Intravitreal Dexamethasone implant in the treatment of distinct optical coherence tomography types of macular edema secondary to retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the efficacy of intravitreal dexamethasone implant(DEX-I)in the treatment of different types of macular edema secondary to retinal vein occlusion(RVO).METHODS:A retrospective observational case study was conducted. A total of 46 patients(46 eyes)who were diagnosed with RVO-macular edema(ME)and received DEX-I of 0.7 mg as the initial treatment in Dalian No.3 People's Hospital from July 2019 to June 2020 were collected. According to the morphological characteristics of optical coherence tomography(OCT), they were divided into diffuse retinal thickening type(DRT type, 13 patients, 13 eyes), cystoid macular edema type(CME type, 22 patients, 22 eyes )and serous retinal detachment type(SRD type, 11 patients, 11 eyes ). The best corrected visual acuity(BCVA)and central retinal thickness(CRT)of patients with three types of macular edema were observed and compared before treatment and 1, 2 and 3mo after treatment.RESULTS:Compared with before treatment, BCVA of patients with DRT, CME and SRD were significantly improved at 1, 2 and 3mo after treatment, and CRT was significantly decreased(all P<0.017). At 3mo after treatment, BCVA(0.21±0.12, 0.22±0.10LogMAR)of DRT and SRD patients was significantly better than that of CME(0.45±0.14LogMAR, both P<0.017), and CRT(254.08±49.07, 248.92±44.19μm)was significantly lower than that of CME(314.70±92.66 μm, both P<0.017).CONCLUSIONS: DEX-I is effective in the treatment of various OCT types of macular edema secondary to RVO, and the treatment response of CME type is worse than that of DRT and SRD types.

Dexamethasone intravitreal implant for macular edema: a pilot study in a public health center

INTRODUCTION: Macula edema consists in one of the most common causes of visual impairment. OBJECTIVE: To evaluate the safety and efficacy of continuous release of 0.7 mg dexamethasone (using implantable device) for treatment of macular edema. METHODS: Cross-sectional observational study of 16 patients treated with 0.7 mg dexamethasone intraocular implant. Visual acuity, intraocular pressure and central macular thickness were recorded at baseline, 1-month and 3-month follow-up. RESULTS: 15 eyes of 13 patients were included. Most eyes (n=9) improve visual acuity from baseline at 1-month follow-up; this improvement persisted through 3-monyh follow-up in six eyes. The central macular thickness decreased in the majority of the subjects at 1-month (n=12) and at 3-month (n=10) follow-up. Three eyes presented with elevated intraocular pressure. CONCLUSION: Dexamethasone implant can both reduce the risk of vision loss and improve anatomical features of macular edema due to several pathologies studied. This implant may be used safely and should be considered a therapeutic option to Brazilian Public Health System.

Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema

Purpose: To evaluate the long-term safety and efficacy of the intravitreal dexamethasone implant in the treatment of diabetic macular edema (DME) as initial therapy. Methods: A hospital-based prospective, non-comparative case study of recently detected DME patients was conducted between July 2016 and December 2017, in which30 eyes of 30 patients were studied. Presenting vision, age, gender, duration of diabetes, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, fundus fluorescein angiography, optical coherence tomography (OCT), and blood sugar levels were noted. Patients with increased central macular thickness (CMT) received an intravitreal dexamethasone implant as initial therapy. All were followed up at 1 week, 1 month, 3 months, 6 months, and 1 year, and the findings were recorded and analyzed using SPSS software. Results: 30 eyes of 30 patients were studied which included 22 males and 8 females. The mean age of presentation was 58.7 ± 4.45 years. The mean decrease in CMT following intravitreal dexamethasone was 269.27 ± 112.002, 253.5 ± 108.294, and 286.73 ± 143.395 ?m at the end of 3, 6, and 12 months, respectively, and the mean improvement in visual acuity (VA) was 2.27 ± 1.70 lines at 3 months, 2.27 ± 1.83 lines at 6 months, and 1.17 ± 2.00 lines at 12 months. Out of 30 cases, 4 had persistent DME and 6 had recurrence of DME at completion of 1 year of follow-up. Conclusion: Intravitreal dexamethasone as initial therapy in the treatment of DME is both safe and efficacious in the reduction of CMT and improvement of vision and can be considered as primary therapy for DME.

