Efficacy of the Intravitreal Sustained-Release Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-Vascular Endothelial Growth Factor Therapy: Meta-Analysis and Clinical Implications

Khan, Zainab; Kuriakose, Robin K.; Khan, M.N.; Chin, Eric K.; Almeida, David R.P.

doi:10.3928/23258160-20170130-10

Cited by 53 publications

(44 citation statements)

References 30 publications

(37 reference statements)

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“…2,7e9 Also, a meta-analysis based on data from 15 studies and 3859 patients reported on the efficacy of DEX inserts in diabetic macular edema (DME) refractory to antievascular endothelial growth factor (VEGF) therapy. 10 The HURON study in uveitis patients demonstrated a significant improvement in intraocular inflammation and visual acuity (VA) persisting for 6 months. 2 Because most of the patients have chronic inflammation with relapsing CME and VH, reinjections are indicated.…”

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confidence: 99%

Dexamethasone Inserts in Noninfectious Uveitis

et al. 2018

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Dexamethasone Inserts in Noninfectious Uveitis

et al. 2018

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“…16,133 Since the results of that large, prospective, randomized-controlled clinical trial were published, therapy with corticosteroids has taken a secondary role to anti-VEGF therapy, often used in cases refractory to, or with incomplete responses to, first-line anti-VEGF therapy. 134,135 The availability of corticosteroids in the form of sustained release implants has potential benefits in terms of durability of therapy in vitrectomized eyes. 136 Results from protocol U from the DRCR Network demonstrated that in the short term, combination intraocular steroid in the form of a dexamethasone implant plus anti-VEGF therapy (ranibizumab) in comparison with that of continued anti-VEGF therapy alone in eyes with persistent center-involved DME and VA impairment despite previous anti-VEGF treatment, had modest improvement in visual gain despite significant reductions in retinal thickness on OCT. 137 In phakic eyes receiving continuous anti-VEGF therapy for DME, the addition of intravitreous corticosteroids did not result in significant visual improvements.…”

Section: Corticosteroid Therapymentioning

confidence: 99%

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Mansour¹,

Browning²,

Wong³

et al. 2020

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Purpose: To review the current therapeutic options for the management of diabetic retinopathy (DR) and diabetic macular edema (DME) and examine the evidence for integration of laser and pharmacotherapy. Methods: A review of the PubMed database was performed using the search terms diabetic retinopathy, diabetic macular edema, neovascularization, laser photocoagulation, intravitreal injection, vascular endothelial growth factor (VEGF), vitrectomy, pars plana vitreous surgery, antiangiogenic therapy. With additional cross-referencing, this yielded 835 publications of which 301 were selected based on content and relevance. Results: Many recent studies have evaluated the pharmacological, laser and surgical therapeutic strategies for the treatment and prevention of DR and DME. Several newer diagnostic systems such as optical coherence tomography (OCT), microperimetry, and multifocal electroretinography (mfERG) are also assisting in further refinements in the staging and classification of DR and DME. Pharmacological therapies for both DR and DME include both systemic and ocular agents. Systemic agents that promote intensive glycemic control, control of dyslipidemia and antagonists of the renin-angiotensin system demonstrate beneficial effects for both DR and DME. Ocular therapies include anti-VEGF agents, corticosteroids and nonsteroidal anti-inflammatory drugs. Laser therapy, both as panretinal and focal or grid applications continue to be employed in management of DR and DME. Refinements in laser devices have yielded more tissue-sparing (subthreshold) modes in which many of the benefits of conventional continuous wave (CW) lasers can be obtained without the adverse side effects. Recent attempts to lessen the burden of anti-VEGF injections by integrating laser therapy have met with mixed results. Increasingly, vitreoretinal surgical techniques are employed for less advanced stages of DR and DME. The development and use of smaller gauge instrumentation and advanced anesthesia agents have been associated with a trend toward earlier surgical intervention for diabetic retinopathy. Several novel drug delivery strategies are currently being examined with the goal of decreasing the therapeutic burden of monthly intravitreal injections. These fall into one of the five categories: non-biodegradable polymeric drug delivery systems, biodegradable polymeric drug delivery systems, nanoparticle-based drug delivery systems, ocular injection devices and with sustained release refillable devices. At present, there remains no one single strategy for the management of the particular stages of DR and DME as there are many options that have not been rigorously tested through large, randomized, controlled clinical trials. Conclusion: Pharmacotherapy, both ocular and systemic, will be the primary mode of intervention in the management of DR and DME in many cases when cost and treatment burden are less constrained. Conventional laser therapy has become a secondary intervention in these instances, but remains a first-line option when cost and ...

