Preliminary results of an intravitreal dexamethasone implant (Ozurdex&amp;reg;) in patients with persistent diabetic macular edema

Pacella, Elena; Vestri, Anna Rita; Muscella, Roberto; Carbotti, Maria Rosaria; Castellucci, Massimo; Coi, L.; Turchetti, Paolo; Pacella, Fernanda

doi:10.2147/opth.s48364

Cited by 102 publications

(84 citation statements)

References 23 publications

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“…[17][18][19] IVD delivers sustained release of corticosteroid and has proven to be an effective treatment modality for DMO. [9][10][11][12] Corticosteroids block production of inflammatory cytokines and VEGF, 27 inhibit leukostasis, 28 improve the barrier function of vascular endothelial cell tight junctions, 29 inhibit endothelial nitric oxide synthase, 30 reduce tissue oedema, and decrease the release of prostaglandins and histamines, 31 all of which could cause vasodilation and choroidal thickening, potentially affecting ocular perfusion pressure. 32 IVD, therefore, could exert its therapeutic effect not only on the retina, but also on the choroid, by decreasing the production of inflammatory cytokines and factors that could increase CT.…”

Section: Discussionmentioning

confidence: 99%

“…6 Intravitreal dexamethasone implants (Ozurdex; Allergan, Irvine, CA, USA) is a sustained-release biodegradable implant, and it was shown to be effective for the treatment of DMO. 7,8 Recent studies showed that certain eyes with DMO were resistant to anti-VEGF therapy, 9 and intravitreal injection of dexamethasone (IVD) implant has proven to be a novel treatment modality for persistent DMO, 10,11 DMO in difficult to treat vitrectomized eyes, 12 and particularly in cases unresponsive to multiple injections of anti-VEGF agents. 9 With the advent of enhanced depth imaging optical coherence tomography (EDI-OCT), changes in choroidal thickness (CT) have been reported in chorioretinal diseases such as DMO, age-related macular degeneration, and uveitis.…”

Section: Introductionmentioning

confidence: 99%

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Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Kim

Cho

Lee

et al. 2016

Eye

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Aims To investigate the effect of intravitreal dexamethasone implant (IVD) on central foveal thickness (CFT), choroidal thickness (CT) and its correlation with visual acuity in eyes with refractory diabetic macular oedema (DMO). Methods This was a retrospective interventional case-series. Thirty-five eyes of 35 patients were treated with a single injection of IVD because of refractory DMO with CFT over 300 μm, and persistent intraretinal and subretinal fluid despite of multiple intravitreal bevacizumab injections. Patients were followed-up for 6 months for the evaluation of CFT and subfoveal CT by spectral-domain optical coherence tomography. Results All eyes (mean age: 59.4 ± 12.35 years; 18 males, 17 females) had been previously treated with multiple bevacizumab injections and showed persistent DMO (mean number of injections 4.08 ± 2.98) The preoperative logMAR BCVA was 0.49 ± 0.24, which gradually improved to 0.46 ± 0.32 at 6 months (P = 0.652) and 26% gained two or more lines of Snellen visual acuity. At baseline, the mean CFT was 526.29 ± 123.48 μm, which significantly improved to 316.15 ± 100.09 μm at 3 months (Po0.001). However, CFT deteriorated to 457.07 ± 136.53 μm at 6 months (P = 0.051). Similarly, the mean preoperative subfoveal CT was 288.91 ± 36.47 μm and it decreased to 266.85 ± 30.93 μm at 3 months (Po0.01), but increased to 278.63 ± 32.55 μm at 6 months (P = 0.137). The reduction of CFT from baseline showed significant correlation with that of subfoveal CT at 3 months (P = 0.041) and at 6 months (P = 0.008). Conclusions In DMO refractory to multiple bevacizumab injections, IVD significantly reduced CFT and subfoveal CT, with BCVA improvement in one-fourth of the patients. The reduction of CFT showed significant correlation with reduction of subfoveal CT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Kim

Cho

Lee

et al. 2016

Eye

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“…There is little evidence in the published literature of the effect of DEX-DDS in the treatment of edema persisting following other treatments [28,29,30,31,32,33]. The purpose of our study was to examine the effect of DEX-DDS in patients with severely recalcitrant CME that had a poor or short-term response to other treatment modalities.…”

