligible for pRCTs. METHODS This retrospective cohort study analyzed Taiwan's Chang Gung Research Database, including DME or CRVO eyes initiating IDIs during 2015-2020. We classified all treated eyes as eligible or ineligible for pRCTs following major selection criteria of the MEAD and GENEVA trials, and evaluated three-, six-, and twelve-month changes in central retinal thickness (CRT) and visual acuity (VA) after initiating IDIs. RESULTS We included 177 IDI-treated eyes (DME: 72.3%; CRVO: 27.7%), of which 39.8% and 55.1% were ineligible for DME and CRVO pRCTs, respectively. LogMAR-VA and CRT changes at different times were comparable in DME eyes eligible (LogMAR-VA difference: 0.11 to 0.16; CRT difference: -32.7 to -96.9 μm) and ineligible (LogMAR-VA difference: -0.01 to 0.15; CRT difference: -54.5 to -109.3 μm) for the MEAD trial. By contrast, CRVO eyes ineligible for the GENEVA trial had greater LogMAR-VA changes (0.37 ~ 0.50) than those eligible (0.05 ~ 0.13), with comparable CRT reductions (eligible eyes: -72.3 to -106.4 μm; ineligible eyes: -61.8 to -110.7 μm) (all p-values <0.05 of the mean differences between eligible and ineligible CRVO eyes for all follow-ups). CONCLUSIONS IDIs had similar VA and CRT outcomes among DME eyes, regardless of pRCT-eligibility. However, among CRVO eyes, those ineligible for pRCTs showed greater deterioration in VA than those eligible.
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Affiliation(s)
- Eugene Yu-Chuan Kang
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Kai-Cheng Chang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sunir J Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tzu-Yi Lin
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Jabbehdari S, Yazdanpanah G, Cantor LB, Hajrasouliha AR. A narrative review on the association of high intraocular pressure and glaucoma in patients with retinal vein occlusion. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1072. [PMID: 36330401 PMCID: PMC9622479 DOI: 10.21037/atm-22-2730] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/14/2022] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Retinal vein occlusion (RVO) is a major cause of vision loss and elevated intraocular pressure (IOP), high ocular perfusion pressure, and glaucoma are known ophthalmic risk factors for RVO. The aim of this paper is to provide the update on the association and management of high IOP/glaucoma and RVO. METHODS A literature review was performed in PubMed and Medline until May 2022 utilizing specific keywords and cross-matched reference lists. KEY CONTENT AND FINDINGS The association of RVO with high IOP/glaucoma may be attributed to retinal ganglion cell loss due to retinal ischemia in high IOP and glaucoma. As new modalities showed, decreased optic disc perfusion, reduced density of blood vessels in the optic nerve head of glaucoma patients, changes in the peripapillary microvascular parameters, and decreased retinal nerve fiber layer (RNFL) thickness of the optic nerve head of eyes with RVO suggest a common pathway between RVO and glaucoma. Literature suggests the close follow up for glaucoma development among patients with non-arteriovenous (AV) crossing (optic cup or optic nerve sited) RVO in fellow eye and management of elevated IOP among RVO cases treated with anti-vascular endothelial growth factor (VEGF) antibodies/corticosteroids and those with preexisting primary open angle glaucoma (POAG). CONCLUSIONS Determining potential patient responses to treatment and considering therapeutic options are challenging among patients with RVO and glaucoma. However, IOP lowering managements in preventing IOP spikes in patients with preexisting glaucoma and early treatment of macular edema in eyes with RVO is recommended.
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Affiliation(s)
- Sayena Jabbehdari
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ghasem Yazdanpanah
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, USA
| | - Louis B. Cantor
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amir Reza Hajrasouliha
- Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
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Rezkallah A, Kodjikian L, Barbarroux A, Laventure C, Motreff A, Chacun S, Matonti F, Denis P, Mathis T. Intra-Ocular Pressure Response to Dexamethasone Implant Injections in Patients with a History of Filtering Surgery: The TRABEX Study. Pharmaceutics 2022; 14:pharmaceutics14091756. [PMID: 36145504 PMCID: PMC9502767 DOI: 10.3390/pharmaceutics14091756] [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: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Patients with both macular edemas, of various etiologies such as diabetes and glaucoma, may suffer serious loss of vision if either disease goes untreated. Where no effective alternative therapies are available, dexamethasone implant (DEX-I) injections may be the only choice of treatment, despite the risk of a possible increase in intraocular pressure (IOP) when using steroids. Although many studies have reported on IOP evolution in eyes treated with DEX-I, little is known specifically about eyes with a history of filtering surgery. The aim of this observational series was to evaluate the IOP response following DEX-I injection in eyes presenting conventional filtering surgeries or microinvasive glaucoma surgeries (MIGS). Twenty-five eyes were included in this study. A total of 64% of the eyes did not experience OHT during follow-up. Additional IOP-lowering therapy was needed for 32% of eyes, and 20% of eyes (all showing bleb fibrosis) required further filtering surgery: 50% of eyes in the MIGS group and 10.5% of eyes in the conventional filtering surgery group. A significant positive correlation was found between IOP at baseline and the maximum IOP throughout follow-ups after DEX-I (r = 0.45, p = 0.02). In conclusion, if DEX-I is used when there are no alternative therapies for treating macular edema, IOP in eyes with a history of filtering surgery is generally manageable. Those eyes which previously underwent conventional therapy with effective blebs obtained better IOP control after DEX-I injections and mostly did not require any additional IOP-lowering therapy or surgery.
