Efficacité des implants intravitréens de dexaméthasone dans l’œdème maculaire hors occlusions veineuses : résultats sur une cohorte de 80 patients

Degoumois, A.; Laurens, C.; Rodallec, F.T.; Raphael, Anthony P.; Blumen-Ohana, E.; Laplace, O.; Virevialle, C.; Du, Bing; Guyader, Vincent; Nordmann, Jean‐Philippe

doi:10.1016/j.jfo.2014.08.003

Cited by 5 publications

(1 citation statement)

References 36 publications

(42 reference statements)

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“…In addition, it was reported that approximately one third of the patients in the group receiving dexamethasone had an increase in intraocular pressure that required treatment. 25 In the study conducted by Totan et al, after intravitreal dexamethasone administration to patients who received 3 doses of 2.5 mg intravitreal bevacizumab at 6-week intervals and whose central macular thickness was above 275 microns, there was a signi cant decrease in central macular thickness in the 1st, 3rd and 6th months; In addition, a signi cant increase in mean visual acuity and mean intraocular pressure was detected in the 1st and 3rd months. 26 In the study of Zhioua et al, intravitreal dexamethasone was administered to 12 patients whose central macular thickness continued to be 300 microns and above, despite 6 consecutive months of Ranibizumab, and they found that dexamethasone was effective on central macular thickness and visual acuity.…”

Section: Discussionmentioning

confidence: 97%

Evaluation Of The Effectiveness Of Intravitreal Anti-VEGF Injection With Intravitreal Dexamethasone Implant In Patients With Treatment-Resistant Diabetic Macular Edema

Koc

Alpay

Hayri

2022

Preprint

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Purpose: To assess the effectiveness of monthly anti-VEGF therapy with an intravitreal dexamethasone (DEX) implant in patients with diabetic macular edema (DME) whose macular edema persists despite anti-VEGF therapy. Materials and methods: This study included 94 eyes of 94 patients whose diabetic macular edema (Central Macular Thickness (CMT) >300 µm) persisted despite previous injections of 3 doses of anti-VEGF. The patients were followed up at the first, second, third, and six month after intravitreal injection. Best corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) change parameters were evaluated. Results: In terms of age, proliferation, and lens status, there was no statistically significant difference between the groups. When CMT, BCVA, and IOP were assessed among the 4 groups at the end of the sixth month, no statistical difference between the groups was found. There was no need for medical intervention despite the statistically significant increase in IOP at the end of the sixth month compared to the third month in the dexamethasone implanted groups. In contrast to the decrease in CMT, which was statistically significant in all 4 groups at the end of the 6th month compared to the 3rd month, the increase in BCVA was not statistically significant in any of the 4 groups at the end of the 6th month. Conclusion: According to the results of our study, there is no superiority between continuing with existing anti-VEGF or switching to dexamethasone implant after 3 doses of anti-VEGF.

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Section: Discussionmentioning

confidence: 97%

Evaluation Of The Effectiveness Of Intravitreal Anti-VEGF Injection With Intravitreal Dexamethasone Implant In Patients With Treatment-Resistant Diabetic Macular Edema

Koc

Alpay

Hayri

2022

Preprint

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Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

