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Smith JR, Thorne JE, Flaxel CJ, Jain N, Kim SJ, Maguire MG, Patel S, Weng CY, Yeh S, Kim LA. Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology. Ophthalmology 2024:S0161-6420(24)00158-1. [PMID: 38647511 DOI: 10.1016/j.ophtha.2024.02.019] [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: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. METHODS A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. RESULTS This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. CONCLUSIONS The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Jennifer E Thorne
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christina J Flaxel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Nieraj Jain
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Maureen G Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shriji Patel
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Christina Y Weng
- Vitreoretinal Diseases & Surgery, Baylor College of Medicine, Cullen Eye Institute, Houston, Texas
| | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Ophthalmology, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Leo A Kim
- Department of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Menia NK, Mohan S, Agarwal A. Intravitreal immunotherapy in non-infectious uveitis: an update. Expert Rev Clin Pharmacol 2023; 16:959-976. [PMID: 37674332 DOI: 10.1080/17512433.2023.2256660] [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: 03/27/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION In the past several years, there have been numerous advances in pharmacotherapeutics for the management of uveitis and other ocular inflammatory diseases, including newer therapeutic agents and ocular drug delivery systems. One of the most attractive modes of drug delivery is the intravitreal route since it has proven to be safe and efficacious and prevents unwanted systemic adverse events related to the agent. AREAS COVERED In this review, intravitreal delivery of various pharmacotherapeutic agents for noninfectious uveitis has been described. An extensive review of the literature was performed using specific keywords on the PubMed database to identify clinical studies employing various pharmacotherapeutic agents with intravitreal drug delivery for noninfectious uveitis. The mode of action, safety, efficacy, and tolerability of these drugs have also been elucidated. EXPERT OPINION Several agents, including biologic response modifier agents, have been found to be safe and efficacious for various indications of uveitis, such as cystoid macular edema, active uveitis, and other conditions such as retinal vasculitis and vitreous haze. The use of intravitreal biological therapies, especially infliximab, has been fraught with potential safety signals such as photoreceptor toxicity. However, pharmacotherapeutic agents such as corticosteroids and anti-vascular endothelial growth factor agents are now widely used in the clinical management of uveitis and its complications.
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Affiliation(s)
- Nitin Kumar Menia
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Jammu, India
| | - Sashwanthi Mohan
- Department of Ophthalmology, Medcare Eye Center, Dubai, United Arab Emirates
| | - Aniruddha Agarwal
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Department of Ophthalmology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Fan S, Shi XY, Zhao CF, Chen Z, Ying J, Yu SP, Li J, Li X. Efficacy and safety of single-dose intravitreal dexamethasone implant in non-infectious uveitic macular edema: A systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1126724. [PMID: 36873888 PMCID: PMC9982842 DOI: 10.3389/fmed.2023.1126724] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023] Open
Abstract
Purpose We conducted a systematic review and meta-analysis to investigate the efficacy and safety of single-dose intravitreal dexamethasone (DEX) implant for treating non-infectious uveitic macular edema (UME). Methods Studies including clinical outcomes of the DEX implant in UME were comprehensively searched in PubMed, Embase, and Cochrane databases for potential studies from inception to July 2022. The primary outcomes were best corrected visual acuity (BCVA) and central macular thickness (CMT) during the follow-up period. Stata 12.0 was used to perform the statistical analyses. Results Six retrospective studies and one prospective investigation involving 201 eyes were ultimately included. Significantly improved BCVA was observed from baseline to 1 month (WMD = -0.15, 95%CI = -0.24, -0.06), 3 months (WMD = -0.22, 95%CI = -0.29, -0.15), and 6 months (WMD = -0.24, 95%CI = -0.35, -0.13), after single-dose DEX implant. When considering CMT, macular thickness of 1 month (WMD = -179.77, 95%CI = -223.45, -136.09), 3 months (WMD = -179.13, 95%CI = -232.63, -125.63), and 6 months (WMD = -140.25, 95%CI = -227.61, -52.88) decreased in comparison with baseline, with statistical significance. Conclusion Based on the current results, this meta-analysis confirmed favorable visual prognosis and anatomical improvement in patients with UME, after receiving the single-dose DEX implant. The most common adverse event is increased intraocular pressure, which could be controlled with topical medications.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022325969.
