Recalcitrant Macular Edema After Intravitreal Bevacizumab Is Responsive to an Intravitreal Dexamethasone Implant in Retinal Vein Occlusion

Sharareh, Behnam; Gallemore, Ron P.; Taban, Mehran; Onishi, Spencer M; Wallsh, Josh

doi:10.1097/iae.0b013e31827c53a0

Cited by 30 publications

(29 citation statements)

References 9 publications

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“…It is important to point out that persistent CME in this study was defined as CME nonresponsive or partially responsive to a minimum of 2 bevacizumab injections and that the average duration of CME prior to injection was 11.08 ± 8.82 weeks. The persistence of CME in this study is therefore relatively short compared to our study and the other studies described above [32]. …”

Section: Discussionmentioning

confidence: 44%

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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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Section: Discussionmentioning

confidence: 44%

“…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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“…16 The group with fluid at 3 months will be further categorized using the definition proposed by Sharareh et al into those who have less than a 1% reduction in MO after 3 injections (the non-responders) and those who respond with at least a 10% reduction in MO (the partial responders). 27 Patients showing no fluid activity (early responders) after 3 monthly injections should be followed up monthly and injected using a PRN protocol for the first year and with gradual monthly extensions of the follow-up period during the second year to maintain gains. Patients showing residual fluid at 3 months should be categorized into partial or non-responders.…”

Section: Discussionmentioning

confidence: 99%

“…To further stratify this group of poorly responsive patients we suggest the definition used by Sharareh et al that suggested that patients who have o1% reduction in MO after injections are to be deemed non-responders and patients who respond with at least a 10% reduction in MO to be categorized as partial responders. 27 With that concept in mind we will explore some of the alternate treatment modalities that can be used in patient deemed nonresponsive or partially responsive after three loading doses of anti-VEGFs.…”

Section: Alternate Treatment Regimensmentioning

confidence: 99%

“…Steroids can be used as a second line drug in resistant cases or as an adjunct from the start. A retrospective study by Sharareh et al, 27 looked at 18 patients categorized as complete or partial responders to Bevazicumab that were given Dexamethasone implants. The study showed that both subgroups responded with an improvement in both central macular thickness (average 147 μm) and visual acuity (mean improvement of 0.25 logMAR).…”

Section: Switching To Steroidsmentioning

confidence: 99%

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Central retinal vein occlusion: modifying current treatment protocols

Ashraf

Souka

Singh

2016

Eye

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Central retinal vein occlusion (CRVO) is a common retinal vascular disorder that can result in severe visual acuity loss. The randomized control study, CRUISE, helped establish anti-VEGFs as the standard of care in cases with CRVO. The extension studies for CRUISE; HORIZON and RETAIN showed that not all visual gains are maintained beyond the first year. In addition, patients showed different behavior patterns; with some patients showing complete response with few recurrences, whereas others showed partial or even no response with multiple recurrences. Long-term follow-up demonstrated that patients responding poorly to anti-VEGFs tended to do so early in the course of treatment. It also demonstrated the effectiveness of a pro re nata (PRN) protocol for improving vision and maintaining these gains over long-term follow-ups. The SHORE study further illustrated this point by demonstrating that there were minimal differences in visual outcomes between patients receiving monthly injections and patients being treated PRN. In this review we analyzed the data from the major randomized clinical trials (RCT) that looked at anti-VEGFs as the primary treatment modality in patients with CRVO (CRUISE and the extension studies HORIZON and RETAIN for ranibizumab as well as GALILEO and COPERNI-CUS for aflibercept). In addition, we looked at SCORE and GENEVA to help determine whether there is a place for steroids as a first line therapy in current treatment practice. We then explored alternative treatment regimens such as laser therapy and switching between anti-VEGF agents and/or steroids for non or partially responding patients. Finally, we propose a simplified modified treatment algorithm for patients with CRVO for better long-term outcomes in all types of responders.

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Leitbild Diagnose und Therapie retinaler Venenverschlüsse

Weger

Egger

2017

Spektrum Augenheilkd.

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Recalcitrant Macular Edema After Intravitreal Bevacizumab Is Responsive to an Intravitreal Dexamethasone Implant in Retinal Vein Occlusion

Abstract: A subset of patients do not have resolution of macular edema after treatment with intravitreal bevacizumab. Such patients may respond to treatment with an intravitreal dexamethasone implant.

Cited by 30 publications

References 9 publications

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

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

Central retinal vein occlusion: modifying current treatment protocols

Leitbild Diagnose und Therapie retinaler Venenverschlüsse

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