Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema

Bastakis, George G.; Dimopoulos, Dimitris; Stavrakakis, Anastasios; Pappas, George

doi:10.1038/s41433-018-0219-8

Cited by 15 publications

(21 citation statements)

References 38 publications

(44 reference statements)

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“…Multiple studies have demonstrated at least equivalence in BCVA response to DEX in vitrectomized versus nonvitrectomized eyes. 28,29 These results were in eyes with DME; however, in our cohort of eyes with uveitis, a significantly better BCVA outcome was noted in the vitrectomized eyes. The majority of these vitrectomized eyes were treated with membrane peeling procedures at the time of vitrectomy for epiretinal membrane or macular hole.…”

Section: Uveitismentioning

confidence: 56%

<p>Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review</p>

Wallsh¹,

Luths²,

Kil³

et al. 2020

OPTH

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Purpose: To evaluate the initial ten years of results from the intravitreal dexamethasone implant (DEX) in patients treated for retinal vein occlusion (RVO), diabetic macular edema (DME) or uveitis. Methods: Retrospective chart review of patients receiving DEX since its FDA approval. Best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography, intraocular pressure and cataract status were collected. Baseline data were collected from the initial DEX and post-treatment data at the visit at least four weeks after the last DEX. Results: In total, 315 eyes received 1216 DEX over 63.9±4.6 weeks. In the branch RVO (n=90), central RVO (n=59) and DME (n=62) cohorts, BCVA improved significantly (p<0.05). The uveitis (n=154) cohort did not have a significant change in BCVA, 0.62 ±0.04 to 0.61±0.04 logMAR (p=0.34). Younger patients, vitrectomized eyes, and eyes without a history of glaucoma were associated with significantly better BCVA outcomes in the uveitis cohort (p<0.05). Overall, CMT decreased significantly from 376.6±6.8 to 322.7±5.0 µm (p<0.05). Intraocular pressure increased significantly (p<0.001) and the percentage of patients requiring anti-glaucoma medications increased from 33.0% to 67.6%. Of phakic eyes, 58.8% (n=63) had cataract progression or underwent surgery with those who underwent surgery experiencing a significant improvement in BCVA (p<0.05). Conclusion: Repeated DEX over extended follow-up offers significant anatomic benefits to all cohorts. Visual benefits are only seen in RVO, DME and select uveitis demographics.

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Section: Uveitismentioning

confidence: 56%

<p>Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review</p>

Wallsh¹,

Luths²,

Kil³

et al. 2020

OPTH

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“…Both groups also shared the same pharmacokinetics after intravitreal placement of dexamethasone implants. Comparable visual/anatomical outcomes and rates of postinjection ocular hypertension were noted between vitrectomized and nonvitrectomized eyes after dexamethasone implant for DME in five previous clinical studies [31][32][33][34][35][36][37]. Dexamethasone implant injections also resulted in noticeable visual gain and foveal thickness reduction in vitrectomized patients with DME.…”

Section: Discussionmentioning

confidence: 68%

Comparison of Intravitreal Dexamethasone Implant and Ranibizumab in Vitrectomized Eyes with Diabetic Macular Edema