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Affiliation(s)
- Shipei Fan
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Xing-Yu Shi
- Department of Nephrology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Chao-Fu Zhao
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Zhen Chen
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Jia Ying
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Song-Ping Yu
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Jun Li
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Xia Li
- Department of Ophthalmology, Lishui Municipal Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
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Modugno RL, Testi I, Pavesio C. Intraocular therapy in noninfectious uveitis. J Ophthalmic Inflamm Infect 2021; 11:37. [PMID: 34632541 PMCID: PMC8502718 DOI: 10.1186/s12348-021-00267-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 09/19/2021] [Indexed: 12/29/2022] Open
Abstract
Systemic corticosteroids and immunosuppressant agents are the mainstay of therapy for non-infectious uveitis (NIU). However, the risks associated with systemic administration and the need of delivering an effective and safe anti-inflammatory treatment targeted to the site of inflammation have prompt the use of local therapy in the management of NIU. This review will analyse the different local treatment options available, including corticosteroids, anti-vascular endothelial growth factor (VEGF), methotrexate and the recent biologics.
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Affiliation(s)
- Rocco Luigi Modugno
- Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy
| | - Ilaria Testi
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK
| | - Carlos Pavesio
- Moorfields Eye Hospital, National Health Service Foundation Trust, 162 City Rd, Old Street, London, EC1V 2PD, UK. .,Biomedical Research Centre, Institute of Ophthalmology, UCL, London, UK.
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Udaondo P, Adan A, Arias-Barquet L, Ascaso FJ, Cabrera-López F, Castro-Navarro V, Donate-López J, García-Layana A, Lavid FJ, Rodríguez-Maqueda M, Ruiz-Moreno JM. Challenges in Diabetic Macular Edema Management: An Expert Consensus Report. Clin Ophthalmol 2021; 15:3183-3195. [PMID: 34349495 PMCID: PMC8327476 DOI: 10.2147/opth.s320948] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/23/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel. Methods A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients. Results Panel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors. Conclusion This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients.
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Affiliation(s)
- Patricia Udaondo
- Department of Ophthalmology, Hospital Universitario y Politecnico la FE, Valencia, Spain
| | - Alfredo Adan
- Department of Ophthalmology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Luis Arias-Barquet
- Department of Ophthalmology, University Complex Bellvitge, Barcelona, Spain
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Universitario Lozano Blesa, Zaragoza, Spain
| | - Francisco Cabrera-López
- Department of Ophthalmology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain
| | | | - Juan Donate-López
- Department of Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain
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Moll-Udina A, Figueras-Roca M, Oliveres J, Sala-Puigdollers A, Esquinas C, Alba-Linero C, Llorenç V, Adán A. Uveitic macular edema response to intravitreal dexamethasone implant is independent of optical coherence tomography findings. Int Ophthalmol 2020; 41:787-796. [PMID: 33184677 DOI: 10.1007/s10792-020-01631-x] [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: 06/17/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify predictive response optical coherence tomography (OCT) findings in uveitic macular edema (UME) treated with intravitreal dexamethasone implant (DEX). METHODS Retrospective study of 66 eyes (53 patients) treated with DEX for UME. SD-OCT macular scans were collected prior to DEX treatment and 6 weeks and 3 months after the DEX implant. OCT images were evaluated for qualitative and quantitative characteristics (central retinal thickness, CRT and macular volume, MV). A multivariate analysis of covariance (ANCOVA) was carried out to study the predictive influence of OCT and clinical covariates on outcomes. The main outcome was a composite endpoint based on the simultaneous gain of 5 or more letters associated with a 20% or more reduction in CRT. RESULTS A significant improvement in BCVA at 6 weeks (mean change from baseline -0.2, SD 0.3) and 3 months (mean -0.2, SD 0.4) was observed after the DEX implant. A significant decrease in CRT (change from baseline -187.7 μm at 3 months) and MV (change from baseline -1.7 mm3 at 3 months) were also observed. An association of ≥ 5-letter improvement in BCVA and a ≥ 20% CRT reduction was observed in 44.6% of cases at 6 weeks and 31.4% at 3 months. ANCOVA multivariate analyses found CRT at 3 months independent from baseline clinical variables but from CRT. CONCLUSION DEX implant is an effective treatment for UME independently of basal characteristics, producing both a gain of visual acuity and improvement of macular anatomy by OCT measures at 3 months.
