Ozurdex<sup>®</sup> reduces the retinal thickness in radiation maculopathy refractory to bevacizumab

Tarmann, Lisa; Langmann, G.; Mayer, Christoph; Weger, Martin; Haas, Anton; Wackernagel, Werner

doi:10.1111/aos.12424

Cited by 28 publications

(16 citation statements)

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“…Comparing groups, CMT was lower ( p = 0.09) and visual acuity was significantly better ( p = 0.02) in the aflibercept group at 1 year. Differing from the findings of Finger and Chin [15] evaluating high-dose ranibizumab therapy and the series evaluating Ozurdex® as rescue therapy for persistent post-radiation CME [13,14,15], statistically significant improvement in vision was observed with aflibercept treatment. …”

Section: Discussionmentioning

confidence: 89%

“…The authors noted sustained anatomic improvement with Ozurdex® compared to prior IVB and intravitreal triamcinolone treatments, but visual acuity improved in only 1 of 2 eyes. Tarmann et al [14] also reported outcomes in 4 eyes treated with Ozurdex® for persistent post-radiation CME despite prior IVB therapy. Similar to the results of Bui et al [13], improvement in CMT was noted in all eyes but visual acuity improved in only 2 of 4 eyes.…”

Section: Discussionmentioning

confidence: 99%

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Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

et al. 2017

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Background/Aims: To investigate the efficacy of intravitreal aflibercept as rescue therapy for post-radiation cystoid macular edema (CME) resistant to prior treatment with intravitreal bevacizumab (IVB). Methods: Retrospective, interventional, case-controlled series. Eyes with persistent post-radiation CME were treated with intravitreal aflibercept (2 mg/0.05 mL). Central macular thickness (CMT) and visual acuity were compared to a matched control group treated with only IVB at 1 year. Results: Ten eyes of 10 patients were included, with 5 eyes in the intervention and 5 in the control group. The eyes in the intervention group had previously been treated with IVB (mean 11.6 injections, range 6-22) but failed to show resolution of CME. Following rescue treatment with a mean of 9 injections of aflibercept, the mean CMT was reduced from 463 ± 138 to 267 ± 80 μm (p = 0.02) and the mean Snellen visual acuity was improved from 20/67 to 20/42 (p = 0.03). At 1 year, the eyes in the intervention group had lower CMT (267 ± 80 vs. 361 ± 71 μm, p = 0.09) and significantly better Snellen visual acuity (20/48 vs. 20/76, p = 0.02) compared to the control group. Conclusions: Aflibercept may be an effective rescue therapy for persistent post-radiation CME in eyes with incomplete response to IVB, with reduction in CMT and improvement in visual acuity.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

et al. 2017

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“…Multiple treatment modalities, including focal laser [10], photodynamic therapy [11], periocular [12,13] or intravitreal [14,15,16] corticosteroids, and intravitreal anti-VEGF agents [6,7,8,17], have since been investigated for treatment and prevention of postradiation CME. Currently, intravitreal injection of anti-VEGF agents is the most commonly used method for treatment of postradiation macular edema [6,7,16,17] but, unfortunately, many of the treated eyes do not show a clinically significant reduction in CMT despite treatment. In one study, only 56% of eyes with macular edema following plaque radiotherapy showed a >10% reduction in CMT after 4 monthly intravitreal injections of standard-dose (1.25 mg) bevacizumb, with 14% of eyes exhibiting a >10% increase in CMT [7].…”

Section: Discussionmentioning

confidence: 99%

High-Dose (2.5 mg) Intravitreal Bevacizumab as Rescue Therapy for Persistent Postradiation Cystoid Macular Edema

