Treatment of anti-vascular endothelial growth factor-resistant diabetic macular edema with dexamethasone intravitreal implant.

PURPOSE: To investigate the efficiency of intravitreal dexamethasone implant in patients with chronic diabetic macular edema nonresponsive to three consecutive monthly intravitreal injections of anti-vascular endothelial growth factor administered previously. METHODS: Fifteen patients (16 eyes) were included in this 4-month prospective clinical trial. Main observed outcomes were the changes between initial and monthly visits in best-corrected visual acuity, central foveal thickness, and intraocular pressure (IOP). Patients included had central foveal thickness of >225 µm (measured by optical coherence tomography) and were nonresponsive to previously administered 3 consecutive monthly intravitreal injections of 1.25-mg bevacizumab. Administration of intravitreal dexamethasone implant was performed at baseline, and patients were followed-up monthly. RESULTS: Statistically significant changes from baseline were observed in best-corrected visual acuity (at 2 months), central foveal thickness (at 1, 2, and 3 months), and IOP (at Months 1, 2, and 3) as follows: mean best-corrected visual acuity significantly increased from 0.29 Snellen lines at baseline to 0.39 lines after 2 months (P = 0.0381). At Months 1, 2, and 3, the mean central foveal thickness significantly decreased, from 462 µm at baseline, to 366 µm (P = 0.0343), 346 µm (P = 0.0288), and 355 µm (P = 0.0370), respectively. When compared with baseline IOP of 15.38 mmHg (12-19 mmHg), IOP increased significantly at Months 1, 2, and 3: 18.93 mmHg (range, 16-24 mmHg; P = 0.0003), 19.5 mmHg (range, 16-27 mmHg; P = 0.0003), and 17.5 mmHg (range, 15-21 mmHg; P = 0.0048), respectively. CONCLUSION: Dexamethasone intravitreal implant may present an alternative option in the treatment of chronic diabetic macular edema nonresponsive to three consecutive monthly bevacizumab injections administered previously. However, IOP measures were only slightly increased. It seems that the effect of dexamethasone may last till 4 months after initial injection.

Anti-VEGF in treatment of central retinal vein occlusion.

Macular edema along with macular ischemia is responsible for decreased visual acuity in central retinal vein occlusion. Bevacizumab (Avastin, Genentech) blocks vascular endothelial growth factor (VEGF) induced hyperpermeability of blood vessels. In this prospective case series we investigated the efficacy of anti-VEGF treatment in reduction of central retinal thickness (CRT) and improvement in visual acuity (VA). 25 patients were followed up for 12 months and treated monthly with intravitreal bevacizumab. VA and CRT were measured at each visit. Treatment was discontinued as the peak improvement of either parameter was reached and reinstituted in case of deterioration/recurrence of edema. Study endpoints included: VA using ETDRS charts, CRT and number of injections at 12 months. Mean VA from all 25 patients increased by 3.1 logMAR lines (p < 0.05 compared to baseline). The improvement of VA after bevacizumab injection was in correlation with a decrease in CRT In subgroup analyses, patients receiving bevacizumab injection within the first 3 months after CRVO showed an average VA gain of 4.2 logMAR lines. Mean of 4.5 injections was needed to control the disease during the follow-up period. Bevacizumab treatment was effective in VA and reducing CRT. It appears from subgroup analysis that initiation of treatment early in the course of disease produced better functional outcome. Several injections were needed to control the disease. Regular OCT examinations and retreatment are advised in order to maintain initially reached VA.

Pregnancy outcome after treatment with radioiodine for differentiated thyroid carcinoma.

The aim of the study was to investigate the influence of radioiodine (RAI) therapy on pregnancies and the health status of children born to mothers who had received therapeutic doses of I-131 for differentiated thyroid carcinoma (DTC). Gestational histories of 76 women treated for DTC from 1971-2005 were retrospectively analyzed. The outcome of 49 pregnancies after RAI was: 35 children (72%), 5 (10%) miscarriages and 9 (18%) induced abortions. RAI did not adversely affect the rate of successful delivery and live birth demographics. Congenital malformation and first year mortality were not observed. The children's ages range from 1 month to 29 years (chi+/-SD=8.0+/-8.4). A higher therapeutic dose (>100 mCi) did not significantly alter the pregnancy outcome. There is no reason to discourage females treated with 1-131 from becoming pregnant. Patients should avoid pregnancy after RAI administration for 1 year.