Efficacy Of Intravitreal Dexamethasone Implants Research Articles

Intravitreal Dexamethasone Implant Switch after Anti-VEGF Treatment in Patients Affected by Retinal Vein Occlusion: A Review of the Literature.

Nowadays, retinal vein occlusion (RVO) is the second most prevalent cause of vision loss associated with retinal vascular disease. Intravitreal injections are currently known as a major advancement in ophthalmology, particularly in the treatment of RVO and other retinal disorders. Particularly, the first line of therapy is usually anti-vascular endothelial growth factor (VEGF) drugs. Notably, for RVO eyes that have not responded to anti-VEGF therapy, an intravitreal dexamethasone (DEX) implant 0.7 mg (Ozurdex®, AbbVie Inc., North Chicago, IL, USA) is considered a suitable therapeutical substitute. Actually, investigations carried out in the real world and clinical trials have shown the safety and the efficacy of intravitreal DEX implants for treating this retinal disease. For this reason, choosing patients carefully may thus be essential to reduce the number of injections that clinics and hospitals have to do to manage RVO and its complications. The primary aim of this review is to summarize the pathophysiology of this retinal vascular disease, as well as the clinical and ocular imaging features that may support a switch from prior anti-VEGF treatment to intravitreal DEX implant, to provide the RVO patients with the best possible treatment to ensure maximum visual recovery.

Results of intravitreal dexamethasone implant (Ozurdex®) for retinal vascular diseases with macular edema: An observational study of real-life situations.

To evaluate the efficacy of intravitreal dexamethasone implants (Ozurdex®) for the treatment of macular edema (ME) associated with retinal vascular diseases in real-life situations.This retrospective study included patients with ME associated with retinal vascular occlusion (RVO) or diabetic macular edema (DME) treated with dexamethasone implants. Demographic data, best-corrected visual acuity (BCVA), and central retinal thickness (CRT) at baseline and at 1, 3, and 6 months postoperatively were collected and analyzed, and the adverse events were recorded.Forty-four eyes, 42 patients were included in the study. The mean logMAR BCVA improved from 0.79 ± 0.38 at baseline to 0.60 ± 0.34 (P < 0.001), 0.72 ± 0.38 (P = .002), and 0.72 ± 0.37 (P = .002) at 1, 3, and 6 months, respectively. The CRT decreased from 526.70 ± 159.58 µm at baseline to 279 ± 66.23, 422.91 ± 206.99, and 350.23 ± 151.51 µm at 1, 3, and 6 months, respectively (P < 0.001, all visits). The average number of injections was 1.43 ± 0.5. Nineteen eyes (43.18%) received second injections at an interval of 4.20 ± 0.61 months. The mean logMAR BCVA was greater in RVO than in DME patients and in treatment-naïve eyes than in previously treated ones. The baseline CRT of the reinjection group was significantly higher than that of the single-injection group for both the RVO (P < 0.001) and DME groups (P = .002). Nine eyes (20.45%) with increasing intraocular pressure (IOP) were well controlled with medication, and cataract progression was observed in five eyes (21.73%) during follow-up.The dexamethasone implant was effective for the treatment of macular edema secondary to RVO and DME in terms of visual acuity and CRT improvement over 6 months. The visual acuity was greater in the RVO and treatment-naïve eyes. Reinjection may be associated with a high baseline CRT. The increase in the occurrence of IOP and cataract progression was similar to that reported in previous studies.

Dexamethasone intravitreal implant (Ozurdex) in diabetic macular edema: real-world data versus clinical trials outcomes.

To investigate the safety and efficacy of intravitreal dexamethasone implants (Ozurdex®/DEX) in patients with diabetic macular edema (DME) either naïve or non-naïve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors (anti-VEGFs). This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients naïve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) was collected over 6mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients (57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment naïve before receiving DEX implant, was collected. Improvement in mean BCVA was observed from 1-4mo after injection with a decreased effect at month 6 as expected, with better outcomes in naïve compared to non-naïve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2mo after DEX therapy. The mean number of injections of the overall population during the 6mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported. This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in naïve patients.

Therapeutic Efficacy of Intravitreal Dexamethasone Implant in Korean Patients with Non-infectious Uveitis

Therapeutic Efficacy of Intravitreal Dexamethasone Implant in Korean Patients with Non-infectious Uveitis

地塞米松玻璃体植入剂治疗不同OCT分型RVO继发ME的疗效对比

地塞米松玻璃体植入剂治疗不同OCT分型RVO继发ME的疗效对比

The efficacy of dexamethasone implants following anti-VEGF failure for macular oedema in retinal vein occlusion.