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Affiliation(s)
- Amina Rezkallah
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
| | - Aymeric Barbarroux
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Corentin Laventure
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Antoine Motreff
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Samuel Chacun
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Frédéric Matonti
- Centre Monticelli Paradis, 13008 Marseille, France
- CNRS, INT, Institut Neuroscience Timone, Univeristé Aix Marseille, 13005 Marseille, France
- Groupe Almaviva Santé, Clinique Juge, 13008 Marseille, France
| | - Philippe Denis
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
| | - Thibaud Mathis
- Service d’Ophtalmologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 69004 Lyon, France
- UMR-CNRS 5510 Matéis, Université Lyon 1, 69100 Villeurbanne, France
- Correspondence:
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Dexamethasone Implant for Diabetic Macular Oedema: 1-Year Treatment Outcomes from the Fight Retinal Blindness! Registry. Ophthalmol Ther 2022; 11:797-810. [PMID: 35179714 PMCID: PMC8927495 DOI: 10.1007/s40123-022-00473-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 01/26/2022] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Phase III clinical trials of dexamethasone intravitreal implant for diabetic macular oedema (DMO) have reported significant improvements in visual acuity (VA). Studies evaluating the treatment of DMO in routine clinical practice provide data to identify areas that need improvement. This study evaluated 12-month treatment outcomes of dexamethasone implant for DMO in routine clinical practice. METHODS Retrospective data analysis of eyes that started dexamethasone implant for DMO from 1 June 2013 to 30 April 2019 in routine clinical practice tracked in the Fight Retinal Blindness! Registry. RESULTS Of the 4282 eyes (2518 patients) that started DMO treatment in the specified period, 267 (6%) eyes (204 patients) received 454 dexamethasone implant injections. Two-fifths (106 eyes) had received prior treatment for DMO. The mean (95% confidence interval [CI]) VA change at 12 months was 1.8 (- 0.5, 4.2) letters from the mean (standard deviation [SD]) VA of 56.5 (19.8) letters at baseline, with 41% eyes achieving at least 20/40. The mean (95% CI) change in central subfield thickness over 1 year was - 79 (- 104, - 54) µm from a mean (SD) of 459 (120) µm at baseline. Eyes that completed 1 year of follow-up received a median (Q1, Q3) of 2 (1, 2) dexamethasone implants. One-tenth of phakic eyes received cataract surgery while 2% had a pressure response requiring anti-glaucoma medications. CONCLUSIONS One-year treatment outcomes of dexamethasone intravitreal implant for DMO in routine clinical practice were inferior to those in the clinical trials perhaps because of fewer treatments in clinical practice.