et al. 2017

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Background/Aims: To investigate the efficacy of intravitreal high-dose (2.5 mg/0.1 mL) bevacizumab as rescue therapy for postradiation cystoid macular edema (CME) resistant to standard-dose (1.25 mg/0.05 mL) bevacizumab. Methods: Retrospective, interventional case series. Results: Fifteen eyes of 15 patients were included. Eyes were treated with a mean of 10 standard-dose (1.25 mg) bevacizumab injections but failed to show CME resolution. Following 3 monthly treatments of high-dose (2.5 mg) bevacizumab, mean central macular thickness (CMT) reduced significantly from 406 ± 100 to 360 ± 83 μm (p = 0.01) and mean logMAR visual acuity improved from 0.55 ± 0.17 (Snellen 20/71) to 0.48 ± 0.21 (Snellen 20/60, p = 0.07). At the final follow-up of 9 months, CMT was 395 ± 124 μm (p = 0.67) and visual acuity was 0.51 ± 0.23 (Snellen 20/65, p = 0.22). Five eyes (30%) had a >10% reduction in CMT at the final follow-up. In these eyes, the observed CMT reduction was statistically significant (p = 0.04) and logMAR visual acuity was significantly better (p ≤ 0.01) compared to the remainder of the cohort. Conclusions: Overall, the use of high-dose (2.5 mg) bevacizumab did not result in a sustained, significant improvement in CMT and visual acuity outcomes following incomplete response to standard-dose (1.25 mg) bevacizumab. However, a minority of eyes exhibited favorable response with significant CMT reduction.

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“…Safety concerns include cataract formation and IOP elevation that is most often transitory and responsive to medical management 16. Previous evidence has described intravitreal injections of dexamethasone implant as “rescue treatments” in eyes affected by chronic RME unresponsive to anti-VEGF treatment (bevacizumab) and triamcinolone acetonide 29,30. Data of naïve RME treated with dexamethasone implant are still poor, but good efficacy and safety results have been published, resizing the concerns due to the raise in IOP and cataract development.…”

Section: Discussionmentioning

confidence: 99%

Long-term follow-up of anatomical and functional macular changes after a single intravitreal implant of dexamethasone 0.7 mg for radiation macular edema secondary to proton beam therapy for choroidal melanoma

Stringa¹,

Marzi²,

Giannì³

et al. 2016

IMCRJ

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PurposeTo describe the efficacy and safety of a single intravitreal implant of dexamethasone in a patient affected by radiation maculopathy due to proton beam radiotherapy for choroidal melanoma.Patient and methodsRetrospective data of a 46-year-old woman treated with a single intravitreal injection of dexamethasone for radiation maculopathy due to proton beam radiotherapy were collected. The main outcome measures were best-corrected visual acuity and central retinal thickness. Intraocular pressure, anterior segment evaluation with slit lamp, macular changes depicted with spectral domain optical coherence tomography, retinal perfusion studied with fundus fluorescein angiography, and grade of macular edema using the Horgan classification were also evaluated during a 16-month follow-up.ResultsMacular edema occurred 25 months after radiation treatment in the left eye. The patient underwent a single intravitreal implant of dexamethasone. Preinjection visual acuity and central retinal thickness were 6/12 and 502 µm, respectively. After 8 months, visual acuity was 6/6 and remained stable until 16 months. Central retinal thickness was 269 µm at 16 months.ConclusionA single intravitreal implant of dexamethasone could effectively and stably improve visual acuity and central retinal thickness in some patients with radiation macular edema for 16 months after injection.

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Ozurdex^® reduces the retinal thickness in radiation maculopathy refractory to bevacizumab

Cited by 28 publications

References 8 publications

Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

High-Dose (2.5 mg) Intravitreal Bevacizumab as Rescue Therapy for Persistent Postradiation Cystoid Macular Edema

Long-term follow-up of anatomical and functional macular changes after a single intravitreal implant of dexamethasone 0.7 mg for radiation macular edema secondary to proton beam therapy for choroidal melanoma

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Ozurdex® reduces the retinal thickness in radiation maculopathy refractory to bevacizumab

Cited by 28 publications

References 8 publications

Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year

High-Dose (2.5 mg) Intravitreal Bevacizumab as Rescue Therapy for Persistent Postradiation Cystoid Macular Edema

Long-term follow-up of anatomical and functional macular changes after a single intravitreal implant of dexamethasone 0.7 mg for radiation macular edema secondary to proton beam therapy for choroidal melanoma

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Ozurdex^® reduces the retinal thickness in radiation maculopathy refractory to bevacizumab