Intraocular Pressure in Patients With Diabetic Macular Edema Treated With Dexamethasone Intravitreal Implant in the 3-Year Mead Study

Maturi, Raj K.; Pollack, Ayala; Uy, Harvey S.; Varano, Monica; Gomes, André Luís; Li, Xiao Yan; Cui, Huadong; Lou, Jingjing; Hashad, Yehia; Whitcup, Scott M.

doi:10.1097/iae.0000000000001004

Cited by 112 publications

(118 citation statements)

References 32 publications

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“…Similar results were reported by Totan et al[31] who showed a significant increase from baseline in IOP at 1 and 3 months ( p ≤ 0.04) after implant; however, these were well controlled with topical treatment. Similar to our findings, Maturi et al [30] reported a non-cumulative increase in IOP after sequential implants.…”

Section: Discussionsupporting

confidence: 93%

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Repeated Dexamethasone Intravitreal Implant for the Treatment of Diabetic Macular Oedema Unresponsive to Anti-VEGF Therapy: Outcome and Predictive SD-OCT Features

et al. 2018

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Purpose: To investigate dexamethasone intravitreal implant 0.7 mg (DEX implant) for the treatment of diabetic macular oedema (DME) refractory to anti-vascular endothelial growth factor (anti-VEGF) therapy and evaluate predictive factors. Methods: Two-centre retrospective interventional case series, including 40 eyes of 31 patients treated with DEX implant for at least 2 consecutive cycles. Results: Mean ± SD intervals from implantation to recurrence in the first (4.2 ± 1.0 months) and second cycles (4.0 ± 0.9 months) were not significantly different. Best corrected visual acuity improved significantly (p < 0.001) by 7.0 ± 8.4 letters from baseline to month 2, and by 5.1 ± 6.9 letters between the first and second cycles. Central retinal thickness reduction 2 months after implantation was greater after the first (–194 ± 172 µm) than the second cycle (–134 ± 150 µm). Ellipsoid zone-external limiting membrane (EZ-ELM) disruption score decreased from 1.39 ± 1.16 at baseline to 1.24 ± 1.16 (p = 0.0832) after cycle 1 and remained stable 2 months after cycle 2. Eyes with persisting severe EZ-ELM disruption (score >2, n = 10) 2 months after the first DEX implant showed significantly (p = 0.0153) smaller visual acuity (VA) gains than eyes with less severe (score ≤2) EZ-ELM disruption. Conclusion: Repeated intravitreal DEX injections with average intervals of 4 months are valuable in patients with DME refractory to anti-VEGF therapy. Disorganization of outer retinal layers (EZ-ELM) may predict smaller VA gains if evaluated after initial reduction of macular oedema.

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Section: Discussionsupporting

confidence: 93%

“…Our results show that re-treatment with DEX after recurrence continued to improve VA and CRT. Improvements in VA after re-treatment have also been seen in other studies [30]. …”

Section: Discussionsupporting

confidence: 62%

Repeated Dexamethasone Intravitreal Implant for the Treatment of Diabetic Macular Oedema Unresponsive to Anti-VEGF Therapy: Outcome and Predictive SD-OCT Features

et al. 2018

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“…The elevated IOP is not merely the result of the added volume, but is also due to the properties of the injected drug. IOP elevation is associated with steroid therapy in general, and rates of this complication have been reported to be between 30 and 60% following IVI of triamcinolone acetonide [36-39], and between 30 and 50% following use of dexamethasone implants (Ozurdex) [40-43]. Anti-vascular endothelial growth factor (VEGF) agents have also been associated with elevated IOP, in as many as 12% of cases.…”

Section: Considerations Before Injectionmentioning

confidence: 99%

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

et al. 2018

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Intravitreal injections (IVI) have become the most common intraocular procedure worldwide with increasing numbers every year. The article presents the most up-to-date review on IVI epidemiology and techniques. Unfortunately, important issues related to pre-, peri- and postinjection management lack randomized clinical trials for a final conclusion. Also, a great diversity of approaches exists worldwide. Therefore, expert consensus recommendations on IVI techniques are provided.

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“…Medication for lowering intraocular pressure (IOP) was used at some point during the study by 41.5 and 9.1% of patients in the dexamethasone implant 0.7 mg and sham groups, respectively [52]. The proportion of patients using IOP-lowering medication remained similar in each year of the study, although 1 patient (0.3%) in each dexamethasone implant group had filtering surgery to manage a steroid-induced IOP increase [52].…”

Section: Phase III Study On the Safety And Efficacy Of Dexamethasone mentioning

confidence: 99%

“…The proportion of patients using IOP-lowering medication remained similar in each year of the study, although 1 patient (0.3%) in each dexamethasone implant group had filtering surgery to manage a steroid-induced IOP increase [52]. The profile of the IOP elevation after dexamethasone implant treatment was predictable, occurring around the second month after injection.…”

Section: Phase III Study On the Safety And Efficacy Of Dexamethasone mentioning

confidence: 99%

Clinical Decision-Making when Treating Diabetic Macular Edema Patients with Dexamethasone Intravitreal Implants

et al. 2018

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Diabetes mellitus (DM) is a metabolic disease frequently associated with comorbidities that include diabetic macular edema (DME). The current medical approach to treating DME involves intravitreal injections with either anti-vascular endothelial growth factors or steroids. However, the burden associated with intravitreal injections and DM-derived complications is high, underlining the need to find optimal treatment regimens. In this article we describe the considerations we apply when treating DME patients with dexamethasone intravitreal implants (Ozurdex®), particularly those that influence the clinical decision-making process during the follow-up period. These considerations are based both on the available medical literature and on our clinical experience following the use of these implants in this type of patient, the goal being to optimize the number of injections and the clinical outcome of this therapy. We also provide a general overview of the pathophysiology of DME, highlighting the inflammatory component as a rationale to use steroids in these patients.

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Intraocular Pressure in Patients With Diabetic Macular Edema Treated With Dexamethasone Intravitreal Implant in the 3-Year Mead Study

Abstract: DEX implant demonstrated clear benefit of treatment despite increases in IOP. Sequential implants had no cumulative effect on IOP.

Cited by 112 publications

References 32 publications

Repeated Dexamethasone Intravitreal Implant for the Treatment of Diabetic Macular Oedema Unresponsive to Anti-VEGF Therapy: Outcome and Predictive SD-OCT Features

Repeated Dexamethasone Intravitreal Implant for the Treatment of Diabetic Macular Oedema Unresponsive to Anti-VEGF Therapy: Outcome and Predictive SD-OCT Features

2018 Update on Intravitreal Injections: Euretina Expert Consensus Recommendations

Clinical Decision-Making when Treating Diabetic Macular Edema Patients with Dexamethasone Intravitreal Implants

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