Treatment of cystoid macular edema secondary to chronic non-infectious intermediate uveitis with an intraocular dexamethasone implant

Rossetto, Julia D.; Nascimento, Heloísa; Fernandes, Delia Diana Paola González; Belfort, Rubens; Muccioli, Cristina

doi:10.5935/0004-2749.20150049

Cited by 7 publications

(5 citation statements)

References 6 publications

(9 reference statements)

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“…However, there can be rebound effects from prolonged treatment or following discontinuation ( Apushkin et al, 2007 ), since CAIs do not address any underlying inflammatory component, as noted in uveitis patients with CME ( Schilling et al, 2005 ). Therefore, in the uveitis subspecialty world, in which the inflammatory etiology of CME is well established and accepted, CME is far more commonly treated with topical steroids, non-steroidal anti-inflammatory drugs (NSAIDs), in conjunction with oral steroids, various types of steroid-sparing immuno-modulating treatment (IMT) regimens such as mycophenolate mofetil (MMF), methotrexate (MTX), azathioprine (AZT), and more recently a variety of biologic agents such as adalimumab, with or without subtenon, intravitreal and—more recently also—suprachoroidal steroid injections or injectable/implantable steroid slow-releasing devices ( Steinmetz et al, 1991 ; Tanner et al, 1998 ; Tranos et al, 2004 ; Androudi et al, 2005 ; Jain et al, 2005 ; Perry and Donnenfeld, 2006 ; Hariprasad and Callanan, 2008 ; Hogewind et al, 2008 ; Jones and Francis, 2009 ; Slabaugh et al, 2012 ; Wu et al, 2012 ; Bourgault et al, 2013 ; Koop et al, 2013 ; Rossetto et al, 2015 ; Sen et al, 2015 ; Grixti et al, 2016 ; Asproudis et al, 2017 ; Feiler et al, 2017 ; Frere et al, 2017 ; Juthani et al, 2017 ; Khurana et al, 2017 ; Pichi et al, 2017 ; Doycheva et al, 2018 ; Petrushkin et al, 2018 ; Schallhorn et al, 2018 ; Hasanreisoglu et al, 2019 ; Ansari et al, 2021 ; Saade et al, 2021 ; Wong et al, 2021 ; Chronopoulos et al, 2022 ; Studsgaard et al, 2022 ; Miguel-Escuder et al, 2023 ). These remedies have been used successfully to manage CME in RP patients who are refractory or incompletely responsive to CAIs ( Forte et al, 1994 ; Heckenlively et al, 1999 ; Saraiva et al, 2003 ; Kim, 2006 ; Scorolli et al, 2007 ; Park et al, 2013 ; Ahn et al, 2014 ; Patil and Lotery, 2014 ; Lemos Reis et al, 2015 ; Schaal et al, 2016 ; ...…”

Section: Introductionmentioning

confidence: 99%

The double-edged sword of inflammation in inherited retinal degenerations: Clinical and preclinical evidence for mechanistically and prognostically impactful but treatable complications

Sarıcı

Vyas

Iannaccone

2023

Front. Cell Dev. Biol.

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We present retrospective data from our clinical research efforts of the past several years alongside a review of past and current clinical and preclinical data independently by several investigators supporting our clinical evidence for the importance of inflammation in inherited retinal degenerations (IRDs). We show how inflammation is a complicating factor in IRDs but, if recognized and managed, also a great opportunity to mitigate disease severity immediately, improve patient prognosis and quality of life, extend the treatment windows for gene-specific and agnostic therapeutic approaches, mitigate the impact of inflammatory complications on the accurate estimate of vision changes in IRD natural history studies, improve the chances of safer outcomes following cataract surgery, and potentially reduce the likelihood of inflammatory adverse events and augment the efficacy of viral vector-based treatment approaches to IRDs. Manuscript contribution to the field. Inflammation has been suspected to be at play in IRDs since the beginning of the 1900s and became a research focus through the early 1990s but was then largely abandoned in favor of genetic-focused research. Thanks to regained cognizance, better research tools, and a more holistic approach to IRDs, the recent reappraisal of the role of inflammation in IRDs has brought back to the surface its importance. A potential confounder in natural history studies and a limiting factor in clinical trials if not accounted for, inflammation can be managed and often offers an opportunity for immediately improved prognosis and outcomes for IRD patients. We present our retrospective clinical evidence for connections with a measurable secondary autoimmune component that can develop in IRDs and contribute to vision loss but is at least in part treatable. We also present ample lines of evidence from the literature corroborating our clinical observations at the preclinical level.

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Section: Introductionmentioning

confidence: 99%

The double-edged sword of inflammation in inherited retinal degenerations: Clinical and preclinical evidence for mechanistically and prognostically impactful but treatable complications

Sarıcı

Vyas

Iannaccone

2023

Front. Cell Dev. Biol.