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Kodjikian L, Bandello F, de Smet M, Dot C, Zarranz-Ventura J, Loewenstein A, Sudhalkar A, Bilgic A, Cunha-Vaz J, Dirven W, Behar-Cohen F, Mathis T. Fluocinolone acetonide implant in diabetic macular edema: International experts' panel consensus guidelines and treatment algorithm. Eur J Ophthalmol 2022; 32:1890-1899. [PMID: 35139688 DOI: 10.1177/11206721221080288] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Center-involving diabetic macular edema (DME) is a leading cause of vision impairment in working-age adults. While its management is particularly challenging in a poorly compliant population, continuous innovation and the advent of new molecules have improved its outcome. The control of glycemia and of systemic aggravating factors remain essential to slow down progression of disease complications including DME. The indications for macular laser photocoagulation has progressively been phased out as a standard of care and replaced by local intraocular anti-VEGFs biologics and glucocorticoids (GCs). Intravitreal GCs in controlled-release drug delivery systems have allowed to reduce injection frequency and treatment burden. The non biodegradable Fluocinolone Acetonide (FAc) implant allows a long-lasting stabilization of both functional and anatomic improvements. However, adequate patient selection and monitoring through regular follow-up are essential for optimal results. Based on their experience and the latest literature, the aim of the present review is to provide international expert panel consensus on the place of the FAc implant in the treatment algorithm of DME, as well as its safety profile and how to manage it.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University Milan, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marc de Smet
- Department of Ophthalmology, 4496University of Leiden, Leiden, the Netherlands.,MicroInvasive Ocular Surgery Center, Lausanne, Switzerland
| | - Corrine Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.,French Military Health Service Academy, Val de Grâce, Paris, France
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), 16493Hospital Clínic de Barcelona, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.,The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Alper Bilgic
- Sudhalkar Eye Hospital and Retina Centre, Baroda, India
| | - José Cunha-Vaz
- Faculty of Medicine, AIBILI - Association for Innovation and Biomedical Research on Light and Image, University of Coimbra, Coimbra, Portugal
| | - Werner Dirven
- Department of Ophthalmology, AZ Turnhout Hospital, Turnhout, Belgium
| | - Francine Behar-Cohen
- Department of Ophthalmology, 26935Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, AP-HP, Université de Paris, Paris, France.,Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, Inserm, From physiopathology of retinal diseases to clinical advances, Paris, France
| | - Thibaud Mathis
- Department of Ophthalmology, 386696Croix-Rousse University Hospital, Hospices Civils de Lyon, University Lyon 1, Lyon, France.,UMR-CNRS 5510 Matéis, University Lyon 1, Villeurbane, France
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11
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Neves P, Ornelas M, Matias I, Rodrigues J, Santos M, Dutra-Medeiros M, Martins D. Dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes. Int J Ophthalmol 2021; 14:1571-1580. [PMID: 34667735 DOI: 10.18240/ijo.2021.10.15] [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: 07/24/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the safety and efficacy of intravitreal dexamethasone implants (Ozurdex®/DEX) in patients with diabetic macular edema (DME) either naïve or non-naïve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors (anti-VEGFs). METHODS This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients naïve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) was collected over 6mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients (57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment naïve before receiving DEX implant, was collected. RESULTS Improvement in mean BCVA was observed from 1-4mo after injection with a decreased effect at month 6 as expected, with better outcomes in naïve compared to non-naïve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2mo after DEX therapy. The mean number of injections of the overall population during the 6mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported. CONCLUSION This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in naïve patients.
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Affiliation(s)
- Pedro Neves
- Department of Ophthalmology, Centro Hospitalar de Setúbal, Setúbal 2910-549, Portugal
| | - Mário Ornelas
- Department of Ophthalmology, Centro Hospitalar de Setúbal, Setúbal 2910-549, Portugal
| | - Inês Matias
- Department of Ophthalmology, Centro Hospitalar de Setúbal, Setúbal 2910-549, Portugal
| | - João Rodrigues
- Department of Ophthalmology, Hospital Beatriz Ângelo, Loures 2674-514, Portugal
| | - Margarida Santos
- Department of Ophthalmology, Hospital da Luz Setúbal, Setúbal 2900-722, Portugal
| | - Marco Dutra-Medeiros
- Department of Ophthalmology, Centro Hospitalar Lisboa Central, Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon 1990-237, Portugal
| | - David Martins
- Department of Ophthalmology, Hospital da Luz Setúbal, Setúbal 2900-722, Portugal
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12
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Arrigo A, Aragona E, Capone L, Di Biase C, Lattanzio R, Bandello F. Intraocular Pressure Changes Are Predictive of Ocular Hypertension Onset After Fluocinolone Acetonide Implant: Significant Cutoffs and the Role of Previous DEX Implant. Front Med (Lausanne) 2021; 8:725349. [PMID: 34490313 PMCID: PMC8416620 DOI: 10.3389/fmed.2021.725349] [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: 06/19/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Fluocinolone acetonide (FAc) implant represents a long-term strategy for the management of diabetic macular edema (DME). Because of the 3-year duration, the careful monitoring of the intraocular pressure (IOP) is necessary. The main aim of the study was to provide quantitative IOP cutoffs associated with the onset of IOP increases. Methods: The study was retrospectively conducted with 2-year of follow-up. We separately considered eyes with good IOP control (Group 1), eyes requiring IOP-lowering medications (Group 2) and eyes undergoing IOP-lowering surgery (Group 3). The statistical analysis assessed Delta% IOP changes over the 2-year follow-up. ROC analysis was performed to detect significant cutoffs associated with Group 2 and Group 3. IOP changes occurring after a previously administered dexamethasone (DEX) implant were also evaluated. Results: We included 48 eyes (48 patients), stratified as follows: Group 1 (25/48; 52%), Group 2 (19/48; 40%) and Group 3 (4/48; 8%). ROC analysis performed on IOP values detected 2-months later DEX implant showed a mean Delta IOP increase>24% significantly associated with IOP-lowering medications after FAc implant, whereas a mean Delta IOP increase>35% was significantly associated with IOP-lowering surgery after FAc implant. With respect to IOP changes occurred after FAc implant, our ROC analysis showed a mean Delta IOP increase>8% significantly associated with IOP-lowering medications, whereas a mean Delta IOP increase>15% was significantly associated with IOP-lowering surgery. DEX-related IOP changes showed 52% sensitivity and 100% specificity of FAc-related IOP increases. Conclusions: IOP changes provides clinically relevant cutoffs associated with the onset of FAc-related IOP increases.
