Dexamethasone Intravitreal Implant Rescue Treatment for Bevacizumab Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

Lee, Kyou Ho; Kang, Eui Chun; Koh, Hyoung Jun

doi:10.3341/kjo.2017.31.2.108

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…Although repeated treatment with anti-VEGF therapy is primarily preferred, in some cases, an insufficient response to treatment or rebound ME can be seen. There are some studies in the literature on the subject; however, these studies did not compare continued use of the same anti-VEGF treatment (9,10).…”

Section: Introductionmentioning

confidence: 99%

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Eriş¹

2019

Beyoglu Eye J

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Branch retinal vein occlusion (BRVO) is the second most common type of retinal vascular disorder. Both inflammation and increased vascular endothelial growth factor (VEGF) levels play important roles in the pathogenesis of macular edema (ME) secondary to BRVO. The aim of this study was to compare the efficacy of 0.7-mg intravitreal dexamethasone implants with continued anti-VEGF treatment in patients with ME secondary to BRVO who were poor responders to at least 6 previous anti-VEGF injections. Methods: Patients exhibiting an insufficient response to at least 6 ranibizumab treatments and who subsequently underwent a dexamethasone implant were included Group 1. Patients who were at risk for cataract or glaucoma continued treatment with the same drug and were defined as Group 2. The best corrected visual acuity (BCVA) and central macular thickness (CMT) changes at month 2, 4, and 6 were measured. Results: Ninety eyes were evaluated. In Group 1, the mean baseline BCVA of 0.71±0.75 logarithm of the minimum angle of resolution (logMAR) improved to 0.53±0.62 logMAR at month 2 (p<.001), 0.67±0.72 logMAR at month 4 (p=0.325), and 1.03±0.83 logMAR at month 6 (p=.001). In Group 2, the mean baseline BCVA was 0.73±0.83 logMAR, and improved to 0.68±0.83 logMAR at month 2 (p=0.12), 0.698±0.81 logMAR at month 4 (p=0.270), and 0.76±0.80 at month 6 (p=0.546). The baseline CMT in each group was 588±176 μm and 545±165 μm, respectively (p=0.248). The mean CMT of Group 1 changed from a baseline measurement of 588±176 μm to 308±132 μm at month 2 (p<.001), 450±195 μm at month 4 (p<.001), and 510±190 μm at month 6 (p<.001). The mean CMT of Group 2 changed from a baseline value of 545±165 μm to 486±162 μm at month 2 (p<.001), 516±168 μm at month 4 (p<.001), and 528±171 μm at month 6 (p=0.037). Conclusion: Dexamethasone implants were a more effective treatment for patients with BRVO-related resistant ME than ranibizumab at month 2. However, this positive effect seems to decline rapidly in the long term.

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Section: Introductionmentioning

confidence: 99%

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Eriş¹

2019

Beyoglu Eye J

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“…Among the remaining 16 articles that underwent a full review, 12 were excluded in compliance with the eligibility criteria. Finally, a total of four articles were eligible for our analysis ( Alshahrani et al, 2016 ; Lee et al, 2017 ; Manousaridis et al, 2017 ; Georgalas et al, 2019 ). Among the four observational studies, one was prospective and three were retrospective in design.…”

Section: Resultsmentioning

confidence: 99%

“…According to the occlusion location, it is classified as central retinal vein occlusion (CRVO), hemiretinal vein occlusion (HRVO), or branch retinal vein occlusion (BRVO) ( Laouri et al, 2011 ; Scott et al, 2012 ; Glanville et al, 2014 ). Macular edema (ME) is the primary cause of bad vision in RVO patients, presenting in 5%–15% of eyes over a period of 1 year in RVO ( Campochiaro et al, 2008 ; Lee et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single-dose intravitreal dexamethasone implantation for retinal vein occlusion patients with refractory macular edema: A systematic review and meta-analysis

Yuan

Gao²,

Liu³

et al. 2022

Front. Pharmacol.

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Purpose: To assess the functional and anatomical consequences of single-dose dexamethasone (DEX) implants for the treatment of refractory macular edema (ME) secondary to retinal vein occlusion (RVO) after anti-vascular endothelial growth factor agents.Methods: A literature search of studies on switching therapy to DEX implants from anti-VEGF agents in refractory RVO patients was performed with five electronic databases (PubMed, Embase, Web of Science, MEDLINE, and Cochrane Library) prior to January 2022. The main outcomes included best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes at different follow-up endpoints from baseline. All analyses were performed using Stata version 15.0.Results: The final analysis included four eligible studies with a total of 99 patients. After single-dose DEX implant application, BCVA improved significantly at 2, 3, and 6 months with an average gain of −0.23 logarithm of the minimum angle of resolution (logMAR) (p = 0.004), −0.20 logMAR (p = 0.027), and -0.09 logMAR (p = 0.021), respectively. Mean CMT reduction was also significant from baseline to 2 months (-241.89 μm, p < 0.001), 3 months (−222.61 μm, p < 0.001), and 6 months (−90.49 μm, p < 0.001). No serious adverse events were observed in any of the included studies.Conclusion: This meta-analysis showed that RVO patients with refractory ME could benefit significantly from switching therapy to DEX implantation, with efficacy lasting 6 months after a single-dose application. Intravitreal DEX implantation is a safe and effective option for refractory cases.

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“…For younger patients who show poor initial BCVA, alternative treatment agents such as ranibizumab or dexamethasone implants may be used for more effective management [28,29].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors for a Favorable Response to Intravitreal Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

Kang

Seo

Choi

et al. 2018

J Retin

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Purpose: To determine the factors for predicting a favorable response to intravitreal bevacizumab (IVB) for macular edema (ME) associated with branch retinal vein occlusion (BRVO). Methods: Thirty-seven eyes of patients first diagnosed with BRVO-associated ME and treated with IVB more than twice were included in this retrospective case series. Baseline characteristics, initial best-corrected visual acuity (BCVA), initial central macular thickness (CMT), and change in CMT after 2 consecutive monthly IVB injections were reviewed. Patients were classified into 2 groups according to their IVB response: non-responders were defined as those in whom CMT was not decreased by greater than 10% of the initial value after 2 consecutive monthly injections. The types of observed macular edema were further subdivided into the cystoid macular edema (CME) only, serous retinal detachment (SRD) only, and combined CME and SRD groups for analysis. Results: Thirty-three patients were classified as responders and 4 patients were classified as non-responders. The responder group was comprised of significantly older patients than the non-responder group (63.8 ± 11.7 vs. 54.5 ± 1.0, p = 0.034). The initial BCVA of the non-responder group was significantly higher than that of the responder group (logMAR 0.08 ± 1.04 vs. 0.37 ± 0.60, p = 0.003). The anatomical type of ME did not significantly influence the response to IVB. There were no differences in the histories of diabetes mellitus or hypertension between the groups, and the existence of an epiretinal membrane did not appear to affect treatment response. Conclusions: Patients with better initial BCVA and those who were older appeared to have a more favorable response to IVB treatment in ME due to BRVO. 21 Kang HG, et al. Favorable response to bevacizumab

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Dexamethasone Intravitreal Implant Rescue Treatment for Bevacizumab Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

Cited by 7 publications

References 33 publications

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Clinical use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion compared with Intravitreal Anti-Vascular Endothelial Growth Factor

Efficacy of single-dose intravitreal dexamethasone implantation for retinal vein occlusion patients with refractory macular edema: A systematic review and meta-analysis

Predictive Factors for a Favorable Response to Intravitreal Bevacizumab for Macular Edema Associated with Branch Retinal Vein Occlusion

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