To investigate the efficacy of intravitreal dexamethasone implants (DEX) after anti-VEGF failure in retinal vein occlusion macular oedema. Retrospective cohort study of DEX implant (0.7 mg) given after anti-VEGF 'failure'. Switch to DEX occurred if a ⩽ +5 ETDRS letter gain and ⩽20% reduction in central subfield thickness was present following ⩾6 consecutive anti-VEGF injections. The primary endpoint was VA change 30 days after DEX. Secondary outcomes were peak VA change, VA change at monthly timepoints, percentage achieving 15-letter gain, central subfield thickness (CST) and intraocular pressure (IOP). Sixty-two injections in 62 patients associated with 26% central retinal vein occlusion (CRVO) and 74% branch retinal vein occlusion (BRVO) were eligible. There was a modest, significant improvement in mean VA change at 30 days compared to baseline (+6 letters, 95% CI +2.2 to +9.1 letters, p < 0.01). DEX implant significantly improved mean peak VA change compared to preceding anti-VEGF by +18.1 letters in CRVO (p = 0.002) and +13.2 letters in BRVO (p < 0.0001). IOP peaked between 30 and 60 days following injection, with 31% of CRVO and 11% of BRVO patients experiencing an IOP ⩾ 25 mmHg. DEX implant provides useful rescue therapy in cases of anti-VEGF 'failure' for macular oedema following retinal vein occlusion, resulting in improved functional outcomes at 30 days.

Efficacy of Intravitreal Dexamethasone Implant in Different Patterns of Diabetic Macular Edema.

PurposeDifferent patterns of diabetic macular edema (DME) suggest different pathogenesis and drug response. We evaluated the outcomes after intravitreal dexamethasone (DEX) implant for DME with or without serous retinal detachment (SRD).MethodsIn this retrospective study, 22 naïve patients (23 eyes) with DME who underwent a single DEX implant were evaluated. Based on the optical coherence tomographic pattern of DME, 12 eyes had a cystoid macular edema pattern (Group 1) and 11 eyes had an SRD pattern (Group 2). The best-corrected visual acuity (BCVA), central retinal thickness (СRТ), central retinal volume (CRV), SRD height (SRDh), and intraocular pressure (IOP) were recorded before and at two and four months after the treatment.ResultsThere were no significant differences between the groups regarding demographic, clinical data and outcomes at baseline. In Group 1, the CRT and CRV significantly decreased at two months (P = 0.002 and P = 0.01, respectively), while the BCVA significantly improved at four months (P = 0.03). In Group 2, the CRT and CRV significantly improved (P 0.01 and P 0.01, respectively) during the follow-up period. At four months, both groups showed a recurrence of DME, Group 1 in particular (two-month CRT reduction, –149 127 µm vs four-month CRT reduction, –72 174 µm; P = 0.04). The mean reduction in CRV was significantly different at four months (Group 1, –0.49 1.7 mm vs Group 2, –1.3 1.3 mm; P = 0.04). In Group 2, the SRDh significantly decreased at two (P = 0.01) and four months (P = 0.01). Four cases with elevated IOP were managed.ConclusionDEX implants were found to be effective in different patterns of DME. The SRD pattern may predict a longer-lasting morphologic efficacy.

Efficacy of Intravitreal Dexamethasone implants in Diabetic Macular Edema Unresponsive to Anti-VEGF Therapy

Background: Diabetic retinopathy is a common microvascular complication of diabetes leading to DiabeticMacular Edema (DME)and visual impairment in the working age population1About one third of diabeticindividuals had some degree of Diabetic retinopathy and less than 10% develop DME.Intravitreal dexamethasone implant in cases unresponsive to anti VEGF therapy has a beneficial role inimproving visual acuity and macular morphology. The possible mechanism of action could be resolution ofedema that was resistant to anti VEGF agentsAims and Objectives: To determine the efficacy of intravitreal dexamethasone implant for DMEunresponsive to anti Vascular Endothelial Growth factor(VEGF)treatmentMethodology: A retrospective analysis of refractory 21 cases, 30 eyes of DME to primary anti VEGFtreatment was performed to analyze the profile of presentation and treatment outcome to Intravitrealdexamethsone implants. Ranibizumab (0.5 mg) administered monthly and if, were unresponsive after 5-6injection were switched to Intravitreal Dexamethasone implants (0.7 mg).Failure to therapeutic response was characterized by increase in central macular thickness from baselinefinding or no response to treatment. Intravitreal dexamethasone implant was administered every two monthsBest corrected visual acuity,Intraocular pressure and central macular thickness was evaluated at baselinesand following intravitreal dexamethasone impant.Result: The mean age was 56.3± 5.9 years. The mean Intra ocular pressure was 17.3±2.7 mmHg.The mean anti VEGF treatment sessions was 5.8±1.2. The mean BCVA improved significantly from LogMar0.76 ±0.16 to 0.67 ±0.19 (p value=0.029) and CMT improved significantly from 431.6 ±100.9µm to 379.1±80.72µm (p value =0.0005).Conclusion: Intravitreal dexamethasone is effective in refractory cases of DME unresponsive to anti VEGFtherapy. Optimal evaluation and tailoring therapy with the therapeutic response will be beneficial.

Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

Efficacy of Intravitreal Dexamethasone Implant for Diabetic Macular Edema According to Previous Responses to Bevacizumab

Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease

Purpose: Investigation of the efficacy of intravitreal dexamethasone implants (0.7 mg) in patients with Behçet disease (BD) who had cystoid macular edema (CME) despite immunomodulatory treatment. Materials and Methods: Twenty-seven eyes of 20 patients who had intravitreal dexameth­asone implant injections and follow-up for more than 6 months were included in this study. Best corrected visual acuities (BCVA), intraocular pressures (IOP), and central macular thicknesses (CMT) were recorded. Systemic immunomodulatory treatment was noted. Injection-related complications and the need for recurrent injections were recorded. Results: Statistically significant anatomical and functional success was achieved with a single injection. BCVA increased from 0.85 ± 0.72 to 0.45 ± 0.52 logMAR, while the mean CMT decreased from 406 ± 190 to 243 ± 101 µm at the sixth month. The peak of visual acuity gain was reached within the first 2 months and a substantial proportion of the patients gained 3 or more lines. There was no complication other than transient IOP elevation in 4 eyes and cataract surgery in 2 eyes. Conclusion: Adjuvant intravitreal dexamethasone implant injections offer promising results in cases of BD with CME. It is effective in preserving the macular anatomy and vision particularly in transition to biological agents.

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

ABSTRACTPurpose: To assess safety and efficacy of intravitreal dexamethasone (DEX) implant in refractory uveitic macular edema (ME).Methods: We retrospectively analyzed medical records of patients with nonresponsive ME secondary to chronic, noninfectious intermediate or posterior uveitis, treated with intravitreal DEX implants.Results: A total of 42 eyes of 34 patients (aged 6–67 years) received 56 implants. Mean follow-up was 19.2 ± 2.2 months after DEX implant. The mean visual acuity (0.48 ± 0.06 logMAR to 0.34 ± 0.1 logMAR) and mean central retinal thickness (472.2 ± 35 to 274.7 ± 60.6 µm) improved considerably before and after DEX implant. A total of 11 eyes needed repeat implants after a prolonged time to recurrence (12.6–20.9 months). A total of 10 eyes needed no additional treatment. Oral steroids could be stopped in 40% patients. Intraocular pressure increased in seven and cataract progressed in six eyes.Conclusion: Intravitreal DEX implant is safe and effective adjunct therapy. It reduces dependence on systemic steroids, immunosuppressives and provides long-term effects.

SAFETY AND EFFICACY OF INTRAVITREAL DEXAMETHASONE IMPLANTS IN THE MANAGEMENT OF MACULAR EDEMA SECONDARY TO INFECTIOUS UVEITIS

To assess the safety and efficacy of intravitreal dexamethasone implants in the treatment of macular edema secondary to infectious uveitis. We retrospectively reviewed clinical records from three uveitis referral units in Spain. The main outcome measures were rate of reactivation of infection, improvements in visual acuity and resolution of macular edema, as measured by optical coherence tomography. We included eight eyes from seven patients with a median age of 64 years (30-75). Etiologies of the infections were Herpes simplex virus-type 1, Varicela-Zoster virus, Treponema pallidum, Brucella mellitensis, Borrelia burgdorferi, Toxoplasma gondii, and cytomegalovirus. Median visual acuity was 20/160 (20/30-20/400) at baseline and 20/70 (20/25-20/200) at the last follow-up visit. Mean macular thickness was 516 μm (115) at baseline and 266.3 μm (40) at the last follow-up visit. Visual acuity improved in 100% of the eyes and none of the eyes showed macular edema at the last follow-up visit. Five patients required reinjections of the implant. Only one patient required antiglaucoma drops for a temporary increase in ocular pressure. There were no cases of reactivation of the infectious ocular disease. Median follow-up time was 18 months. In this small case series of eyes with macular edema secondary to infectious uveitis, treatment with dexamethasone intravitreal implants was not associated with reactivation of the infectious ocular disease. Furthermore, significant improvements in visual acuity and macular thickness were observed in our patients.

Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration

Purpose: To evaluate the efficacy of intravitreal dexamethasone implants for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) according to the duration of symptoms. Methods: Thirty-one patients who received an intravitreal dexamethasone implant for ME due to BRVO were included in this retrospective study. The patients were divided into 2 groups. Group A included eyes with symptom duration less than 12 weeks and Group B included eyes with symptom duration of 12 weeks or longer. The main efficacy outcomes such as best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and every 4 weeks over 24 weeks. Retreatment criteria included an increased CMT of 150 μm or reduction of logarithm of the minimal angle of resolution (log MAR) scores of at least 0.2. Results: The CMT and BCVA improved significantly at each follow-up compared with the baseline (p 0.05). At 24 weeks, Group A showed less CMT and better BCVA compared with Group B (p = 0.043, p = 0.041, respectively). Conclusions: The intravitreal dexamethasone implant significantly reduced the CMT and improved BCVA in patients with ME due to BRVO. Patients with shorter symptom duration showed better anatomical and functional outcomes over 24 weeks. Early treatment with the intravitreal dexamethasone implant could produce better clinical results. J Korean Ophthalmol Soc 2015;56(8):1208-1214

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6‐month follow‐up – The SOLO study

To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit. Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.