Wang

Huang

Chang

et al. 2021

Journal of Ophthalmology

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Purpose. This retrospective study aimed to compare the efficacy of intravitreal ranibizumab (IVR) and intravitreal dexamethasone implant (IDI) for pseudophakic vitrectomized eyes with diabetic macular edema (DME) in a single institution. Methods. Pseudophakic vitrectomized eyes with treatment-naïve center-involved DME were enrolled, with one eye in each patient. They were divided into two groups: one group receiving IDI every 3 to 4 months and another group receiving IVR using 3 monthly plus treat-and-extend injections, all with monthly follow-up for 6 months. Switch of intravitreal drugs or deferred macular laser was not allowed. Primary outcome measures included change in central foveal thickness (CFT) in 1 mm by spectral-domain optical coherence tomography and best-corrected visual acuity (BCVA) at Month 6. Results. Twenty-two eyes were included in the IDI group and 26 eyes in the IVR group. The baseline demographics, glycosylated hemoglobin level, intraocular pressure (IOP), BCVA, and CFT did not significantly differ ( p > 0.05 ). Compared to baseline data, CFT decreased and BCVA improved significantly after either IDI or IVR at Month 6 ( p < 0.05 ). Significantly better mean final BCVA (0.38 logMAR vs. 0.62 logMAR, p = 0.04 ), more mean visual gain (−0.30 logMAR vs. −0.15 logMAR, p = 0.02 ), lower mean final CFT (310.9 μm vs. 384.2 μm, p = 0.04 ), and larger mean CFT decrease (−150.0 μm vs. −60.1 μm, p = 0.03 ) were found in the IDI group compared to those in the IVR group. A smaller mean treatment number (2.6 vs. 5.6, p < 0.001 ) and higher rate of postinjection ocular hypertension requiring topical hypotensive agent therapy (27.3% vs. 0%, p = 0.0002 ) were demonstrated in the IDI group than those in the IVR group. Conclusion. We concluded that IDI and IVR can both effectively treat vitrectomized eyes with DME. Dexamethasone implants had significantly better visual/anatomical improvement, smaller treatment number, and higher rate of elevated IOP after injection than IVR in pseudophakic vitrectomized eyes with DME in a 6-month period.

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“…Çevik et al 31 also reported that DEX was similarly effective in the treatment of DME in eyes with and without vitrectomy. Bastakis et al 32 reported that previous vitrectomy did not adversely affect the effectiveness of DEX in patients with refractory DME, and that the maximum effect was observed within the first 3 months in both vitrectomized and nonvitrectomized eyes.…”

Section: Discussionmentioning

confidence: 98%

Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes

Özdemir¹,

Hasanreisoğlu²,

Yuksel³

et al. 2019

tjo

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Objectives: To report the effectiveness and long-term outcomes of intravitreal dexamethasone implantation for diabetic macular edema (DME) in vitrectomized eyes Materials and Methods: Medical records of patients were retrospectively reviewed. Time of pars plana vitrectomy (PPV), PPV indications, interval between DEX injection and PPV, other intravitreal treatment prior to DEX application, best corrected visual acuity (BCVA), intraocular pressure (IOP), and central retinal thickness (CRT) measured by optical coherence tomography were recorded. Results: Seventeen eyes of 17 patients were included in the study. The mean follow-up after DEX injection was 21±2.4 months (12-43 months). The female/male ratio was 11/6. Mean age was 60.7 years (46-70 years). Sixteen eyes (94.1%) were pseudophakic at the time of DEX treatment. The most common indication for PPV was tractional retinal detachment (8 eyes, 47.1%). Ten eyes (58.8%) received a single injection and a total of 30 DEX implantations were performed. Mean BCVA was 0.77 logarithm of the minimum angle of resolution (logMAR) units before the first injection and improved to 0.64, 0.68 and 0.66 logMAR after 1, 3 and 6 months, respectively (p<0.01). CRT decreased significantly from 452 μm at baseline to 310, 368±34 and 375 μm after 1, 3 and 6 months, respectively (p<0.04). Mean IOP was 16±1.2 mmHg at baseline and 18.2, 18.8 and 18.5 mmHg after 1, 3, and 6 months (p>0.05). Two eyes (%8) received topical anti-glaucoma medication (IOP≥25 mmHg). Similar results were observed in eyes receiving repeated DEX injections. Conclusion: Intravitreal DEX injection treatment seems to be effective for improving BCVA and decreasing CRT in vitrectomized eyes with DME. This effect seemed to last for 6 months in most eyes, but maximized at 3 months. Patients with repeated injections often require injection before 6 months.

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Long-term efficacy and duration of action of dexamethasone implant, in vitrectomised and non-vitrectomised eyes with persistent diabetic macular oedema

Cited by 15 publications

References 38 publications

<p>Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review</p>

<p>Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review</p>

Comparison of Intravitreal Dexamethasone Implant and Ranibizumab in Vitrectomized Eyes with Diabetic Macular Edema

Effectiveness of Intravitreal Dexamethasone Implant Treatment for Diabetic Macular Edema in Vitrectomized Eyes

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