OCTA as evaluation methods for the efficacy and safety of Dexamethasone intravitreal implants for retinal vein occlusion-related macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate the short-term efficacy and safety of intravitreal dexamethasone implant(IDI)for patients with retinal vein occlusion-related macular edema(RVO-ME)by using optical coherence tomography(OCTA).<p>METHODS: Seventeen eyes in 17 patients with RVO-ME were treated with intravitreal injection of sustained-release IDI. The best corrected visual acuity(BCVA), central macular thickness(CMT)and superficial retinal vascular network were observed at baseline, 1d, 1mo, 2mo, 3mo, 4mo and 6mo.<p>RESULTS: CMT was significantly reduced from baseline by 24h after injection and improved further during the 3mo follow-up, and the improvement of visual acuity was consistent with that of CMT. OCTA showed improvement from baseline in terms of decreased number and size of cysts and restoration of the retinal vascular network. A slight increase in intraocular pressure was observed in 2 eyes after injection. There were no systemic side effects associated with injection or medication during follow-up.<p>CONCLUSION: CMT reduced as early as 24h after the injection of IDI, with further reduction during follow-up, and OCTA could visually observe the changes of retinal vascular network in macular area.

Research progress of intravitreal Dexamethasone implant in the treatment of non-infectious uveitic macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

@#Macular edema(ME)is a typical non-specific complication of uveitis, one of the common causes of visual impairment in patients with non-infectious uveitis(NIU). The treatment of uveitis related ME is still challenging in clinic. Various agents, such as corticosteroids, anti-vascular endothelial growth factors, and immune-modulators, have been used for combating uveitis related 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. Recent studies have demonstrated that IDI effectively improves uveitis related ME, and this effect could be sustained for at least six months with close monitoring and retreatment, as needed. Currently, we reviewed major clinical studies about IDI in eyes with NIU and briefly overviewed their results.

The Effect of Epiretinal Membrane on Dexamethasone Implant for Branch Retinal Vein Occlusion Macular Edema

PURPOSE: To evaluate the effect of epiretinal membrane (ERM) on the outcomes of intravitreal dexamethasone implant (Ozurdex®, Allergan, Irvine, CA, USA) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Thirty eyes of 30 patients who received Ozurdex treatment for ME secondary to BRVO, and were followed-up for at least 6 months were retrospectively reviewed. Patients were divided into two groups based on the presence (ERM [+] or absence ERM [−]) of ERM at baseline. The best-corrected visual acuity (BCVA), central foveal thickness (CFT), recurrence of ME, and retreatment rate were evaluated at baseline, 1, 3, and 6 months after Ozurdex injection. RESULTS: Ten eyes of 30 eyes (33%) showed ERM at baseline. While the mean CFT was significantly reduced at 1 month after Ozurdex injection, it began to increase gradually thereafter in both groups. The ERM (+) group showed a significantly higher mean CFT than the corresponding values of the ERM (−) group at 1 (p = 0.022) and 6 months (p = 0.001) after Ozurdex injection. However, no significant difference was found in the BCVA between the two groups at every visit. The proportion of eyes with ME was significantly higher in the ERM (+) group (90%) than that in the ERM (−) group (35%) at 6 months after Ozurdex injection (p = 0.009). There were no significant differences between the two groups in the percentage of retreatment, time to retreatment, and type of materials used for retreatment. CONCLUSIONS: In patients with ME secondary to BRVO, the treatment effect of Ozurdex was low and the duration of treatment was short when ERM was concurrently present. However, the presence of ERM did not significantly affect visual outcomes after treatment with Ozurdex.

