Intravitreal steroids in the management of macular oedema

Sivaprasad, Sobha; McCluskey, Peter; Lightman, Susan

doi:10.1111/j.1600-0420.2006.00698.x

Cited by 64 publications

(50 citation statements)

References 143 publications

(150 reference statements)

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“…DEX is also used in the treatment of posterior segment eye diseases such as uveitis and macular edema (4,5). It exerts anti-inflammatory activity by inhibiting multiple inflammatory cytokines (6,7).…”

Section: Introductionmentioning

confidence: 99%

Optimization of Dexamethasone Mixed Nanomicellar Formulation

et al. 2014

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Abstract. The purpose of this study was to develop a clear aqueous mixed nanomicellar formulation (MNF) of dexamethasone utilizing both D-α-tocopherol polyethylene glycol-1000 succinate (Vit E TPGS) and . In this study, Vit E TPGS and Oc-40 are independent variables. Formulations were prepared following solvent evaporation method. A three level full-factorial design was applied to optimize the formulation based on entrapment efficiency, size, and polydispersity index (PDI). A specific blend of Vit E TPGS and Oc-40 at a particular wt% ratio (4.5:2.0) produced excellent drug entrapment, loading, small mixed nanomicellar size and narrow PDI. Solubility of DEX in MNF is improved by~6.3-fold relative to normal aqueous solubility. Critical micellar concentration (CMC) for blend of polymers (4.5:2.0) was found to be lower (0.012 wt%) than the individual polymers (Vit E TPGS (0.025 wt%) and Oc-40 (0.107 wt%)). No significant effect on mixed nanomicellar size and PDI with one-factor or multifactor interactions was observed. Qualitative 1 H NMR studies confirmed absence of free drug in the outer aqueous MNF medium. MNF appeared to be highly stable. Cytotoxicity studies on rabbit primary corneal epithelial cells did not indicate any toxicity suggesting MNF of dexamethasone is safe and suitable for human topical ocular drops after further in vivo evaluations.

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Section: Introductionmentioning

confidence: 99%

Optimization of Dexamethasone Mixed Nanomicellar Formulation

et al. 2014

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“…Corticosteroids are anti-inflammatory agents that stabilize retinal capillaries and tend to reduce their permeability by enhancing the activity or density of the tight junctions in the retinal capillary endothelium [6][7][8] as well inhibit and downregulate the metabolic pathway of the vascular endothelial growth factor [9][10][11][12] in order to decrease the leakage of plasma proteins into the interstitial tissue compartment and help to restore the osmotic gradient between blood and tissue compartments, and eventually will resolve edema formation [7,13,14] . Corticosteroid has emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities [15][16][17][18][19][20][21][22][23] .…”

Section: Introductionmentioning

confidence: 99%

Clinical trials on corticosteroids for diabetic macular edema

Dhibi

Arévalo

2013

WJD

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Diabetic macular edema (DME) is a common cause of visual impairment in diabetic patients. It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier. The pathogenesis of DME is multifactorial. Several therapeutic modalities have been proposed for the treatment of DME. Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities, due to anti-inflammatory, anti-vascular endothelial growth factor and anti-proliferative effects. Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME. Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease. Steroid-related side effects include elevated intraocular pressure, cataract, and injection related complications such as endophthalmitis, vitreous hemorrhage, and retinal detachment particularly with intravitreal steroid injections. In order to reduce the risks, complications and frequent dosing of intravitreal steroids, intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.© 2013 Baishideng Publishing Group Co., Limited. All rights reserved.Key words: Corticosteroids; Diabetic macular edema; Intravitreal triamcinolone acetonide injection; Intravitreal steroid sustained-release implants; Peribulbar steroid injections; Subtenon's steroid Injections Core tip: Despite the documented ocular side effects of corticosteroids by the time being they are still considered as one of the essential effective adjunct modalities for the treatment of diabetic macular edema especially in refractory and persistent cases.

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“…All corticosteroids increase the activity of endothelial tight junctions and inhibit the VEGF gene expression and the effects of VEGF by modulating downstream signaling pathways subsequently reducing capillary permeability [11, 12]. …”

Section: Introductionmentioning

confidence: 99%

Comparison of Bevacizumab and Triamcinolone for Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion – A Matched-Pairs Analysis

Guthoff

Meigen²,

Hennemann³

et al. 2009

Ophthalmologica

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Purpose: Our aim was to evaluate differences in the outcome of bevacizumab or triamcinolone acetate (TA) treatment in patients with macular edema (ME) after central retinal vein occlusion (CRVO). Procedures: In a retrospective assessment 9 bevacizumab-treated patients and 9 TA-treated ones with ME after CRVO were pair-matched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT) as measured by Stratus optical coherence tomography. BCVA and CMT were the main endpoints. Results: The initial BCVA of 0.15 ± 0.1 increased not significantly by 1.0 ± 3.1 lines in the bevacizumab-treated patients after a mean of 10 months. The initial BCVA of 0.17 ± 0.1 decreased by –1.0 ± 5.2 lines after a mean of 13 months following initial TA injection. The only significant decrease in mean CMT by 239 ± 209 µm occurred 8 weeks after initial bevacizumab injection. Conclusions: Both substances are able to stabilize CMT and BCVA in ME after CRVO, but only bevacizumab was devoid of unfavorable intraocular pressure elevation.

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Intravitreal steroids in the management of macular oedema

Cited by 64 publications

References 143 publications

Optimization of Dexamethasone Mixed Nanomicellar Formulation

Optimization of Dexamethasone Mixed Nanomicellar Formulation

Clinical trials on corticosteroids for diabetic macular edema

Comparison of Bevacizumab and Triamcinolone for Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion – A Matched-Pairs Analysis

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