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Affiliation(s)
- Alessandro Arrigo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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13
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Garay-Aramburu G, Gómez-Moreno Á, Urcola A. Short-term effectiveness prognostic factors after dexamethasone intravitreal implant in macular edema due to retinal vein occlusion. Eur J Ophthalmol 2021; 32:1671-1679. [PMID: 34254547 DOI: 10.1177/11206721211032520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to describe functional and anatomical changes (best-corrected visual acuity [BCVA], central macular thickness [CMT], and central macular volume [CMV]) in patients with macular edema (ME) secondary to retinal vein occlusion (RVO) treated with intravitreal dexamethasone implant (IDI) and identify its clinical predictors in a real-world setting. METHODS Data from 111 patients who underwent IDI to treat RVO-associated ME were retrospectively reviewed. Demographic, preoperative, and postoperative variables were assessed using a logistic regression analysis to determine predictors of visual and anatomical improvement. RESULTS Mean BCVA, CMT, and CMV improved from baseline after IDI (p < 0.001). The strongest predictors of different treatment outcomes were: a baseline BCVA ⩽60 ETDRS letters (OR = 50.600; p < 0.001) and first IDI injection (OR = 2.988; p < 0.001) for BCVA gain ⩾15 Early Treatment Diabetic Retinopathy Study (ETDRS) letters; a baseline BCVA ⩽60 ETDRS letters (OR = 7.893; p = 0.002) and non-chronic ME (OR = 3.875; p = 0.019) for BCVA ⩾80 ETDRS letters achievement; a baseline CMT ⩾400 µm (OR = 49.083; p < 0.001) and a baseline CMV ⩾12 mm3 (OR = 4.235; p < 0.001) for CMT reduction ⩾50%; and a baseline CMT ⩾400 µm (OR = 11.471; p < 0.001) and a baseline CMV ⩾12 mm3 (OR = 10.284; p < 0.001) for CMV reduction ⩾15%. CONCLUSION This study confirmed the effectiveness of IDI to treat ME secondary to RVO and identified new predictive factors for two visual (⩾15 ETDRS letters gain and BCVA ⩾80 ETDRS letters) and two anatomical outcomes (>50% CMT and >15% CMV reduction).
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Affiliation(s)
- Gonzaga Garay-Aramburu
- Ophthalmology Department, Basurto University Hospital, Bilbao, Spain.,Universidad del Pais Vasco-Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Spain
| | | | - Aritz Urcola
- Universidad del Pais Vasco-Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Spain.,Ophthalmology Department, Araba University Hospital, Vitoria-Gasteiz, Spain
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14
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Rezkallah A, Mathis T, Abukhashabah A, Voirin N, Malclès A, Agard É, Lereuil T, Denis P, Dot C, Kodjikian L. LONG-TERM INCIDENCE AND RISK FACTORS OF OCULAR HYPERTENSION FOLLOWING DEXAMETHASONE-IMPLANT INJECTIONS: THE SAFODEX-2 STUDY. Retina 2021; 41:1438-1445. [PMID: 33315814 DOI: 10.1097/iae.0000000000003080] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To analyze the incidence, risk factors, and time to onset of ocular hypertension (OHT) after intravitreal injections (IVI) of dexamethasone implant and to evaluate the long-term cumulative probability of intraocular pressure elevation. METHODS Eyes of patients having received at least one dexamethasone implant IVI between October 2010 and February 2015 were included in the present study. Ocular hypertension was defined as intraocular pressure > 25 mmHg and/or an increase of 10 mmHg over the follow-up period compared with baseline intraocular pressure. RESULTS Four hundred ninety-four eyes were studied in 410 patients. For a total of 1,371 IVI, the incidence of OHT was 32.6% in the study eyes with a mean follow-up period of 30 months (3-62.5) and a median follow-up of 29 months. Pressure-lowering treatment was introduced for 36.9% of eyes. Topical treatment alone was sufficient to manage OHT in 97%. Young age, male sex, uveitis and retinal vein occlusion, and glaucoma treated with a double- or triple-combination topical pressure-lowering medication were found to be risk factors for OHT. The incidence of OHT did not change with an increase in the number of IVI, and there was no cumulative effect, defining by an increase of the incidence of OHT in patients after repeated IVI (P = 0.248). CONCLUSION This study confirmed that OHT is of moderate incidence, transient, controlled by topical treatment and provides data on the long-term cumulative probability of intraocular pressure elevation in a large cohort of eyes treated with dexamethasone implant IVI. Repeat injections of dexamethasone implant neither increase nor decrease the risk of OHT.