Intravitreal dexamethasone as an adjunct for the treatment of dengue virus related maculopathy: a case report

Dengue infection related ocular pathology whether as a direct manifestation of coagulopathy or as a sequale of immunological reaction is being increasingly recognized in endemic regions and has expanded out into a spectrum with pan ocular presentation. Authors present a case of a young female from an endemic region who developed visual field abnormality and loss of vision several days after onset of fever. She was diagnosed with dengue virus infection and subsequently went on to develop thrombocytopenia requiring transfusion. Detailed ophthalmological evaluation revealed maculae edema, and changes consistent with neuroretinitis and posterior segment vasculitis. She was treated with a combination of pulse steroid therapy and intravitreal dexamethasone injection. Patient went on to have excellent visual recovery on follow up with no persisting visual field deficit.

A Case of Intravitreal Dexamethasone Implantation in a Patient with Vogt-Koyanagi-Harada Disease

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease with chronic recurrence, which was treated with intravitreal dexamethasone implantation. CASE SUMMARY: A 39-year-old female presented with decreased visual acuities in both eyes accompanied by headaches and tinnitus the previous week. On fundus examination and optical coherence tomography, multiple serous retinal detachments with subretinal septa were observed in both eyes, and she was diagnosed with VKH disease. After undergoing high dose intravenous steroid therapy at another hospital, she was treated with oral prednisolone and immunosuppressant drugs. However, she showed frequent recurrences, and also complained of side effects from prolonged systemic steroids. We then performed intravitreal injections of dexamethasone implants in both eyes at 3-week intervals. One month following the injections, the inflammations in the anterior chamber and vitreous opacities were improved. Until the last visit at 6 months after the injection, there was no significant recurrence of inflammation, although oral prednisolone had been tapered. CONCLUSIONS: In VKH disease, intravitreal dexamethasone implantation may be an effective treatment option if chronic recurrence occurs, despite systemic steroid and immunosuppressant therapy or sustained treatment being difficult to maintain because of side effects.

Recurrence of Punctate Inner Choroidopathy with an Intravitreal Dexamethasone Implant

PURPOSE: To report a case of punctate inner choroidopathy (PIC) treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment. CASE SUMMARY: A 23-year-old highly myopic female who presented with PIC in her right eye was treated with an intravitreal dexamethasone implant due to side effects of systemic steroid treatment including facial edema and sleep disturbances. Three months after the implant she complained of severe acute visual disturbances in her right eye. Her visual acuity was classified as hand movement. Choroidal neovascularization (CNV) was observed on optical coherence tomography and indocyanine green angiography revealed more multiple hypofluorescent lesions compared to the initial visit. Six months after the systemic steroid and intravitreal bevacizumab injection treatments, visual acuity in right eye improved and the CNV disappeared. CONCLUSIONS: This report describes a case of PIC after, treatment with an intravitreal dexamethasone implant due to the side effects of systemic steroid treatment, which recurred with complications.

Efficacy and Safety of Intravitreal Dexamethasone Implants for Treatment of Refractory Diabetic Macular Edema

PURPOSE: To evaluate the safety and efficacy of intravitreal dexamethasone (IVD) implants in eyes with diabetic macular edema that did not respond to previous treatment. METHODS: We included 46 eyes of 46 patients in this retrospective study. Each month, we recorded patient visual acuity with logarithm of the minimum angle of resolution using the Early Treatment Diabetic Retinopathy Study chart, central macular thickness measurements with optical coherence tomography, intraocular pressure (IOP), and posttreatment complication occurrence. RESULTS: The mean follow-up time was 8.95 ± 1.33 months (range, 6 to 12). Best-corrected visual acuity improved significantly in the first 4 months after IVD, but no statistically significant change was observed over the following 2 months. Although a statistically significant decrease in central macular thickness was observed in the first 3 months, the change was not statistically significant in the following 3 months. There was a statistically significant increase in IOP in the first 2 months, but no statistically significant change was observed in the following months. IOP was controlled with medication in all patients with elevated IOP. Of the 26 phakic patients, two had cataracts requiring surgery. CONCLUSIONS: Cases of refractory diabetic macular edema that did not respond to previous treatment, such as anti-vascular endothelial growth factor injections and laser photocoagulation, exhibited improvements in visual acuity and decreases in retinal thickness after IVD implantation. Both functional and anatomical effects were observed in the first 3 months after injection. Repeat injections and frequent examination might be required for continued improvement. Side effects, such as cataracts and elevation of IOP, may require medical or surgical treatment.

