Intravitreal Steroids Compared with Anti-VEGF Treatment for Diabetic Macular Edema

Patil, Nikhil S.; Mihalache, Andrew; Hatamnejad, Amin; Popović, Marko; Kertes, Peter J.; Muni, Rajeev H.

doi:10.1016/j.oret.2022.10.008

Cited by 9 publications

(11 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, Veritti et al 67 critically appraised the existing studies surveying DME management. A recent meta-analysis 68 included the RCTs to compare the intravitreal steroids including triamcinolone acetonide and Ozurdex. They found the intravitreal steroid resulted in similar BCVA change and lower retinal thickness in DME patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety profile of intravitreal dexamethasone implant versus antivascular endothelial growth factor treatment in diabetic macular edema: a systematic review and meta-analysis

Chi

Kang

Huang

2023

Sci Rep

View full text Add to dashboard Cite

To better understand the efficacy of intravitreal dexamethasone implant (Ozurdex) versus antivascular endothelial growth factor (anti-VEGF) treatment in patients with diabetic macular edema (DME). A systematic review and meta-analysis. The study included randomized control trials (RCTs) and non-randomized control trials (Non-RCTs) before December 2021 that compare the efficacy of Ozurdex-related therapyand anti-VEGF therapy. We searched PubMed, Cochrane Library, and EMBASE. The quality of the included studies was assessed carefully. 30 studies were included. Regarding BCVA change, the overall result revealed no significant differences between Ozurdex and anti-VEGF therapies in patients with nonresistant DME, but Ozurdex group had significantly more VA improvement than anti-VEGF therapies in patients with resistant DME (MD 0.12, 95% CI 0.02–0.21). In terms of central retinal thickness (CRT) decrease, there was a significant difference between Ozurdex therapy and anti-VEGF therapy in patients with nonresistant DME (MD 48.10, 95% CI 19.06–77.13) and resistant DME (MD 65.37, 95% CI 3.62–127.13). Overall, Ozurdex therapy resulted in significantly greater VA improvement and CRT decrease than anti-VEGF therapy in resistant DME patients. Ozurdex therapy was not inferior to anti-VEGF therapy in patients with nonresistant DME.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy and safety profile of intravitreal dexamethasone implant versus antivascular endothelial growth factor treatment in diabetic macular edema: a systematic review and meta-analysis

Chi

Kang

Huang

2023

Sci Rep

View full text Add to dashboard Cite

show abstract

“…In general, the comparison of the Ozurdex IV implant and anti-VEGF in DME eyes has shown that Ozurdex is associated with the following: lower BCVA gain [ 107 , 108 , 120 ], which became comparable to anti-VEGF when pseudophakic eyes were analyzed separately [ 107 , 108 , 115 ]; better anatomical results, i.e., higher ability in reducing the macular edema, that did not translate directly into better BCVA improvements [ 107 , 115 , 120 , 121 , 122 , 123 , 124 ], which may be likely due to the cataract development; comparative better results in naïve than in non-naïve eyes, whereas the outcomes in the two groups appear similar in anti-VEGF studies [ 105 ]; better results in chronic and persistent DME eyes and in eyes with moderate-severe DME (CRT > 410 microns) [ 124 , 125 ] better outcomes in real-life studies than in interventional studies [ 126 ]: the possibility of retreating at an earlier stage and the higher number of naïve (2/3 of treatment-naïve eyes in anti-VEGF studies vs. 1/5 in the Ozurdex studies), or short duration DME eyes with better baseline VA in the real-life studies, may explain these differences (on the other hand, systematic review and meta-analysis studies have demonstrated that IV anti-VEGF showed better anatomical and functional results in RCTs compared to the observational studies, likely because fewer injections are administered in the observation studies than those suggested by the RCTs [ 105 , 120 , 126 ], and VA gain seems to be strictly related to the number of the IV injections, at least during the first year of therapy [ 127 , 128 ]); higher risk of OHT, glaucoma, and cataracts and lower risk of serious systemic adverse events [ 107 , 108 , 115 , 119 , 120 , 123 ]; lower number of required IV injections [ 105 , 107 , …”

Section: Corticosteroids For the Management Of Dmementioning

confidence: 99%

“…better anatomical results, i.e., higher ability in reducing the macular edema, that did not translate directly into better BCVA improvements [ 107 , 115 , 120 , 121 , 122 , 123 , 124 ], which may be likely due to the cataract development;…”

Section: Corticosteroids For the Management Of Dmementioning

confidence: 99%

See 1 more Smart Citation

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

Salvetat,

Pellegrini,

Spadea

et al. 2024

JCM

View full text Add to dashboard Cite

Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25–30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy.

show abstract

“…Steroids maintain a similar efficacy to anti-VEGF treatment and function via anti-proliferative and anti-inflammatory properties [6]. Corticosteroids are postulated to be effective at treating ME when delivered intravitreally, given the ability to bypass the blood-retinal barrier [1].…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis

Mihalache¹,

Hatamnejad²,

Patil³

et al. 2023

Ophthalmologica

Self Cite

View full text Add to dashboard Cite

Background: The comparative safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is unclear. Objectives: This meta-analysis aimed to compare the safety and efficacy of different doses of IVTA in this setting. Methods: A systematic literature search for randomized clinical trials (RCTs) was conducted on Cochrane Library, Ovid MEDLINE and EMBASE from January 2005 to May 2022. Studies reporting on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA. A random effects meta-analysis was performed. Cochrane’s risk of bias tool 2 was used to assess the risk of bias and grading of recommendations, assessment, development and evaluation (GRADE) guidelines were used to assess certainty of evidence. Results: Five RCTs reporting on 1,041 eyes at baseline were included in this meta-analysis. In eyes with ME secondary to RVO, high dose (4 mg) IVTA achieved a significantly better change in best-corrected visual acuity (WMD=-4.75 ETDRS letters, 95%CI=[-7.73, -1.78], p=.002) and reduction in retinal thickness (WMD=-93.02 µm, 95%CI=[-153.23, -32.82], p=.002) at months 4-6 compared to low dose (1-2 mg) IVTA. However, high dose IVTA had a higher risk of intraocular pressure (IOP)-related adverse events (RR=2.99, 95%CI=[1.05, 8.50], p=.04) and cataract surgery (RR=5.67, 95%CI=[3.09, 10.41], p<.00001) than low dose IVTA in eyes with ME secondary to RVO. These efficacy and safety differences in high dose and low dose IVTA were not observed in DME eyes. Conclusions: The RCT evidence in this setting is limited. High dose IVTA achieved greater improvements in visual acuity and reductions in retinal thickness than low dose IVTA at months 4-6. However, high dose IVTA had a less favourable safety profile than low dose IVTA. The significance of these outcomes was based on patients with ME secondary to RVO, but not DME.

show abstract

Intravitreal Steroids Compared with Anti-VEGF Treatment for Diabetic Macular Edema

Cited by 9 publications

References 36 publications

Efficacy and safety profile of intravitreal dexamethasone implant versus antivascular endothelial growth factor treatment in diabetic macular edema: a systematic review and meta-analysis

Efficacy and safety profile of intravitreal dexamethasone implant versus antivascular endothelial growth factor treatment in diabetic macular edema: a systematic review and meta-analysis

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis

Contact Info

Product

Resources

About