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Affiliation(s)
- Amina Rezkallah
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- UMR-CNRS 5510 Matéis, Villeurbane, France
| | - Amro Abukhashabah
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Voirin
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Ariane Malclès
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Émilie Agard
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
- French Military Health Service Academy, Val de Grâce, Paris, France
| | - Théo Lereuil
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France; and
- French Military Health Service Academy, Val de Grâce, Paris, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, Lyon, France
- UMR-CNRS 5510 Matéis, Villeurbane, France
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15
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Li YT, Cui XX, Yang XT, Li B, Ren XJ, Li XR, Zhang XM. Utilizing dexamethasone intravitreal implant to control postoperative inflammation in refractory uveitis undergoing cataract surgery. Int J Ophthalmol 2021; 14:317-322. [PMID: 33614464 DOI: 10.18240/ijo.2021.02.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/30/2020] [Indexed: 12/25/2022] Open
Abstract
AIM To report the effectiveness of intravitreal implantation of dexamethasone implant (Ozurdex) after phacoemulsification and intraocular lens implantation in refractory uveitis patients. METHODS This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation. The main outcome measurements were best-corrected visual acuity (BCVA), central retinal thickness (CRT), grade of anterior chamber cell (AAC), intraocular pressure (IOP), and systemic/ocular adverse events. RESULTS Ten eyes of 7 patients were included. BCVA showed significant improvement at 1mo (P=0.004), 3mo (P=0.0004), and 6mo (P=0.001) post operation. There were no statistically significant differences in the postoperative CRT among follow-up groups (P>0.05). No significant differences were observed in the baseline IOP when compared to 1, 3, and 6mo (all P>0.05) post operation. One patient developed a transient elevated IOP post injection. Two eyes (20%) developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy. In six patients (8 eyes, 71.4%), the systemic steroid usage was reduced to below 10 mg/d. The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6mo before operation and 0.7±0.48 in the 6mon post operation. The mean recurrence time was 13±0.58wk (range 12-14wk) post operation. In five of seven patients (7 out of 10 eyes), inflammation relapse was developed postoperatively. Only one patient (2 eyes) needed increased amounts of oral corticosteroids. Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids. CONCLUSION Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study. After the disappearance of Ozurdex's anti-inflammatory effects over time, in most cases the recurrent inflammation can be controlled by topical steroids.
