Safety and Efficacy of Intravitreal Dexamethasone Implant for Refractory Uveitic Macular Edema in Adults and Children

Ratra, Dhanashree; Barh, Atanu; Banerjee, Manideepa; Ratra, Vineet; Biswas, Jyotirmay

doi:10.1080/09273948.2018.1424342

Cited by 18 publications

(13 citation statements)

References 18 publications

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“…The results of this study are similar to prior retrospective studies that demonstrated favorable visual outcomes in pediatric patients with macular edema of various noninfectious etiologies ( [3,6], .and [5].) In the series by Eiger-Moscovich et al of 25 children (33 eyes), 75.8% achieved resolution of macular edema by 24 months.…”

Section: Discussionsupporting

confidence: 88%

Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

Nguyen

Mekonnen

Kim

et al. 2021

J Ophthal Inflamm Infect

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Background Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients. Methods Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012 to 2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema. Results The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7). By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3–6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3–12.2, P = 0.01). Conclusions Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.

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Section: Discussionsupporting

confidence: 88%

Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

Nguyen

Mekonnen

Kim

et al. 2021

J Ophthal Inflamm Infect

View full text Add to dashboard Cite

show abstract

“…The results of this study are similar to prior retrospective studies that demonstrated favorable visual outcomes in pediatric patients with macular edema of various non-infectious etiologies (Eiger-Moscovich et al 2019, Shulman et al 2012., and Ratra et al 2018 In the series by Eiger-Moscovich et al of 25 children (33 eyes), 75.8% achieved resolution of macular edema by 24 months. Patients in their series had similar uveitis etiologies and also received a varied combination of treatment regimens, including a combination of local corticosteroid injections or dexamethasone implants, systemic corticosteroids, antimetabolites and anti-TNF alpha agents.…”

Section: Discussionsupporting

confidence: 88%

Clinical Outcomes of Pediatric Macular Edema Associated with Non-infectious Uveitis

Nguyen

Mekonnen

Kim

et al. 2020

Preprint

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Background Macular edema (ME) is the most frequent cause of irreversible visual impairment in patients with uveitis. To date, little data exists about the clinical course of ME in pediatric patients. A retrospective, observational study was performed to examine the visual and macular thickness outcomes of ME associated with chronic, noninfectious uveitis in pediatric patients.Methods Pediatric patients with noninfectious uveitis complicated by ME seen in the University of California San Francisco Health System from 2012-2018 were identified using ICD-9 and ICD-10 codes. Data were collected from medical records including demographics, diagnoses, ocular history, OCT imaging findings, complications, and treatments at first encounter and at 3, 6, 9, and 12-month follow-up visits. Cox proportional hazards regression was used to investigate the association between different classes of treatment (steroid drops, steroid injections, oral steroids and other immunosuppressive therapies) and resolution of macular edema. Results The cohort comprised of 21 children (26 eyes) with a mean age of 10.5 years (SD 3.3). Undifferentiated uveitis was the most common diagnosis, affecting 19 eyes (73.1%). The majority of observed macular edema was unilateral (16 patients, 76.2%) and 5 patients had bilateral macular edema. The mean duration of follow-up at UCSF was 35.3 months (SD 25.7).By 12 months, 18 eyes (69.2%) had achieved resolution of ME. The median time to resolution was 3 months (IQR 3-6 months). Median best-corrected visual acuity (BCVA) at baseline was 0.54 logMAR (Snellen 20/69, IQR 20/40 to 20/200). Median BCVA at 12 months was 0.1 logMAR (Snellen 20/25, IQR 20/20 to 20/50) Corticosteroid injections were associated with a 4.0-fold higher rate of macular edema resolution (95% CI 1.3-12.2, P = 0.01).Conclusions Although only 15% of the pediatric patients with uveitis in the study cohort had ME, it is clinically important to conduct OCTs to detect ME in this population. Treatment resulted in 69% of eyes achieving resolution of ME by 12 months, accompanied with improvement in visual acuity. Corticosteroid injections were significantly associated with resolution of macular edema.

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“…Ratra et al, investigated the role of Dex in nonresponsive ME secondary to chronic NIUs in adults and children, reporting a significant VA improvement and a good safety profile [57]. Moreover, a single injection of Ozurdex was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behcet posterior uveitis for a 6-month period [58,59].…”

Section: Evidence Of the Efficacy Of Dex In Posterior Non-infectious mentioning

confidence: 99%

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

et al. 2020

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Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.

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Safety and Efficacy of Intravitreal Dexamethasone Implant for Refractory Uveitic Macular Edema in Adults and Children

Abstract: Intravitreal DEX implant is safe and effective adjunct therapy. It reduces dependence on systemic steroids, immunosuppressives and provides long-term effects.

Cited by 18 publications

References 18 publications

Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

Clinical outcomes of pediatric macular edema associated with non-infectious uveitis

Clinical Outcomes of Pediatric Macular Edema Associated with Non-infectious Uveitis

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

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