Section: Introductionmentioning

confidence: 99%

Intravitreal Dexamethasone Implant in Patients with Persistent Macular Edema of Variable Etiologies

et al. 2014

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Purpose: To examine the effect of an intravitreal dexamethasone drug delivery system (DEX-DDS) in the treatment of persistent cystoid macular edema (CME) of different etiologies. Methods: Thirty-seven eyes with persistent CME were treated with DEX-DDS and analyzed for changes in best-corrected visual acuity (BCVA) and optical coherence tomography. Eyes were categorized into three groups: diabetic macular edema (DME, n = 14), vein occlusion (n = 15) and uveitis (n = 7). Results: The mean follow-up was 22 ± 6.9 weeks. BCVA improved from 0.62 ± 0.38 to 0.35 ± 0.29 logMAR (p < 0.0001). Central macular thickness decreased by 184 ± 246 µm from baseline (p < 0.0001). In eyes where CME resolved and recurred, the average CME-free period was 11 weeks. The uveitis group showed faster CME resolution (2 weeks) and a longer CME-free period (20 weeks). Similar efficacy was shown for repeat DEX-DDS injections. The safety profile was good. Conclusion: DEX-DDS is beneficial in the treatment of persistent CME. In cases of uveitis, CME resolution is rapid, resulting in the longest effect duration, when compared with other CME etiologies.

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“…[80][81][82][83][84][85] In the first study, Zucchiatti et al 80 showed that a single intravitreal injection of Ozurdex produced improvement in BCVA and FT in eyes with persistent DMO. Such improvement was evident from the third day to the first month after injection, peaked at the third month and was no more significant 6 months after the injection.…”

Section: Interventional Case Series Studiesmentioning

confidence: 99%

“…82 Seventeen patients (20 eyes) affected by DMO were selected. Thirteen patients had also previously been treated with anti-VEGF medication.…”

Section: Interventional Case Series Studiesmentioning

confidence: 99%

Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

Dutra-Medeiros

Alkabes

Nucci

2014

European Endocrinology

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Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex ® ; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment. KeywordsRefractory diabetic macular oedema, pathogenesis, inflammatory mediators, corticosteroids, dexamethasone intravitreal implant, implantable drug delivery system. 4 On the basis of the data from all 35 studies on more than 20,000 participants with diabetes, they estimated that among individuals with diabetes, the overall prevalence of any DR was 34.6 %, PDR was 7.0 %, DMO was 6.8 % and VTDR was 10.2 %. DR is a highly specific vascular complication of both type 1 and 2 diabetes, with prevalence strongly related to the duration of diabetes.5 In addition to the duration of diabetes, factors that increase the risk of, or are associated with, retinopathy include chronic hyperglycaemia, 6 nephropathy 7 and hypertension.8 Intensive diabetes management with the goal of achieving near-normoglycemia has been shown in large prospective randomised studies to prevent and/or delay the onset and progression of DR.9-11 Lowering blood pressure has been shown to decrease the progression of retinopathy. 12DMO is a frequent complication of DR and the most common cause of vision loss in patients with diabetes. Left untreated, up to 33 % of patients with DMO will experience moderate vision loss. 13 Laser photocoagulation has been considered, for a long time, as the main treatment option for DMO, based on the results of the Early Treatment Diabetic Retinopathy Study (ETDRS) clinical trial.14 Focal laser treatment reduced the risk of moderate visual loss in patients with DMO by 50 %. 15In more recent studies that involved only patients with DMO-associated vision loss, repeated applications of focal/grid laser photocoagulation treatment resulted in at least a 10-letter improvement in visual acuity in 28-32 % of patients, but 13-19 % of patients lost at least 10 letters in visual acuity. [16][17] In DMO, vascular leakage from dilated hyperpermeable capillaries and microaneurysms leads to accumulation of extracellular fluid in the macula. Inflammation has a key role in the pathogenesis and maintenan...

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Preliminary results of an intravitreal dexamethasone implant (Ozurdex®) in patients with persistent diabetic macular edema

Cited by 102 publications

References 23 publications

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Effect of intravitreal dexamethasone implant on retinal and choroidal thickness in refractory diabetic macular oedema after multiple anti-VEGF injections

Intravitreal Dexamethasone Implant in Patients with Persistent Macular Edema of Variable Etiologies

Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

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