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Affiliation(s)
- Yong-Tao Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xue-Xue Cui
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Tong Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Bing Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xin-Jun Ren
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Rong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Xiao-Min Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
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16
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Cicinelli MV, Rosenblatt A, Grosso D, Zollet P, Capone L, Rabiolo A, Lattanzio R, Loewenstein A, Bandello F. The outcome of fluocinolone acetonide intravitreal implant is predicted by the response to dexamethasone implant in diabetic macular oedema. Eye (Lond) 2021; 35:3232-3242. [PMID: 33479485 DOI: 10.1038/s41433-020-01373-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/15/2020] [Accepted: 12/09/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate if the visual and anatomic response to the first dexamethasone implant (DEX) predicts the 12-month clinical outcome after shifting to fluocinolone acetonide (FAc) implant in patients with diabetic macular oedema (DMO). METHODS Retrospective cohort study including pseudophakic patients with previously treated DMO, undergone one or more DEX injections before FAc. Functional and morphologic response to DEX was defined based on the best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes after the first DEX, respectively. Steroid-response was defined as intraocular pressure (IOP) elevation ≥5 mmHg or IOP > 21 mmHg after any previous DEX exposure. Pairwise comparisons for BCVA, CMT, and IOP after FAc were performed with linear mixed models and a repeated-measure design. RESULTS Forty-four eyes of 33 patients were included. Patients were shifted to FAc after a mean ± standard deviation of 4.6 ± 3.2 DEX injections. Overall, BCVA and CMT improved during the first 12 months after switching to FAc (p = 0.04 and p < 0.001, respectively). Only eyes with a good morphologic response to DEX had a significant CMT reduction after FAc (p < 0.001), while no significant relationship was found between BCVA improvement after DEX and after FAc. IOP elevation occurred in 9 eyes (20%) following DEX implant. These eyes carried a 20-fold increased risk of having an IOP rise after FAc (p < 0.001), with a non-linear relationship between the IOP increase after DEX and the one after FAc. CONCLUSION The response to previous DEX may anticipate the morphologic response to subsequent FAc. Eyes with steroid-induced IOP elevation after DEX are at a high risk of IOP increase after FAc. The visual response after FAc was not associated with the visual response to previous steroids, indicating that FAc may have a role also in patients refractory to DEX implant.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Amir Rosenblatt
- Division of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Domenico Grosso
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Piero Zollet
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Capone
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Rabiolo
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, United Kingdom
| | - Rosangela Lattanzio
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Anat Loewenstein
- Division of Ophthalmology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Francesco Bandello
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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17
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Zarranz-Ventura J, Romero-Núñez B, Bernal-Morales C, Velazquez-Villoria D, Sala-Puigdollers A, Figueras-Roca M, Copete S, Distefano L, Boixadera A, García-Arumi J, Adan A. Differential response to intravitreal dexamethasone implant in naïve and previously treated diabetic macular edema eyes. BMC Ophthalmol 2020; 20:443. [PMID: 33176749 PMCID: PMC7659223 DOI: 10.1186/s12886-020-01716-2] [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: 08/31/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Background To identify different response patterns to intravitreal dexamethasone implants (IDI) in naïve and previously treated (PT) diabetic macular edema (DME) eyes in a real-life setting. Methods 342 IDI injections (203 DME eyes) were included. Number of IDI injections, percentage (%) of eyes with 1, 2, 3 and ≥ 4 injections, time to reinjections, visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) were evaluated for naïve and PT DME eyes over 24 months. Results Mean number of injections was significantly lower in naïve vs PT DME eyes (1.40 ± 0.9 vs 1.82 ± 0.9, p < 0.001). The percentage of eyes receiving 1 injection was significantly higher in naïve vs PT DME eyes (76.1 vs 47.7), (p < 0.001). However, it was significantly lower for 2 (16.4 vs 29.4), or 3 injections (1.4 vs 17.6) (both p < 0.001), with no differences in eyes receiving ≥4 injections (5.9 vs 5.1 respectively, p = 0.80). Mean time to reinjection was not significantly different between both groups for the second, third and fourth injection (9.6 ± 4.0 vs 10.0 ± 5.5, p = 0.75, 13.2 ± 4.0 vs 16.0 ± 3.5, p = 0.21 and 21.7 ± 3.8 vs 19.7 ± 5.8, p = 0.55). VA scores were consistently better in naïve vs PT DME eyes at all studied timepoints, with no significant differences in CRT reduction or adverse effect rates. Conclusion Naïve DME eyes received lower number of IDI injections and showed better VA levels than PT DME eyes for 24 months in a real-world setting. This data supports the IDI use in early DME stages and provide further evidence of better IDI response when used as first-line therapy.
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Affiliation(s)
- Javier Zarranz-Ventura
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain. .,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Barbara Romero-Núñez
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | - Carolina Bernal-Morales
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain
| | | | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marc Figueras-Roca
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sergio Copete
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Laura Distefano
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Anna Boixadera
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Jose García-Arumi
- Departmento de Oftalmología, Hospital Vall de Hebron, Barcelona, Spain
| | - Alfredo Adan
- Institut Clínic d'Oftalmología (ICOF), Hospital Clinic, C/ Sabino Arana 1, 08028, Barcelona, Spain.,Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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18
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Carnevali A, Giannaccare G, Gatti V, Scuteri G, Randazzo G, Scorcia V. Intravitreal injections during COVID-19 outbreak: Real-world experience from an Italian tertiary referral center. Eur J Ophthalmol 2020; 31:10-12. [PMID: 32967465 DOI: 10.1177/1120672120962032] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report our experience during COVID-19 outbreak for intravitreal injections in patients with maculopathy. We proposed a treatment priority levels and timings; the "High" priority level includes all monocular patients; the "Moderate" is assigned to all patients with an active macular neovascularization; the patients affected by diabetic macular edema or retinal vein occlusion belong to the "Low" class. This organization allowed us to treat the most urgent patients although the injections performed had a 91.7% drop compared to the same period of 2019.