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Affiliation(s)
- Aina Moll-Udina
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain. .,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
| | - Marc Figueras-Roca
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Joan Oliveres
- Hospital Vall D'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Anna Sala-Puigdollers
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Esquinas
- Vall Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Hospital Clínic, Instituto Clínic de Oftalmologia (ICOF), University of Barcelona, Sabino de Arana 1, 08028, Barcelona, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
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Castro-Navarro V, Monferrer-Adsuara C, Navarro-Palop C, Montero-Hernández J, Cervera-Taulet E. Effect of Dexamethasone Intravitreal Implant on Visual Acuity and Foveal Photoreceptor Integrity in Macular Edema Secondary to Retinal Vascular Disease. Ophthalmologica 2020; 244:83-92. [PMID: 33045712 DOI: 10.1159/000512195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to evaluate the effect of the dexamethasone intravitreal (DEX) implant on the external limiting membrane (ELM) and ellipsoid zone (EZ) integrity in treatment-naïve patients with macular edema (ME) secondary to retinal vascular disease (RVD). METHODS This is a retrospective study conducted on patients with ME secondary to RVD, who underwent a DEX implant. RESULTS One-hundred eyes were included. Mean age was 70.3 ± 11.1 years. Mean ELM integrity significantly improved from 1,575.9 ± 285.9 μm at baseline to 1,711.7 ± 244.0 μm at month 3 (p < 0.0001). Similarly, there was a significant improvement in EZ integrity from baseline to month 3 (1,531.5 ± 317.1 vs. 1,694.3 ± 252.8 μm, respectively, p < 0.0001). At month 3, mean visual acuity (VA) gain was 9.9 ± 14.1 letters (p < 0.0001). Mean central retinal thickness (CRT) significantly decreased by -193.2 ± 185.7 μm from baseline to month 3 (p < 0.0001). Mean changes in VA and CRT were significantly correlated with baseline ELM integrity (p = 0.0065 and p = 0.0046, respectively) and EZ integrity (p = 0.0300 and p = 0.0035, respectively). At month 3, the proportion of eyes which had an intact ELM (mean difference 16.0%, 95% CI 5.4-26.4%, p = 0.0033) and EZ (mean difference 12.0%, 95% CI 1.8-22.1%, p = 0.0210) was significantly higher than at baseline. CONCLUSIONS DEX implant was able to significantly improve ELM and EZ integrity in naïve patients with ME.
