Effect of an Intravitreal Dexamethasone Implant on Diabetic Macular Edema After Cataract Surgery

Calvo, Pilar; Ferreras, Antonio; Adel, Fadwa Al; Dangboon, Wantanee; Brent, Michael H.

doi:10.1097/iae.0000000000001552

Cited by 36 publications

(51 citation statements)

References 39 publications

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“…Regarding the optimal time of intravitreal dexamethasone implant insertion in patients with DME and cataract, there are various approaches. Previous studies have used dexamethasone implant either at the beginning or immediately after surgery in an attempt to prevent or control postoperative macular edema [27][28][29][30][31]35 . Agarwal et al used intravitreal dexamethasone implant in 18 eyes with DME and cataract, at the beginning of phacoemulsification, reporting 15-18 letters gain in visual acuity compared to stable visual acuity in controls associated with a decrease in CMT 35 , while Sze et al also showed improvement in BCVA and CST using dexamethasone implant just before initiation of cataract surgery, but about 10% of patients required further treatment due to recurrence of macular edema in about 21 weeks post-operation 28 .…”

Section: Discussionmentioning

confidence: 99%

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Kabanarou¹,

Xirou²,

Boutouri³

et al. 2020

Sci Rep

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to examine preoperative use of intravitreal dexamethasone implant in patients with refractory diabetic macular edema (DME) undergoing cataract surgery. Participants in this study were 17 patients with DMe refractory to previous treatment with anti-vascular endothelial growth factor agents or dexamethasone implant, and co-existent cataract. All participants received intravitreal dexamethasone implant at baseline and underwent phacoemulsification within one month after its insertion. Bestcorrected visual acuity (BCVA) and central subfield thickness (CST) changes between baseline, time of cataract surgery and postoperative months 1, 2 and 3 were evaluated. At month 1 after surgery, BCVA improved significantly from 42.3 ± 9.6 to 58.7 ± 11.9 letters compared to baseline (p < 0.001) and the improvement was sustained at month 2 and month 3 postoperatively. One month postoperatively, CST improved significantly compared to baseline (p < 0.001) and the improvement was sustained at month 2 (p < 0.001), while at month 3 CST started to increase, but remained significantly lower than baseline (p = 0.003). At month 3 postoperatively, 35.3% of patients presented recurrence of ME. Patients with refractory DME and cataract can safely undergo phacoemulsification when dexamethasone implant is inserted one month prior to surgery to ensure adequate control of postoperative inflammation and prevent deterioration of Me. Diabetic macular edema (DME) is a common complication of diabetes mellitus, affecting about 20% of patients with diabetic retinopathy, and can lead to visual loss if left untreated 1,2. Patients with diabetes mellitus seem to develop cataract more frequently and earlier compared to non-diabetic population, because of the inherent metabolic condition of the disease 3-5. It is worthy to note that cataract surgery in diabetic patients has been associated with higher risk of complications, including postoperative macular edema (Irvine-Gass syndrome) or worsening of pre-existing DME, especially in the presence of unstable diabetic retinopathy 6-12. In fact, it has been reported that about 22% of diabetic patients, who undergo cataract surgery, develop macular edema 7. Previous studies have shown that intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents or triamcinolone pre-operatively, post-operatively or at the time of phacoemulsification may reduce the development of postoperative DME, although rapid recurrence of macular edema occurred and in case of triamcinolone the risk of intraocular pressure (IOP) increase may also exist 13-22. Intravitreal dexamethasone implant (Ozurdex, Allergan) is a biodegradable corticosteroid implant, which provides sustained-release of 700 μg dexamethasone into the vitreous for up to 6 months 23. It has been successfully applied for the treatment of DME, retinal vein occlusion and non-infectious posterior uveitis 24-26. There are few studies using intravitreal dexamethasone implant to control postoperative macular edema in patients affected by DME, showing promis...

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Section: Discussionmentioning

confidence: 99%

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Kabanarou¹,

Xirou²,

Boutouri³

et al. 2020

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Currently dexamethasone slow release implant (Ozurdex 0.7 mg) has been used in various studies in refractory diabetic macular edema and has shown promising results. [16][17][18] The availability of this implant is a major limitation for its use in our setup.…”

Section: Discussionmentioning

confidence: 99%

Combined Intravitreal Triamcenolone Acetonide And Bevacizumab For Refractory Diabetic Macular Edema

Arain¹,

Muzaffar²,

Farooq³

et al. 2018

J Coll Physicians Surg Pak

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“…Previous reports have indicated that DEX, indomethacin (IND), ciprofloxacin (CIP) presented anti-inflammation activity for patients with cataract (8)(9)(10)(11). On these premises, we sought to compare anti-inflammation among DEX, IND and CIP in controlling immediate inflammation after cataract surgery in clinical treatment.…”

Section: Introductionmentioning

confidence: 99%

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

et al. 2017

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Abstract. The aim of the present study is to determine the efficacy of dexamethasone (DEX) vs. indomethacin (IND) and ciprofloxacin (CIP) in modulating immediate inflammation following cataract surgery. A total of 644 patients with cataract were recruited and inflammation was investigated during the perioperative period. The management protocol was similar in both groups. Each drug was given four times a day for 30 days starting 7 days prior to surgery. The primary efficacy criteria for evaluation were the reduction in anterior chamber (AC) flare and AC inflammation score, in addition, a different secondary efficacy and safety evaluation criteria were maintained. The results demonstrated that the average inflammation score was 1.2±0.8 in the DEX group, which was significantly lower compared with the IND (1.9±0.7) and CIP (1.8±0.6) groups. Intra-ocular pressure was decreased following treatment with DEX, while intra-ocular pressure was slightly increased in the IND (1.9±0.7) and CIP (1.8±0.6) groups. The final visual outcomes for patients postcataract surgery were clinically superior in the DEX group compared with that of the IND and CIP groups (P=0.034 and P=0.042, respectively), but there was no significant difference between the ND and CIP groups (P= 0.78). Outcomes indicated that AC inflammation, conjunctival hyperaemia, corneal and lid oedema, ocular infection, pain, photophobia, and tearing were significantly improved in each group. No significant poor local tolerance or adverse reaction was observed in the DEX, IND and CIP groups. In conclusion, the outcomes of the present study suggest that DEX serves an important role in the clinical pharmaceutical treatment of patients with cataract surgery.

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Effect of an Intravitreal Dexamethasone Implant on Diabetic Macular Edema After Cataract Surgery

Cited by 36 publications

References 39 publications

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Pre-operative intravitreal dexamethasone implant in patients with refractory diabetic macular edema undergoing cataract surgery

Combined Intravitreal Triamcenolone Acetonide And Bevacizumab For Refractory Diabetic Macular Edema

The role of Dexamethasone in clinical pharmaceutical treatment for patients with cataract surgery

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