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Section: Discussionmentioning

confidence: 99%

“…The treatment of uveitic macular edema can sometimes prove difficult, as the blood-retinal barrier limits the efficacy of medications to suppress the inflammation sufficiently ( 13 ). The dexamethasone 0.7 mg implant has been shown to be effective and safe for the local treatment of chronic cystoid macular edema secondary to non-infectious uveitis in previous studies ( 6 , 13 ). While the dexamethasone implant is primarily administered for the treatment of uveitic macular edema, it is also employed in other rare uveitic occasions, such as birdshot chorioretinopathy ( 14 ), diffuse uveal melanocytic proliferation ( 15 ), serpiginous choroiditis ( 16 ), exudative RD associated with uveal melanoma ( 17 ), punctate inner choroidopathy ( 18 ), autoimmune retinopathy ( 19 ), ampiginous choroidopathy, tubulointerstitial nephritis and uveitis syndrome, sympathetic ophthalmia and IRVAN syndrome ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone intravitreal implant for macular edema and some other rare indications in uveitis

Koksaldi

Kayabaşı

Ayhan

et al. 2023

Med Int

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In the present study, 110 eyes of 81 patients with uveitis who underwent intravitreal dexamethasone implant (IDI) injection and had a follow-up of at least 6 months between January, 2012 and September, 2022, were retrospectively analyzed. A total of 298 IDI injections were administered (mean, 2.71±2.37; range, 1-12). The mean age of the patients was 49.44±16.67 years (range, 15-86 years). The mean follow-up time after the first IDI was 34.31±26.53 months (range, 6-115 months). In total, 77 (95.1%) patients had non-infectious uveitis, while 4 patients (4.9%) received IDI for uveitic macular edema in association with infectious uveitis (1 patient with acute retinal necrosis and 3 patients with systemic tuberculosis). IDI was injected under the umbrella of intravitreal ganciclovir injection in the patient with healed acute retinal necrosis for the associated pseudophakic cystoid macular edema. A total of 6 patients (7.4%) received IDI prior to phacoemulsification surgery to control the possible post-operative macular edema. In addition, 3 patients (3.7%) with Vogt-Koyanagi-Harada disease received bilateral IDI as the systemic therapy could not be administered due to side-effects of the systemic treatment. In total, 1 patient (1.2%) with idiopathic retinal vasculitis, aneurysms and neuroretinitis was treated with IDI injections in both eyes in addition to systemic therapy to reduce the ongoing inflammation. Of note, two eyes (1.8%) received simultaneous single IDI and anti-vascular endothelial growth factor administration for the treatment of unilateral extrafoveal macular neovascularization (one with active serpiginous choroiditis and one with sympathetic ophthalmia). IDI was administered for the treatment of uveitic macular edema in 68 patients (83.9%). Best-corrected visual acuity improved from 0.69±0.64 to 0.60±0.76 logMAR at the final visit (P=0.008). Baseline mean central macular thickness (CMT) was 499.74±229.60 µm (range, 187-1,187 µm) and the mean final CMT was 296.60±152.02 µm (range, 126-848 µm). Intraocular pressure elevation requiring topical antiglaucomatous eye drops occurred in 28 eyes (25.5%). During the follow-up period, bilateral glaucoma surgery was required in 1 patient (1.2%) and 25 of 65 phakic eyes (38.4%) underwent phacoemulsification. Retinal detachment occurred in one eye (0.9%), endophthalmitis in one eye (0.9%), and transient intravitreal hemorrhage occurred in three eyes (2.7%) after the IDI injections. On the whole, the present study demonstrates that although IDI is mostly employed in non-infectious uveitic eyes with macular edema, it can also be administered in cases with systemic therapy intolerance, pseudophakic macular edema prophylaxis, and with great caution, in selected cases involving infectious uveitis and macular edema.

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“…In 2011, the Ozurdex HURON study group reported that VA improved after a single DEX implant in eyes with noninfectious uveitis, and that improvement was sustained for up to six months [19]. Later, investigators found that intravitreal DEX implants were effective in treating refractory uveitic ME [20], and in a multicenter, retrospective cohort study using DEX implants in eyes with noninfectious uveitis, a significant improvement in VA, central foveal thickness, and vitreous haze was reported, and the effects lasted for at least six months [21]. Other studies described positive outcomes one month after DEX implants, which remained for six months [10,19,22].…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Dexamethasone Implants for Refractory Macular Edema in Eyes with Noninfectious Uveitis

Kang

Chen

et al. 2021

JCM

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Macular edema (ME) is a common cause of visual loss among eyes with uveitis, and its management can be challenging. Steroids are an effective treatment for ME, and intravitreal dexamethasone (DEX) implants provide sustained steroid release. The purpose of this study is to evaluate intravitreal DEX implant on refractory ME in eyes with noninfectious uveitis. A retrospective study including 52 eyes of 37 patients with refractory uveitic ME was conducted from January 2011 through August 2017 at Linkou Chang Gung Memorial Hospital in Taiwan. Patients’ demographic characteristics were collected. In addition, clinical information, including corrected visual acuity (VA), intraocular pressure (IOP), and central retinal thickness (CRT) on optical coherence tomography, was recorded and analyzed. During the study period, affected eyes received a total of 110 intravitreal DEX implants (range, one to six in each eye). After the first DEX implant injection in all eyes, VA significantly improved at one and two months. CRT significantly decreased one month after a single DEX implant, and the effect lasted for six months and waned over time. Patients receiving multiple DEX implants still showed significant decreases in CRT one month after the first implant. Increases in IOP were noted one month after the DEX implant, but the IOP could be medically controlled. Intravitreal DEX implants can effectively treat refractory uveitic ME, improving both VA and CRT with an acceptable safety profile. Further studies are necessary to evaluate the effect of multiple implants and long-term outcomes.

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Treatment of cystoid macular edema secondary to chronic non-infectious intermediate uveitis with an intraocular dexamethasone implant

Cited by 7 publications

References 6 publications

The double-edged sword of inflammation in inherited retinal degenerations: Clinical and preclinical evidence for mechanistically and prognostically impactful but treatable complications

The double-edged sword of inflammation in inherited retinal degenerations: Clinical and preclinical evidence for mechanistically and prognostically impactful but treatable complications

Dexamethasone intravitreal implant for macular edema and some other rare indications in uveitis

Intravitreal Dexamethasone Implants for Refractory Macular Edema in Eyes with Noninfectious Uveitis

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