Intravitreal Dexamethasone Implant for Macular Edema in Branch Retinal Vein Occlusion According to Previous Responses to Bevacizumab

PURPOSE: To compare the efficacy of intravitreal dexamethasone implant according to previous responses to Bevacizumab treatment in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty eyes of 60 patients who received an intravitreal dexamethasone implant for ME secondary to BRVO and followed up for at least 6 months were retrospectively reviewed. Of these, 31 patients were treatment naïve and 29 patients had previously received intravitreal injection of anti-vascular endothelial growth factor (VEGF). Out of these previously-treated patients, 17 patients were categorized as a refractory group who did not respond to previous injection and 12 patients were categorized as a responder group who showed recurrent ME despite a good response to previous anti-VEGF treatment. The best corrected visual acuity (BCVA), central macular thickness (CMT) and recurrence of ME were assessed monthly for 6 months. RESULTS: At each 3-month follow-up, the BCVA improved significantly from baseline in the naïve group, while the refractory group and the responder group showed significant improvement for only 2 months. At each 3-month follow-up, the CMT showed significant decreases in every group. However, the mean change in CMT from baseline showed significant differences between the 3 groups at month 3 (p < 0.001). During follow-up, 18 eyes in the naïve group (58.1%), 16 eyes in the refractory group (94.1%), and 6 eyes in the responder group (50.0%) received retreatment for the recurrence of ME, and there was a significant difference in the retreatment rate between the three groups (p = 0.016). CONCLUSIONS: Intravitreal dexamethasone implant showed early good functional and anatomical improvements irrespective of the response to the previous treatment in patients with ME secondary to BRVO. However, when treating the refractory group, more careful observation and intensive retreatment are required, considering the short duration of its efficacy.

Risk Factors and Incidence of Elevated Intraocular Pressure after Dexamethasone Intravitreal Implant

PURPOSE: To report the incidence of intraocular pressure (IOP) elevation and identify the risk factors of IOP elevation after intravitreal dexamethasone 0.7 mg (Ozurdex®, Allergan, Irvine, CA, USA) implant. METHODS: A total of 86 eyes of 79 patients who underwent intravitreal dexamethasone implantation and who were followed for ≥ 3 months were included in the present study. IOP elevation was defined as a pressure > 21 mm Hg at some time during follow-up. RESULTS: Twenty-nine eyes (33.7%) had an IOP > 21 mm Hg after dexamethasone intravitreal implant. The incidence of IOP elevation increased rapidly at 2–3 months after dexamethasone intravitreal implant. The Kaplan-Meier estimated incidence of IOP elevation was 25.6 ± 4.7% (mean ± standard error) at 81 days. Cox multivariate analysis showed the significant risk factors of IOP elevation to be age < 55 years (p = 0.045), baseline IOP ≥ 15 mm Hg (p < 0.001), and history of intraocular surgery (p = 0.039). CONCLUSIONS: This study demonstrates the incidence of IOP elevation to be 33.7% and describes the risk factors associated with IOP elevation. Clinicians should be cautious regarding the possibility of IOP elevation after intravitreal dexamethasone implant, especially in the presence of identified risk factors.