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Affiliation(s)
- Adriano Carnevali
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
| | | | - Valentina Gatti
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
| | - Gianfranco Scuteri
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
| | - Giorgio Randazzo
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy
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19
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Kuley B, Storey PP, Pancholy M, Bello N, Murphy J, Goodman J, Wibbelsman TD, Obeid A, Chiang A, Regillo C, Garg S. Ocular hypertension following 40 mg sub-Tenon triamcinolone versus 0.7 mg dexamethasone implant versus 2 mg intravitreal triamcinolone. Can J Ophthalmol 2020; 55:480-485. [PMID: 32853591 DOI: 10.1016/j.jcjo.2020.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare rates of ocular hypertension (OHT) in eyes receiving 40 mg sub-Tenon triamcinolone (STT), 0.7 mg dexamethasone implant (DEX), and 2 mg intravitreal triamcinolone (IVT). METHODS This study is a single-centre, retrospective case series. All patients receiving STT and DEX between 4/1/2014 and 3/1/2017 and IVT between 3/1/2012 and 3/1/2017 with a minimum of 3 months' follow-up were included. OHT was defined as an intraocular pressure (IOP) >24 mm Hg. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded. RESULTS 113 eyes from 104 patients in the STT group, 122 eyes from 109 patients in the DEX group, and 109 eyes from 103 patients in the IVT group were included. The mean number of injections for each eye was 1.7 in the STT group, 2.6 for the DEX group, and 2.8 for the IVT group (p < 0.001). Twenty eyes (17.7%) developed OHT in the STT group, 19 eyes (15.6%) developed OHT in the DEX group, and 14 eyes (12.8%) developed OHT in the IVT group (p = 0.60). IOP was controlled in all eyes with observation, topical IOP-lowering medication, or surgical intervention. The rate of incisional glaucoma surgery was 1.7% in the STT group, 1.6% in the DEX group, and 0% in the IVT group (p = 0.55). CONCLUSIONS The rate of OHT was similar across treatment groups. The proportion of OHT in patients with a history of glaucoma was no different from that in patients without a history of glaucoma. All cases were successfully managed with observation, medical treatment, or incisional surgery.
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Affiliation(s)
- Brandon Kuley
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | | | - Maitri Pancholy
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Nicholas Bello
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - James Murphy
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jake Goodman
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Turner D Wibbelsman
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Anthony Obeid
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Allen Chiang
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Carl Regillo
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Sunir Garg
- From the Mid Atlantic Retina, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA.
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Association between Early Anatomic Response and Intraocular Pressure Change after Intravitreal Dexamethasone Implant: An Optical Coherence Tomography Study. J Clin Med 2020; 9:jcm9092692. [PMID: 32825291 PMCID: PMC7564688 DOI: 10.3390/jcm9092692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose: To investigate the associations between early anatomical responses and intraocular pressure (IOP) changes in macular edema (ME) due to retinal vascular diseases treated with an intravitreal dexamethasone (DEX) implant. Methods: A retrospective review was conducted involving ME patients who underwent intravitreal DEX implantation. The eyes were divided into increased IOP (IIOP) or non-IIOP (nIIOP) groups according to the presence or absence of significant IOP elevation. Significant IOP elevation was defined by both the absolute value of IOP elevation (5 mmHg or higher) and an elevation percentage of the baseline IOP (an increase equal to 30% of the pre-injection IOP or higher). We analyzed the difference in central subfield thickness (CST) change according to the IOP elevation after DEX implantation. Relationships between IOP change and CST reduction after intravitreal DEX implantation were analyzed by Pearson correlation coefficients. Results: A total of 49 eyes, 29 with diabetic ME and 20 with ME due to retinal vein occlusion (RVO), were included in this study. Of the 49 eyes, 18 eyes (36.7%) were classified as IIOP group and 31 (63.3%) as nIIOP group. Significant differences in mean CST reductions over baseline one week after DEX implantation were observed between the groups. The degree of CST reduction from baseline to 1 week was significantly correlated with the degree of IOP change from baseline at 1 week and 1 month after intravitreal DEX implantation. Conclusions: In patients with ME due to retinal vascular diseases, we noted an early anatomical response significantly correlated with IOP change after intravitreal DEX implantation. Therefore, patients with favorable early anatomical responses to DEX implantation should be carefully monitored for IOP elevation.
