Intravitreal Corticosteroids in the Management of Diabetic Macular Edema

Schwartz, Stephen G.; Flynn, Harry W.

doi:10.1007/s40135-013-0015-3

Cited by 31 publications

(23 citation statements)

References 56 publications

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“…Schwartz and colleagues recently reviewed the literature on the variety of delivery systems for introducing glucocorticoids into the vitreous cavity (Schwartz et al, 2013). There are currently three different synthetic corticosteroids in clinical use for this purpose.…”

Section: Current Clinical Perspectivementioning

confidence: 99%

Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine

Fini

Schwartz

Gao

et al. 2017

Progress in Retinal and Eye Research

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121

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Elevation of intraocular pressure (IOP) due to therapeutic use of glucocorticoids is called steroid-induced ocular hypertension (SIOH); this can lead to steroid-induced glaucoma (SIG). Glucocorticoids initiate signaling cascades ultimately affecting expression of hundreds of genes; this provides the potential for a highly personalized pharmacological response. Studies attempting to define genetic risk factors were undertaken early in the history of glucocorticoid use, however scientific tools available at that time were limited and progress stalled. In contrast, significant advances were made over the ensuing years in defining disease pathophysiology. As the genomics age emerged, it appeared the time was right to renew investigation into genetics. Pharmacogenomics is an unbiased discovery approach, not requiring an underlying hypothesis, and provides a way to pinpoint clinically significant genes and pathways that could not have been discovered any other way. Results of the first genome-wide association study to identify polymorphisms associated with SIOH, and follow-up on two novel genes linked to the disorder, GPR158 and HCG22, is discussed in the second half of the article. However, knowledge of genetic variants determining response to steroids in the eye also has value in its own right as a predictive and diagnostic tool. This article concludes with a discussion of how the Precision Medicine Initiative®, announced by U.S. President Obama in his 2015 State of the Union address, is beginning to touch the practice of ophthalmology. It is argued that SIOH/SIG may provide one of the next opportunities for effective application of precision medicine.

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Section: Current Clinical Perspectivementioning

confidence: 99%

Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine

Fini

Schwartz

Gao

et al. 2017

Progress in Retinal and Eye Research

Self Cite

121

View full text Add to dashboard Cite

show abstract

“…Эффективность стероидов доказана как в качестве монотерапии, так и в виде комбинированной терапии при лечении ДМО [41]. Интравитреальное введение сте-роидов эффективно воздействует на макулярный отек и улучшает остроту зрения, особенно в случае резистент-ности к лазерному лечению [42,43].…”

Section: интравитреальные инъекции кортикостероидовunclassified

Macular oedema as manifestation of diabetic retinopathy

et al. 2017

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ОфтальмологияOphthalmology иабетическая ретинопатия (ДР) -микрососуди-стое осложнение сахарного диабета (СД) с пер-вичным поражением прекапиллярных артериол, капилляров и посткапиллярных венул с возможным вовле-чением сосудов более крупного калибра и развитием ми-кроаневризм, кровоизлияний, экссудативных изменений, с макулопатией и пролиферацией новообразованных со-судов на глазном дне [1]. В экономически развитых странах одной из ведущих причин слепоты у лиц трудоспособного возраста является ДР, на долю которой приходится 80-90% всей инвалидности по зрению, обусловленной СД [2]. ЭпидемиологияСогласно данным эпидемиологического исследова-ния Wisconsin Epidemiological Study of Diabetic Retinopathy (WESDR), при длительности СД 1 типа (СД1) более 20 лет частота ДР достигает почти 100% [3], с полной потерей зре-ния у каждого 30-го больного [4]. В целом признаки ДР по-являются через 5 лет после начала СД1 у 20% больных, через 10 лет -у 60%, а через 20-30 лет -практически у всех.При СД 2 типа (СД2) через 20 лет после начала за-болевания примерно 2/3 больных имеют ДР, при этом

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“…[2, 20] Corticosteroids act in multiple ways for the treatment of DME. [21] They are potent anti-inflammatory agents and inhibit VEGF expression. [3, 22]…”

Section: Introductionmentioning

confidence: 99%

New Drugs and New Posterior Delivery Methods in CME

Dias

Nunes

Goldhardt

2017

Curr Ophthalmol Rep

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Purpose To discuss the characteristics, indications and adverse events (AEs) of sustained-release corticosteroid devices for the treatment of cystoid macular edema (CME). Recent findings Ozurdex® is approved for the treatment of diabetic macular edema (DME), retinal vein occlusion related-CME and noninfectious posterior uveitis (NIPU). It releases dexamethasone over a maximum period of 6 months making repeated intravitreal injections necessary for recurrent CME. Iluvien® releases fluocinolone for up to 36 months and is effective for the treatment of chronic DME. Retisert® (Bausch & Lomb, Rochester, NY) also releases fluocinolone, and is approved for chronic NIPU. Both Iluvien® and Retisert® are non-biodegradable devices and are highly associated with cataract and glaucoma. Summary Long-acting intraocular corticosteroid formulations offer a more predictable drug-release profile and reduced dosing frequency in comparison to conventional formulations of the same compounds but the risk-benefit ratio must be taken into consideration previous to the implantation of those devices.

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Intravitreal Corticosteroids in the Management of Diabetic Macular Edema

Cited by 31 publications

References 56 publications

Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine

Steroid-induced ocular hypertension/glaucoma: Focus on pharmacogenomics and implications for precision medicine

Macular oedema as manifestation of diabetic retinopathy

New Drugs and New Posterior Delivery Methods in CME

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