Kodjikian

Bellocq

Mathis

2018

BioMed Research International

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Objectives of the Study Summary of observational studies concerning the pharmacological management of diabetic macular edema (DME). Methods A literature review was conducted using the PubMed database on 1 February 2018 to identify studies evaluating the efficacy of anti-VEGF and dexamethasone (DEX) implants for DME. Studies with more than 10 patients and follow-up of more than 6 months were selected. Analyses were carried out on the overall population and on subgroups defined according to baseline visual acuity (BVA) and the patients' naïve or non-naïve status. Results Thirty-two studies evaluating the efficacy of anti-VEGF and 31 studies evaluating the efficacy of DEX-implants were retained, concerning 6,842 and 1,703 eyes, respectively. A mean gain of +4.7 letters for a mean of 5.8 injections (mean follow-up: 15.6 months) and +9.6 letters for a mean of 1.6 injections (10.3 months) was found in the anti-VEGF and DEX-implant studies, respectively. Final VA appears to be similar for both treatment (62 letters for anti-VEGF, 61.2 letters for DEX-implant), and BVA appears lower for DEX-implant, which may partially explain the greater visual gain. The DEX-implant studies show greater gains in VA compared to the anti-VEGF studies, especially for higher BVA. Indeed, mean gains for the subgroups of patients with BVA<50 letters, 5060 letters are +4.3, +5.8, and +3.1 letters, respectively, in the anti-VEGF studies and +10.5, +9.3, and +8.8 letters, respectively, in the DEX-implant studies. Regarding the patient's initial status, only naïve status appears to confer the best functional response in DEX-implant studies. Conclusion Observational studies investigating DEX-implant report clinically similar final VA when compared to anti-VEGF, but superior visual gains in real-life practice. This latter difference could be due to the better BVA, but also to the fact that less injections were administered in the anti-VEGF observational studies than in the interventional studies.

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Evaluation of Functional Outcomes and OCT-Biomarkers after Intravitreal Dexamethasone Implant for Postoperative Cystoid Macular Edema in Vitrectomized Eyes

Freissinger

Vounotrypidis

Wolf

et al. 2020

Journal of Ophthalmology

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Purpose. To evaluate the efficacy of dexamethasone implant (DEX) for the treatment of postoperative cystoid macular edema (PCME) in vitrectomized eyes and to investigate visual and morphological OCT predictive factors. Methods. In this retrospective study, eyes with PCME after vitrectomy were treated with at least one DEX injection and were observed over 12 months. Indications for surgery were epiretinal membrane (ERM) or rhegmatogenous retinal detachment (RRD) without macular involvement. Prior treatments, if any, were noted. Best corrected visual acuity (BCVA), central foveal thickness (CFT), and OCT morphology including the presence of intraretinal cysts/fluid or subretinal fluid (IRF/SRF) and ellipsoid zone (EZ) continuity were evaluated. Correlations between OCT measures and visual outcomes were analyzed by the generalized estimating equations procedure. Results. Forty-six eyes with ERM and 15 eyes with RRD were enrolled. The ERM group was more likely to gain BCVA than RRD (odds ratio (OR), 1.168; 95% confidence interval (CI), 1.003–1.360; p=0.046). The absence of SRF (OR, 0.860; 95% CI, 0.743–0.995; p=0.043) was predictive of worse BCVA, whereas the integrity of EZ (OR, 1.094; 95% CI, 0.951–1.257; p=0.209) or naïve status (OR, 0.946; 95% CI, 0.871–1.137, p=0.853) was not. Eyes with a worse baseline BCVA were more likely to gain >1 line after 12 months (OR, 1.485; 95% CI, 1.171–1.884; p=0.001). Conclusion. The efficacy of the treatment of PCME in vitrectomized eyes seems to be affected by baseline BCVA, the absence of SRF, and the indication for surgery. Naïve status appears not to play any significant role in the prediction of BCVA. This trial is registered with DRKS00018955.

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Efficacité des implants intravitréens de dexaméthasone dans l’œdème maculaire hors occlusions veineuses : résultats sur une cohorte de 80 patients

Cited by 5 publications

References 36 publications

Evaluation Of The Effectiveness Of Intravitreal Anti-VEGF Injection With Intravitreal Dexamethasone Implant In Patients With Treatment-Resistant Diabetic Macular Edema

Evaluation Of The Effectiveness Of Intravitreal Anti-VEGF Injection With Intravitreal Dexamethasone Implant In Patients With Treatment-Resistant Diabetic Macular Edema

Pharmacological Management of Diabetic Macular Edema in Real-Life Observational Studies

Evaluation of Functional Outcomes and OCT-Biomarkers after Intravitreal Dexamethasone Implant for Postoperative Cystoid Macular Edema in Vitrectomized Eyes

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