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Seraj H, Alhamoud M, Khoshhal MS, Alhashim H, Alsaif A, Abukhashabah A. The Uses of Photodynamic Therapy Versus Anti-vascular Endothelial Growth Factor in the Management of Acute Central Serous Chorioretinopathy: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e46100. [PMID: 37900481 PMCID: PMC10611943 DOI: 10.7759/cureus.46100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Central serous chorioretinopathy (CSCR) is an idiopathic chorioretinal disease characterized by localized serous detachment of the neurosensory retina at the macula. To date, there is no high-quality evidence of recent updates on treating acute CSCR, focusing on photodynamic therapy (PDT) and anti-vascular endothelial growth factor (anti-VEGF). Hence, this review aims to conduct a comprehensive systematic review of the most recent therapeutic approaches for acute CSCR using the following electronic databases for a comprehensive and systematic literature review: MEDLINE, EMBASE, and Cochrane. In addition, we analyzed studies comparing PDT with placebo, anti-VEGF with placebo, or PDT with anti-VEGF in treating acute CSC eyes with no previous intervention. Seven studies were included, with a total of 292 eyes. The overall positive results were significantly higher among patients who received PDT compared to control groups (odds ratio [OR] = 7.96, 95% confidence interval [CI], 3.02 to 20.95, p < 0.001). The proportions of positive results were 81.0% and 97.1% among patients who received anti-VEGF and PDT, respectively, with no statistically significant differences between the groups. In addition, there were no significant differences between anti-VEGF and control groups. In contrast, PDT was significantly associated with lower recurrence odds than the control groups (OR = 0.12, 95% CI, 0.04 to 0.39, p = 0.042). According to our findings, PDT showed higher positive results than anti-VEGF in acute CSCR. In addition, PDT was significantly associated with a lower recurrence rate than the control group. However, the analysis needs to be confirmed and updated by large-scale, well-designed randomized clinical trials.
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Affiliation(s)
- Hadeel Seraj
- Department of Ophthalmology, King Abdulaziz University, Jeddah, SAU
| | - Mustafa Alhamoud
- Department of Ophthalmology, King Fahd Hospital of the University, Dammam, SAU
| | | | - Hassan Alhashim
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Anas Alsaif
- College of Medicine, King Saud University, Riyadh, SAU
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Mathis T, Rezkallah A, Ricard C, Vartin C, Abukhashabah A, Devin F, Kodjikian L. REAL WORLD STUDY COMPARING PHAKIC VERSUS PSEUDOPHAKIC EYES IN DIABETIC MACULAR EDEMA TREATED WITH DEXAMETHASONE IMPLANT: The PHAKIDEX Study. Retina 2023; 43:1088-1096. [PMID: 36977332 DOI: 10.1097/iae.0000000000003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE Dexamethasone implant (DEX-implant) is one treatment choice in diabetic macular edema. However, steroid-induced cataract is a common complication when treating a chronic disease and could lead to vision loss. Because of the lack of studies specifically focused on the functional outcomes according to the lens status, the authors therefore aim to analyze the effectiveness and safety of DEX-implant treatment for diabetic macular edema in phakic versus pseudophakic eyes. METHODS This multicenter, retrospective study conducted in France included eyes of consecutive patients who had received a DEX-implant for diabetic macular edema. RESULTS A total of 328 eyes were included: 158 eyes (48.2%) were phakic, 167 eyes (50.9%) were pseudophakic and three were unknown. According to the lens status, mean change in best-corrected visual acuity from baseline was never significantly different between phakic and pseudophakic eyes (likelihood ratio test, P = 0.09) nor in the change in central macular thickness (likelihood ratio test, P = 0.79) in multivariate analysis. Cataract surgery was performed in 63 phakic eyes (39.9%) during the study period with a mean delay of 8.1 months (CI95% [6.59-9.69]). The mean change in best-corrected visual acuity between phakic eyes who underwent cataract surgery and those who did not, was not significantly different during the follow-up at each visit. The risk of ocular hypertension was not statistically different between phakic and pseudophakic subsets ( P = 0.9). CONCLUSION The authors showed here that phakic eyes treated with DEX-implant for diabetic macular edema did not have a significant difference in visual gain in comparison to pseudophakic eyes, with a comparable safety profile.
