Dexamethasone Intravitreal Implant for Treatment of Patients with Persistent Diabetic Macular Edema

Dutra-Medeiros, Marco; Postorino, Maurizio; Navarro, Rafael; García‐Arumí, José; Mateo, Carlos; Corcóstegui, Borja

doi:10.1159/000356413

Cited by 85 publications

(69 citation statements)

References 23 publications

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“…These are mostly retrospective case series or prospective cohort studies, most of which demonstrated both anatomical and visual improvement at the end of follow-up [69][70][71][72][73][74][75][76][77]. The only randomised controlled trial assessing dexamethasone for anti-VEGF-resistant DMO found an anatomical benefit in combination with bevacizumab, but demonstrated no change in BCVA at 12 months [73].…”

Section: Anti-inflammatory Therapymentioning

confidence: 99%

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Bahrami

Zhu

Hong³

et al. 2016

Diabetologia

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Diabetic macular oedema (DMO) is the leading cause of vision loss in patients living with diabetes. DMO results from hyperglycaemia-induced activation of pathways that lead to oxidative stress and release of cytokines, impairing the inner and outer blood-retinal barriers. Improved understanding of the pathophysiological mechanisms leading to DMO have led to the development of effective therapies, including vitreoretinal surgery, laser photocoagulation, intravitreal anti-vascular endothelial growth factor drugs and corticosteroids. Advances in imaging, including fluorescein angiography and optical coherence tomography, have also enhanced diagnosis and management of the condition. Despite these advances, there remain patients who do not respond completely to therapy, reflecting the complex pathophysiology of DMO. These patients may be considered treatment-resistant. In this review, we summarise the pathophysiology of DMO, as well as the available treatments and their mechanism of action. Additionally, we focus on treatment-resistant disease and review the literature on potential options for managing this complication of diabetes.

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Section: Anti-inflammatory Therapymentioning

confidence: 99%

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Bahrami

Zhu

Hong³

et al. 2016

Diabetologia

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“…The following studies by Bonnin et al, 48 Dutra Medeiros et al, 49 Bansal et al 50 and Totan et al 51 are summarised in Table 2. They are all similar studies with relatively short (4-6 month) follow-up.…”

Section: Review Diabetic Macular Oedemamentioning

confidence: 99%

“…51 The patient cohort in this study had not responded to previous anti-VEGF therapy and treatment may have been wearing off towards the end of the 6 months. The studies by Dutra Medeiros et al 49 and Bansal et al 50 specifically recruited patients with refractory/chronic DMO with encouraging results. With regards to adverse events, as might be expected IOP rises were observed, the majority of which were controlled with topical therapy or conservative management.…”

Section: Review Diabetic Macular Oedemamentioning

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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“…[80][81][82][83][84][85] In the first study, Zucchiatti et al 80 showed that a single intravitreal injection of Ozurdex produced improvement in BCVA and FT in eyes with persistent DMO. Such improvement was evident from the third day to the first month after injection, peaked at the third month and was no more significant 6 months after the injection.…”

Section: Interventional Case Series Studiesmentioning

confidence: 99%

Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

Dutra-Medeiros

Alkabes

Nucci

2014

European Endocrinology

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Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex ® ; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment. KeywordsRefractory diabetic macular oedema, pathogenesis, inflammatory mediators, corticosteroids, dexamethasone intravitreal implant, implantable drug delivery system. 4 On the basis of the data from all 35 studies on more than 20,000 participants with diabetes, they estimated that among individuals with diabetes, the overall prevalence of any DR was 34.6 %, PDR was 7.0 %, DMO was 6.8 % and VTDR was 10.2 %. DR is a highly specific vascular complication of both type 1 and 2 diabetes, with prevalence strongly related to the duration of diabetes.5 In addition to the duration of diabetes, factors that increase the risk of, or are associated with, retinopathy include chronic hyperglycaemia, 6 nephropathy 7 and hypertension.8 Intensive diabetes management with the goal of achieving near-normoglycemia has been shown in large prospective randomised studies to prevent and/or delay the onset and progression of DR.9-11 Lowering blood pressure has been shown to decrease the progression of retinopathy. 12DMO is a frequent complication of DR and the most common cause of vision loss in patients with diabetes. Left untreated, up to 33 % of patients with DMO will experience moderate vision loss. 13 Laser photocoagulation has been considered, for a long time, as the main treatment option for DMO, based on the results of the Early Treatment Diabetic Retinopathy Study (ETDRS) clinical trial.14 Focal laser treatment reduced the risk of moderate visual loss in patients with DMO by 50 %. 15In more recent studies that involved only patients with DMO-associated vision loss, repeated applications of focal/grid laser photocoagulation treatment resulted in at least a 10-letter improvement in visual acuity in 28-32 % of patients, but 13-19 % of patients lost at least 10 letters in visual acuity. [16][17] In DMO, vascular leakage from dilated hyperpermeable capillaries and microaneurysms leads to accumulation of extracellular fluid in the macula. Inflammation has a key role in the pathogenesis and maintenan...

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Dexamethasone Intravitreal Implant for Treatment of Patients with Persistent Diabetic Macular Edema

Cited by 85 publications

References 23 publications

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

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

Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

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