Dexamethasone Intravitreal Implant for Treatment of Diabetic Macular Edema in Vitrectomized Patients

Boyer, David S.; Faber, David; Gupta, Sunil; Patel, Sunil; Tabandeh, Homayoun; Li, Xiaoyan; Liu, Charlie C; Lou, Jingjing; Whitcup, Scott M.

doi:10.1097/iae.0b013e318206d18c

Cited by 341 publications

(254 citation statements)

References 22 publications

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“…Disadvantages of use of intravitreal TA include its lack of FDA approval for treatment of DME and the possible need for more frequent injections. DEX implant has been demonstrated to be effective in patients with previous vitrectomy, 39 patients with previously treated DME, 40 and patients with DME that has been demonstrated to be resistant to anti-VEGF treatment. [41][42][43][44][45] The primary role of corticosteroids in the treatment paradigm for DME is as alternative treatment after a suboptimal anti-VEGF response, but corticosteroids may also be considered for treatment in patients who discontinue anti-VEGF therapy because of systemic safety concerns.…”

Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Regillo¹,

Callanan²,

Diana³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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BACKGROUND AND OBJECTIVE: Guidance on the use of corticosteroids in the treatment of diabetic macular edema (DME) is lacking. This study aimed to develop a clinically recommended treatment paradigm for DME with emphasis on the role of corticosteroids. PATIENTS AND METHODS: An expert panel of nine retinal specialists in the United States developed consensus recommendations for DME treatment through a modified Delphi process. RESULTS: The panelists typically use intravitreal injections of vascular endothelial growth factor (VEGF) antagonists as first-line treatment of DME and switch patients with an inadequate response to anti-VEGF therapy (failure of best-corrected visual acuity to improve to 20/40 or better because of edema after three to six monthly injections, or a less-than-50% reduction in excess macular thickness after three to four monthly injections) to intravitreal corticosteroid treatment. CONCLUSION: Intravitreal corticosteroids have a potentially useful role in the treatment of patients with DME who have an inadequate response to intravitreal anti-VEGF therapy. [ Ophthalmic Surg Lasers Imaging Retina. 2017;48:291–301.]

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Section: Discussionmentioning

confidence: 99%

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Regillo¹,

Callanan²,

Diana³

et al. 2017

Ophthalmic Surg Lasers Imaging Retina

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“…57 There may be reduced efficacy of intravitreal anti-VEGF agents in vitrectomised eyes because of increased drug clearance; 58 however, Bressler et al in a small subgroup analysis of DRCRnet Protocol I did not identify that the 25 vitrectomised eyes receiving ranibizumab had significantly worse visual outcomes than the rest of the cohort (325 eyes). 59 Patient factors are another important consideration.…”

Section: Guidelinesmentioning

confidence: 99%

An Evidence-based Approach to Using Intravitreal Steroids in the Management of Diabetic Macular Oedema

Öztürk¹,

Harris²,

Mehta³

2017

European Ophthalmic Review

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Diabetic macular oedema (DMO) is the leading cause of acquired visual loss in the working age population. The landscape for DMO treatment has changed significantly over the past decade. Macular laser has been reported to reduce the risk of moderate visual loss in seminal clinical trials from the 1980s, but relatively few patients achieved visual gain. With the advent of intravitreal pharmacotherapy it is now possible to achieve visual gains in the majority of patients. Intravitreal anti-vascular endothelial growth factor (VEGF) agents are now a first-line treatment option in centre-involving DMO. This review assesses clinical trial and more recent real-world evidence to guide clinicians as to when intravitreal steroids should be considered in the management of DMO. In particular, intravitreal steroids can be considered in pseudophakic patients, or those due to undergo cataract surgery, in patients unable to attend for regular intravitreal procedures, and non-responders to intravitreal anti-VEGF therapy. Assessing clinical trial data, the dexamethasone implant appears to have a more predictable intraocular rise profile than triamcinolone or fluocinolone with a lower requirement for incisional glaucoma surgery. There is a need for consensus regarding real-world outcome measures for intravitreal steroids in the management of DMO to allow easier comparison across studies.

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“…At week 8, 30.4% of patients had gained ≥ 10 letters in BVCA. 44 In their most recent report, Boyer et al 45 have evaluated the 3-year outcomes of treatment of DMO, and suggest that the dexamethasone implant was efficacious in the treatment of DMO over the medium term. The mean number of treatments given over 3 years was 4.1, 4.4, and 3.3 with dexamethasone implant 0.7 mg, dexamethasone implant 0.35 mg, and sham, respectively.…”

Section: Dexamethasonementioning

confidence: 99%

“…36,[42][43][44][45][46][47][48] These treatments are summarised in Table 1. These treatments are particularly useful in eyes with centre-involving DMO.…”

Section: Pharmacologic Treatmentsmentioning

confidence: 99%

A review of therapies for diabetic macular oedema and rationale for combination therapy

Amoaku

Saker

Stewart

2015

Eye

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Diabetic macular oedema (DMO) is responsible for significant visual impairment in diabetic patients. The primary cause of DMO is fluid leakage resulting from increased vascular permeability through contributory anatomical and biochemical changes. These include endothelial cell (EC) death or dysfunction, pericyte loss or dysfunction, thickened basement membrane, loss or dysfunction of glial cells, and loss/change of EC Glycocalyx. The molecular changes include increased reactive oxygen species, pro-inflammatory changes: advanced glycation end products, intracellular adhesion molecule-1, Complement 5-9 deposition and cytokines, which result in increased paracellular permeability, tight junction disruption, and increased transcellular permeability. Laser photocoagulation has been the mainstay of treatment until recently when pharmacological treatments were introduced. The current treatments for DMO target reducing vascular leak in the macula once it has occurred, they do not attempt to treat the underlying pathology. These pharmacological treatments are aimed at antagonising vascular endothelial growth factor (VEGF) or non-VEGF inflammatory pathways, and include intravitreal injections of anti-VEGFs (ranibizumab, aflibercept or bevacizumab) or steroids (fluocinolone, dexamethasone or triamcinolone) as single therapies. The available evidence suggests that each individual treatment modality in DMO does not result in a completely dry macula in most cases. The ideal treatment for DMO should improve vision and improve morphological changes in the macular (eg, reduce macular oedema) for a significant duration, reduced adverse events, reduced treatment burden and costs, and be well tolerated by patients. This review evaluates the individual treatments available as monotherapies, and discusses the rationale and potential for combination therapy in DMO.

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Dexamethasone Intravitreal Implant for Treatment of Diabetic Macular Edema in Vitrectomized Patients

Abstract: Treatment with dexamethasone intravitreal implant led to statistically and clinically significant improvements in both vision and vascular leakage from diabetic macular edema in difficult-to-treat vitrectomized eyes and had an acceptable safety profile.

Cited by 341 publications

References 22 publications

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

Use of Corticosteroids in the Treatment of Patients With Diabetic Macular Edema Who Have a Suboptimal Response to Anti-VEGF: Recommendations of an Expert Panel

An Evidence-based Approach to Using Intravitreal Steroids in the Management of Diabetic Macular Oedema

A review of therapies for diabetic macular oedema and rationale for combination therapy

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