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Affiliation(s)
- Verónica Castro-Navarro
- Department of Ophthalmology, Consorci Hospital General Universitari de Valencia, Valencia, Spain,
| | - Clara Monferrer-Adsuara
- Department of Ophthalmology, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Catalina Navarro-Palop
- Department of Ophthalmology, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Javier Montero-Hernández
- Department of Ophthalmology, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Enrique Cervera-Taulet
- Department of Ophthalmology, Consorci Hospital General Universitari de Valencia, Valencia, Spain
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RETAINED, NONDISSOLVING, TUBULAR FOREIGN BODIES IN THE VITREOUS CAVITY AFTER INTRAVITREAL DEXAMETHASONE (OZURDEX) IMPLANTATION. Retina 2020; 40:2221-2225. [PMID: 32379167 PMCID: PMC9206819 DOI: 10.1097/iae.0000000000002824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the retention of large, tubular, nondissolving foreign bodies because of a complication of the intravitreal dexamethasone implant (Ozurdex). METHODS This is a single-center, retrospective chart review of patients who were found to have retained, nondissolvable tubular foreign bodies in the vitreous cavity for more than 6 months (the expected dissolution time of the implants) after Ozurdex injections. Ocular symptomatology and multimodal imaging were reviewed. RESULTS Five patients had retained, nondissolvable tubular foreign bodies in the vitreous that persisted for months (mean 28.2 months, range 9-67 months) after intravitreal injection of Ozurdex. Two patients were symptomatic due to the foreign bodies and chose alternate local therapy, but none of the patients opted for surgical explantation. CONCLUSION Persistent, nondissolving, tubular foreign bodies can be seen in the vitreous cavity for years after injection of the Ozurdex implant. Clinicians should be aware of this complication that has the potential to cause visual symptoms and ocular morbidity.
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Evaluation of Functional Outcomes and OCT-Biomarkers after Intravitreal Dexamethasone Implant for Postoperative Cystoid Macular Edema in Vitrectomized Eyes. J Ophthalmol 2020; 2020:3946531. [PMID: 32411428 PMCID: PMC7204163 DOI: 10.1155/2020/3946531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy of dexamethasone implant (DEX) for the treatment of postoperative cystoid macular edema (PCME) in vitrectomized eyes and to investigate visual and morphological OCT predictive factors. Methods In this retrospective study, eyes with PCME after vitrectomy were treated with at least one DEX injection and were observed over 12 months. Indications for surgery were epiretinal membrane (ERM) or rhegmatogenous retinal detachment (RRD) without macular involvement. Prior treatments, if any, were noted. Best corrected visual acuity (BCVA), central foveal thickness (CFT), and OCT morphology including the presence of intraretinal cysts/fluid or subretinal fluid (IRF/SRF) and ellipsoid zone (EZ) continuity were evaluated. Correlations between OCT measures and visual outcomes were analyzed by the generalized estimating equations procedure. Results Forty-six eyes with ERM and 15 eyes with RRD were enrolled. The ERM group was more likely to gain BCVA than RRD (odds ratio (OR), 1.168; 95% confidence interval (CI), 1.003–1.360; p=0.046). The absence of SRF (OR, 0.860; 95% CI, 0.743–0.995; p=0.043) was predictive of worse BCVA, whereas the integrity of EZ (OR, 1.094; 95% CI, 0.951–1.257; p=0.209) or naïve status (OR, 0.946; 95% CI, 0.871–1.137, p=0.853) was not. Eyes with a worse baseline BCVA were more likely to gain >1 line after 12 months (OR, 1.485; 95% CI, 1.171–1.884; p=0.001). Conclusion The efficacy of the treatment of PCME in vitrectomized eyes seems to be affected by baseline BCVA, the absence of SRF, and the indication for surgery. Naïve status appears not to play any significant role in the prediction of BCVA. This trial is registered with DRKS00018955.