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Affiliation(s)
- Thibaud Mathis
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Univ Lyon, UCBL, INSA Lyon, CNRS, MATEIS, UMR5510, Villeurbanne, France
| | - Amina Rezkallah
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
| | - Cécile Ricard
- StatMed74, Independent Epidemiologist, Annecy, France
| | - Cristina Vartin
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Amro Abukhashabah
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Devin
- Centre Monticelli Paradis, Marseille, France; and
- Groupe Almaviva Santé, Clinique Juge, Marseille, France
| | - Laurent Kodjikian
- Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France
- Univ Lyon, UCBL, INSA Lyon, CNRS, MATEIS, UMR5510, Villeurbanne, France
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Kodjikian L, Abukhashabah A, Fardeau C, Tadayoni R, Brézin A, Dumas S, Weber M, Bernard L, Loria O, Decullier E, Huot L, Mathis T. Efficacy and safety of Aflibercept for the treatment of inflammatory choroidal neovascularization: The ALINEA study. Acta Ophthalmol 2023; 101:e43-e49. [PMID: 35822428 DOI: 10.1111/aos.15214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/07/2022] [Accepted: 06/26/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE To evaluate mean change in best-corrected visual acuity (BCVA) at 52 weeks in patients with inflammatory choroidal neovascularization (CNV) treated with aflibercept. METHODS We conducted a prospective non-comparative open-label trial. Following one mandatory intravitreal injection of aflibercept, patients were treated under a pro re nata (PRN) dosing regimen with monthly visits. RESULTS A total of 19 patients were included, but one presented exclusion criteria; 16 patients were followed for the whole 52-week study, and data for the primary endpoint analysis were available for 14. At baseline, mean BCVA and mean central retinal thickness (CRT) were 64.53 (±19.64) letters and 351.79 (±97.77) μm, respectively. At 52 weeks, the mean change in BCVA was +9.50 (±12.90) letters [95%CI = +2.05-+16.95]. One patient had lost more than 15-letters at 24 weeks, and another one at 52 weeks. CRT change was -62.77 (±100.73) μm at 24 weeks and -66.53 (±97.47) μm at 52 weeks. There was a mean number of 3.56 (±3.29) intravitreal injections at 52 weeks (min = 1; max = 12). No serious ocular adverse events related to the treatment were reported. CONCLUSIONS Our study shows that aflibercept is clinically effective, both anatomically and functionally in the treatment of inflammatory CNV. Following the first injection, the PRN strategy appears sufficient for treating most choroidal neovessels.
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Affiliation(s)
- Laurent Kodjikian
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,Université Lyon 1, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
| | - Amro Abukhashabah
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,Ophthalmology Department, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Christine Fardeau
- Ophthalmology Department, Reference Center for Rare Diseases, La Pitié-Salpêtriètre Hospital, Paris-Sorbonne University, Paris, France
| | - Ramin Tadayoni
- Université de Paris, Service d'Ophtalmologie, AP-HP, Hôpital Lariboisière, Paris, France.,Service d'Ophtalmologie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Antoine Brézin
- Hôpital Cochin, Service d'Ophtalmologie, Université de Paris, Paris, France
| | | | - Michel Weber
- Hôpital Universitaire Centre Nantes, Nantes, France
| | - Lorraine Bernard
- Université Lyon 1, Lyon, France.,Pôle de Santé Publique, Service de Biostatistique et Bioinformatique, Hospices Civils de Lyon, Lyon, France.,CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbane, France
| | - Olivier Loria
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
| | - Evelyne Decullier
- Pôle de Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
| | - Laure Huot
- Université Lyon 1, Lyon, France.,Pôle de Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
| | - Thibaud Mathis
- Hospices Civils de Lyon, Service d'Ophtalmologie, Centre Hospitalier Universitaire de la Croix-Rousse, Lyon, France.,Université Lyon 1, Lyon, France.,UMR5510 MATEIS, CNRS, INSA Lyon, Université Lyon 1, Villeurbanne, France
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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