Intravitreal Injection of Dexamethasone Implant during Cataract Surgery in Patients with Noninfectious Uveitis

PURPOSE: To investigate the efficacy and safety of intravitreal dexamethasone implant for controlling postoperative inflammation among uveitis patients undergoing cataract extraction. METHODS: Ten eyes with noninfectious uveitis underwent phacoemulsification with intraocular lens implantation followed by intravitreal injection of 0.7-mg dexamethasone implant (implant group) between February 2011 and January 2014. Twenty age- and gender-matched controls who received cataract surgery without implantation during the same period were recruited (non-implant group). Medical records of the subjects were retrospectively reviewed and 6-month postoperative clinical outcomes were compared between the 2 groups. RESULTS: The mean age was 42.30 +/- 15.81 years in the implant group and 45.65 +/- 13.63 years in the non-implant group. The 2 groups were similar in terms of age, gender, preoperative inflammatory status, and preoperative visual acuity (p = 0.552, 1.000, 0.133 and 0.767, respectively). After surgery, oral steroid was used in the non-implant group (8.8 +/- 1.5 mg/day on average) and the implant group (3.5 +/- 1.3 mg/day; p = 0.029). Visual acuity (log MAR) improved significantly in both groups (p = 0.789) with no significant difference between the 2 groups. Postoperative recurrence rates of uveitis were reduced more (40%) in the implant group than in the non-implant group (50%) but without significance (p = 0.709). Elevated intraocular pressure > or =25 mm Hg occurred in 3 eyes (30%) in the implant group and 4 eyes (20%) in the non-implant group (p = 0.657), of which 1 in each group required a filtering surgery. Otherwise, no significant complications developed in either group. CONCLUSIONS: Intravitreal dexamethasone implants help reduce conventional oral steroid dosage for controlling postoperative inflammation. Dexamethasone implants could be an effective and safe alternative to control the inflammation after cataract surgery in uveitis patients.

The Effect of Prophylactic IOP-Lowering Medication after Intravitreal Dexamethasone Implantation

PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.

The Effect of Prophylactic IOP-Lowering Medication after Intravitreal Dexamethasone Implantation

PURPOSE: To investigate the effect of prophylactic intraocular pressure (IOP)-lowering medication after intravitreal dexamethasone implantation. METHODS: This is a retrospective analysis of 39 eyes undergoing intravitreal dexamethasone implantation for macular edema. Eyes were divided into two groups, those which had used prophylactic IOP-lowering medication and those which had not. IOP was measured preoperatively, at one week, and monthly until six months post-injection in each group. RESULTS: The mean pre-injection IOP for the group that had not used prophylactic IOP-lowering medication and the group that had was 13.95 +/- 3.32 mm Hg and 13.56 +/- 3.71 mm Hg, the mean post-injection IOP at two months was 15.81 +/- 3.75 mm Hg and 12.56 +/- 5.02 mm Hg, and that at six months was 12.90 +/- 2.95 mm Hg and 11.44 +/- 3.59 mm Hg, respectively. The difference between the two groups was statistically significant at one week, one month, two months, and three months (p = 0.001, 0.002, 0.011, 0.035, respectively). A greater than 22 mm Hg increase in IOP was seen in four eyes (19.05%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. A greater than 5 mm Hg increase in IOP from baseline was seen in eight eyes (38.10%) in the group that had not used IOP-lowering medication and in one eye (5.56%) in the group that had. CONCLUSIONS: After intravitreal dexamethasone implantation, prophylactic IOP-lowering medication will significantly prevent IOP increase and decrease the number of patients requiring additional treatment that could cause potential damage to the retina and optic nerve.

Reversal of Early Central Retinal Vein Occlusion by Alleviating Optic Nerve Edema with an Intravitreal Dexamethasone Implant

This case describes the reversal of early central retinal vein occlusion (CRVO) with disc swelling after intravitreal dexamethasone implant (Ozurdex) injection. A 44-year-old female presented with sudden-onset intermittent blurred vision in her left eye. Fundus examination revealed multiple retinal hemorrhages without macular edema (ME). Two weeks later, an increased number of retinal hemorrhages with severe disc swelling were noted with still no sign of ME. An intravitreal dexamethasone implant was injected. Five days later, there were improvements in disc swelling and retinal hemorrhage. One month later, her subjective visual symptoms were completely improved, and fundus examination revealed marked improvement along with almost complete resolution of disc swelling. Intravitreal dexamethasone implant injection may potentially change the natural course of CRVO progression and its various subsequent complications.