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Adán A, Cabrera F, Figueroa MS, Cervera E, Ascaso FJ, Udaondo P, Abraldes M, Reyes MÁ, Pazos M, Pessoa B, Armadá F. Clinical-Decision Criteria to Identify Recurrent Diabetic Macular Edema Patients Suitable for Fluocinolone Acetonide Implant Therapy (ILUVIEN ®) and Follow-Up Considerations/Recommendations. Clin Ophthalmol 2020; 14:2091-2107. [PMID: 32801618 PMCID: PMC7398681 DOI: 10.2147/opth.s252359] [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: 03/03/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022] Open
Abstract
Current management of diabetic macular edema (DME) predominantly involves treatment with short-acting intravitreal injections of anti-vascular endothelial growth factors (anti-VEGFs) and/or corticosteroids; however, short-acting therapies (lasting between 1 and 6 months) require frequent injections to maintain efficacy, meaning a considerable treatment burden for diabetic patients with multiple comorbidities. Continuous injections needed in some cases are an economic burden for patients/healthcare system, so real-life clinical practice tends to adopt a reactive approach, ie, watch and wait for worsening symptoms, which consequently increases the risk of undertreatment and edema recurrence. On March 7th 2019, a group of experts in retinal medicine and surgery held a roundtable meeting in Madrid, Spain to discuss how to (1) optimize clinical outcomes through earlier use of fluocinolone acetonide (FAc) implant (ILUVIEN®) in patients with persistent or recurrent DME despite therapy; and, (2) to provide guidance to assist physicians in deciding which patients should be treated with ILUVIEN. In this regard, a 36-month follow-up consensus protocol is presented. In conclusion, patients that achieve a complete or partial anatomical, and preferably functional, response following one or two intravitreal dexamethasone implants, but with recurrence of edema after 3-4 months, are deemed by the authors most likely to benefit from ILUVIEN, and the switch to FAc implant should not be delayed more than 12 months after the initiation of at least the first dexamethasone implant.
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Affiliation(s)
| | - Francisco Cabrera
- Complejo Hospitalario Universitario Insular Materno-Lnfantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Francisco J Ascaso
- Hospital Clínico Universitario Lozano Blesa de Zaragoza, Aragon Health Research Institute (IIS Aragon), Zaragoza, Spain
| | - Patricia Udaondo
- Hospital Universitario y Politécnico la Fe de Valencia, Valencia, Spain
| | - Maximino Abraldes
- Complexo Hospitalario Universitario de Santiago de Compostela, Universidad de Santiago de Compostela, Instituto Oftalmológico Gómez-Ulla, Santiago de Compostela, Spain
| | - Miguel Ángel Reyes
- Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Marta Pazos
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Bernardete Pessoa
- Centro Hospitalar e Universitário do Porto, Hospital Geral de Santo António, Porto, Portugal
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Yorio T, Patel GC, Clark AF. Glucocorticoid-Induced Ocular Hypertension: Origins and New Approaches to Minimize. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 15:145-157. [PMID: 38274668 PMCID: PMC10810227 DOI: 10.1080/17469899.2020.1762488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Introduction Glucocorticoids (GCs) have unique actions in their combined anti-inflammatory and immunosuppressive activities and are among the most commonly-prescribed drugs, particularly for inflammatory conditions. They are often used clinically to treat inflammatory eye diseases like uveitis, optic neuritis, conjunctivitis, keratitis and others, but are often accompanied by side effects, like ocular hypertension that can be vision threatening. Areas covered The review will focus on the complex molecular mechanism of action of GCs that involve both transactivation and transrepression and their use therapeutically that can cause significant systemic side effects, particularly ocular hypertension that can lead to glaucoma. Expert Opinion While we are still unclear as to all the mechanisms responsible for GC-induced ocular hypertension, however, there are potential novel therapies that are in development that can separate some of the anti-inflammatory therapeutic efficacy from their ocular hypertension side effect. This review provides some insight into these approaches.
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Affiliation(s)
- Thomas Yorio
- Department of Pharmacology & Neuroscience, UNTHSC
- North Texas Eye Research, Institute, UNTHSC
| | | | - Abbot F. Clark
- Department of Pharmacology & Neuroscience, UNTHSC
- North Texas Eye Research, Institute, UNTHSC
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Adán A, Moll-Udina A, Alba-Linero C, Figueroa-Vercellino JP, Llorenç V. Recent progress in the treatment of uveitic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1644168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Alfredo Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Juan Pablo Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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