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Saincher SS, Gottlieb C. Ozurdex (dexamethasone intravitreal implant) for the treatment of intermediate, posterior, and panuveitis: a systematic review of the current evidence. J Ophthalmic Inflamm Infect 2020; 10:1. [PMID: 31925591 PMCID: PMC6954157 DOI: 10.1186/s12348-019-0189-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022] Open
Abstract
Background This study aims to determine if the intravitreal dexamethasone implant (DEX implant, Ozurdex; Allergan, Inc., Irvine, California) is effective for treating intermediate, posterior, and panuveitis as a monotherapy or adjunctive treatment to systemic immunomodulatory therapies. Methods A systematic review using MEDLINE, EMBASE, and PubMed database searches was conducted with the Oxford Centre for Evidence-based Medicine Levels of Evidence criteria to select publications. Available background information and patient data from each study was tabulated. Outcomes studied were central retinal thickness (CRT), best corrected visual acuity, intraocular inflammation (anterior chamber cells, vitreous haze), number of patients with prior and concomitant immunomodulatory treatments, intraocular pressure (IOP) elevation (≥ 25 mmHg), and other adverse effects associated with the implant. Results One hundred ninety-five (61.51%) patients had previous immunomodulatory treatment while 232 (64.8%) were treated with concomitant immunomodulatory therapy with the DEX implant. CRT decreased by an average of 198.65 μm (42.74%). Visual acuity improved to an average of 0.451 (logMAR) or 20/57 (Snellen) which is a 43.11% improvement from baseline. One hundred seventy-three (59%) of eyes were quiescent at the end of the trials, of which 40 (13.7%) previously inflamed eyes became quiescent. Elevated IOP occurred in 91 (20.6%). The most common adverse events were cataract/posterior subcapsular opacities in 47 (11.03%) patients and conjunctival hemorrhage in 24 (5.44%) patients. Conclusions The DEX implant is an effective medication for the treatment of posterior segment uveitis, uveitic macular edema, and results in improved visual acuity. Development of elevated IOP and cataract should be closely monitored as they are tangible risks associated with the DEX implant. This study was not able to determine whether the DEX implant was more effective as a monotherapy or as an adjunctive therapy to systemic immunomodulatory treatment.
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Affiliation(s)
- Saanwalshah Samir Saincher
- Department of Health-Sciences, Bristol Medical School, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, UK. .,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Chloe Gottlieb
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,University of Ottawa Eye Institute, The Ottawa Hospital, General Campus, 501 Smyth Road, CCW Box 307, Ottawa, Ontario, K1H 8L6, Canada
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11
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Dexamethasone intravitreal implant (OZURDEX®) for macular edema secondary to noninfectious uveitis: a review of the literature. Ther Deliv 2019; 10:343-351. [DOI: 10.4155/tde-2019-0024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Macular edema (ME) is the leading cause of visual loss in uveitis and may persist long after ocular inflammation has been resolved. Local steroids are the first line treatment for uveitis and uveitic ME. Dexamethasone intravitreal implant (OZURDEX®; Allergan, Inc., CA, USA) has been used to treat diabetic ME and ME secondary to retinal vein occlusion. Recent studies have also demonstrated that Ozurdex may be effective treatment for patients with persistent uveitic ME. In this review, we present the results of the real word studies concerning the efficacy and safety of Ozurdex for the treatment of uveitic ME.
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12
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The Role of Optical Coherence Tomography Angiography in the Management of Uveitis. Int Ophthalmol Clin 2018; 56:1-24. [PMID: 27575755 DOI: 10.1097/iio.0000000000000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Shah KK, Majumder PD, Biswas J. Intravitreal therapeutic agents in noninfectious uveitic macular edema. Indian J Ophthalmol 2018; 66:1060-1073. [PMID: 30038143 PMCID: PMC6080427 DOI: 10.4103/ijo.ijo_35_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The management of uveitis is challenging for most treating ophthalmologists. The treatment of uveitis often requires the use of high dose of systemic corticosteroid and immunosuppressive agents, which are almost always associated with potential side effects. Intravitreal medications have become a popular mode of drug administration in uveitis patients as they provide high volume of drug to the target tissues, eliminating the risk of systemic toxicity. There has been tremendous development in the intravitreal therapeutics over the last few years. With the advent of sustained-release technique, increasing patient compliance, biodegradable nature of the implant, and introduction of newer agents with better safety profile, the intravitreal medications have become more popular in recent years. This review presents evidence in the scientific literature supporting the use of intravitreal medications for the management of uveitis and its complications.