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“…Kodjikian i wsp. przeprowadzili porównanie skuteczności leczenia z zastosowaniem doszklistkowych iniekcji czynnika anty-VEGF oraz implantu DEX 0,7 mg, dokonując analizy wyników 63 badań obejmujących odpowiednio 6842 i 1703 oczu z DME [15]. Średni okres obserwacji wynosił 15,6 miesiąca w grupie anty-VEGF i 10,3 miesiąca w grupie DEX 0,7 mg, a średnia liczba wykonanych doszklistkowych iniekcji wynosiła odpowiednio 5,8 i 1,6.…”

Section: Rola Doszklistkowych Iniekcji Steroidów: Ozurdex -Dane Z Codunclassified

Rola doszklistkowych steroidów we współczesnym leczeniu cukrzycowego obrzęku plamki

et al. 2018

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STRESZCZENIEPowikłania cukrzycy są jednym z najczęstszych i najpoważniejszych problemów we współczesnej okulistyce. W pracy przedstawiono dane epidemiologiczne i zasady leczenia retnopatii cukrzycowej i cukrzycowego obrzęku plamki. Szczególną uwagę zwrócono na rolę iniekcji doszklistkowych, w tym steroidów, które w niektórych przypadkach mogą być alternatywą dla inhibitorów naczyniowo-śrdódbłonkowego czynnika wzrostu (anty-VEGF). Zdaniem grupy ekspertów konieczne jest stworzenie programu lekowego obejmującego leczenie cukrzycowego obrzęku plamki, który istotnie poprawi dostęp do nowoczesnej terapii dużej grupie chorych. W programie lekowym lekiem pierwszego rzutu powinien być anty-VEGF z możliwością zmiany na doszklistkowy implant deksametazonu, w przypadku braku odpowiedzi na leczenie lub istnienia przeciwskazań do terapii anty-VEGF. Należy stworzyć precyzyjne kryteria kwalifikacji do programu, zdefiniować brak odpowiedzi na leczenie oraz określić wskazania do zmiany leku. SŁOWA KLUCZOWE: cukrzyca; cukrzycowy obrzęk plamki; iniekcje doszklistkowe; deksametazon ABSTRACTComplications of diabetes are one of the most common and serious problems in contemporary ophthalmology. The paper presents epidemiological data and principles of treatment of diabetic retinopathy and diabetic macular edema. Particular attention has been paid to the role of intravitreal injections, including steroid injections, which in some cases may be an alternative to anti-VEGF therapy. According to the group of experts, it is necessary to develop a drug program for the treatment of diabetic macular edema, which will significantly improve access to modern treatment for a large group of patients. In the drug program, the first-line treatment should be a VEGF inhibitor, with the possibility of switching to the intravitreal dexamethasone implant in patients who do not respond to treatment or have contraindications for anti-VEGF therapy. Precise qualification criteria for the program should be determined, the lack of response to treatment defined and indications for drug change specified.

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Efficacy of the Intravitreal Sustained-Release Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-Vascular Endothelial Growth Factor Therapy: Meta-Analysis and Clinical Implications

Cited by 53 publications

References 30 publications

Dexamethasone Inserts in Noninfectious Uveitis

Dexamethasone Inserts in Noninfectious Uveitis

<p>The Evolving Treatment of Diabetic Retinopathy</p>

Rola doszklistkowych steroidów we współczesnym leczeniu cukrzycowego obrzęku plamki

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