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Affiliation(s)
- Kunal Kaushik Shah
- Shri Bhagwan Mahavir VitreoRetinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Jyotirmay Biswas
- Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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14
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Hatz K, Ebneter A, Tuerksever C, Pruente C, Zinkernagel M. Repeated Dexamethasone Intravitreal Implant for the Treatment of Diabetic Macular Oedema Unresponsive to Anti-VEGF Therapy: Outcome and Predictive SD-OCT Features. Ophthalmologica 2018; 239:205-214. [PMID: 29402873 DOI: 10.1159/000485852] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/28/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate dexamethasone intravitreal implant 0.7 mg (DEX implant) for the treatment of diabetic macular oedema (DME) refractory to anti-vascular endothelial growth factor (anti-VEGF) therapy and evaluate predictive factors. METHODS Two-centre retrospective interventional case series, including 40 eyes of 31 patients treated with DEX implant for at least 2 consecutive cycles. RESULTS Mean ± SD intervals from implantation to recurrence in the first (4.2 ± 1.0 months) and second cycles (4.0 ± 0.9 months) were not significantly different. Best corrected visual acuity improved significantly (p < 0.001) by 7.0 ± 8.4 letters from baseline to month 2, and by 5.1 ± 6.9 letters between the first and second cycles. Central retinal thickness reduction 2 months after implantation was greater after the first (-194 ± 172 µm) than the second cycle (-134 ± 150 µm). Ellipsoid zone-external limiting membrane (EZ-ELM) disruption score decreased from 1.39 ± 1.16 at baseline to 1.24 ± 1.16 (p = 0.0832) after cycle 1 and remained stable 2 months after cycle 2. Eyes with persisting severe EZ-ELM disruption (score >2, n = 10) 2 months after the first DEX implant showed significantly (p = 0.0153) smaller visual acuity (VA) gains than eyes with less severe (score ≤2) EZ-ELM disruption. CONCLUSION Repeated intravitreal DEX injections with average intervals of 4 months are valuable in patients with DME refractory to anti-VEGF therapy. Disorganization of outer retinal layers (EZ-ELM) may predict smaller VA gains if evaluated after initial reduction of macular oedema.
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Affiliation(s)
- Katja Hatz
- Vista Klinik, Binningen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland
| | | | | | - Christian Pruente
- Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, Kantonsspital Liestal, Liestal, Switzerland
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15
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Karti O, Saatci AO. Intravitreal Dexamethasone Implant in the Treatment of Non-Infectious Uveitic Macular Edema. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2018; 7:169-175. [PMID: 30505868 PMCID: PMC6229676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Macular Edema (ME) is a common complication, leading to severe vision loss in patients with Non-Infectious Uveitis (NIU). The treatment of uveitic ME is still very challenging for many ophthalmologists. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combatting uveitic ME. However, there is not enough evidence to support the efficacy of any of these agents. Intravitreal Dexamethasone Implant (IDI) (Ozurdex; Allergan Inc, Irvine, CA) is a widely administered corticosteroid for the long-term management of uveitic ME in certain cases. Ophthalmic implant is made up of a biodegradable copolymer that contains glycolic acid and lactic acid. Recent studies have demonstrated that dexamethasone implant effectively improves uveitis-related ME. The authors suggest that this effect could be sustained for at least six months with close monitoring and re-treatment, as needed. The current study reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results.
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Affiliation(s)
- Omer Karti
- Department of Ophthalmology, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, İzmir, Turkey
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16
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Iacono P, Parodi MB, Scaramuzzi M, Bandello F. Morphological and functional changes in recalcitrant diabetic macular oedema after intravitreal dexamethasone implant. Br J Ophthalmol 2016; 101:791-795. [DOI: 10.1136/bjophthalmol-2016-308726] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/22/2016] [Accepted: 08/28/2016] [Indexed: 01/04/2023]
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