Intravitreal Injection Of Dexamethasone Research Articles

Secondary Glaucoma After Intravitreal Dexamethasone 0.7 mg Implant in Patients with Retinal Vein Occlusion: A One-Year Follow-Up

To investigate the rate of secondary glaucoma after intravitreal dexamethasone 0.7 mg (Ozurdex(®)) implantation over a clinical treatment period of 1 year. A prospective study of a series of 16 patients (9 males, 7 females; mean age 76 years) suffering from central- or branch retinal vein occlusion treated with dexamethasone 0.7 mg were followed up for 12 months. Main outcome measures were intraocular pressure (IOP) determined with Goldmann applanation tonometry (GAT) and Pascal dynamic contour tonometry (DCT), as well as best-corrected visual acuity (BCVA) and central retinal thickness measured with optical coherence tomography (OCT). BCVA (logMAR) improved in treated patients from mean 0.81 at baseline to a peak of 0.47 after 2 months but declined irrespective of reinjections to 0.87 at 12 months. Central retinal thickness measured with OCT initially decreased but increased again with recurring macular edema. 69% of patients treated with dexamethasone 0.7 mg had an IOP increase of at least 5 mmHg. In total, 50% of patients had an increase of ≥10 mmHg during the studied period. The IOP increase in treated eyes was significant 1, 2, 3, and 8 months after dexamethasone 0.7 mg implantation. Secondary glaucoma after intravitreal injection of dexamethasone 0.7 mg might be underestimated in the GENEVA studies. The clinical safety profile reported here calls for thorough identification of suitable patients and frequent IOP control if dexamethasone 0.7 mg (Ozurdex) is applied as a long-term treatment.

Effect of intravitreal dexamethasone implant on the contralateral eye: a case report.

To describe the effect of unilateral intravitreal injection of 0.7-mg dexamethasone implant on the other eye. Interventional case report and literature review. A 54-year-old woman with bilateral, refractory, clinically significant macular edema was given an intravitreal injection of 0.7-mg dexamethasone sustained release implant in the right eye. The central foveal thickness improved in both the eyes with recurrence of edema after 16 weeks in both the eyes. An intravitreal dexamethasone injection seems to have bilateral effect after unilateral injection.

Utility of Anterior Segment OCT Measurements for Predicting Severe Eye Pressure Increase after Intravitreal Dexamethasone Implant

Background/aims: To assess the utility of non-contact anterior segment ocular coherence tomography (AS-OCT) measurement of the angle recess width (AR) to predict eyes prone to intraocular pressure (IOP) spikes after injection of intravitreal dexamethasone implant in patients with CRVO and BRVO. Methods: Cohort study with fellow-eye control of 34 patients with gonioscopically open angles and RVO undergoing intravitreal injection of dexamethasone implant (Ozurdex). All participants received pre-injection AS-OCT in both eyes using spectral domain Cirrus OCT. Independent masked assessors measured the AR width using electronic imaging calipers. IOP was monitored prior to implant placement, and monthly for 6 months thereafter. Comparisons between AR width and degree of steroid response, phakic status, gender, and prior history of glaucoma were analyzed. Results: Seven eyes (20%) developed severe IOP spikes (IOP ≥ 30 mmHg). There was a highly significant (p=0.0085) difference in angle recess width between severe responders (175.0 ± 27.1 μm) and those eyes with less severe response (272.9 ± 24.3 μm). There was also strong correlation between the AR width in study and fellow eyes (mean 248.1 ± 19.8 vs. 261.9 ± 22.6 μm; R2=0.67). Conclusions: This study reaffirms the potential utility of AS-OCT measurement of AR width as a practical means for helping identify eyes at high risk of ocular hypertension after intravitreal corticosteroid administration.

Treatment of macular oedema following proton beam therapy for choroidal melanoma with dexamethasone 700µg intravitreal implant

AbstractPurpose To report the treatment of radiation macular edema following proton beam therapy for choroidal melanoma with dexamethasone 700µg intravitreal implant.Methods Retrospective cases reportResults Five patients were treated with a single injection of intravitreal dexamethasone 700 µg. These patients presented with an uveal melanoma (mean thickness: 4.44 mm, mean highest diameter: 11.14mm) located at 2.58mm (range 0 to 3.5mm) from the macula. Patients were treated with proton beam irradiation (60 Gy cobalt relative biological effectiveness in 4 fractions) 26.75 months (range 16‐43 months) before the occurrence of radiation macular edema. The intravitreal injection of dexamethasone700 µg was performed 5.5 months (1‐14) after the diagnosis of macular edema. Best corrected visual acuity improved for 4 patients (5; 7; 9 and 10 letters), and remained unchanged for 1 patient, over a 5 months follow‐up period. Central retinal thickness decreased for 3 patients (231; 151 and 97 µm) and remained unchanged for 2 patients. Intraocular pressure increased for 1 patient (IOP>25 mmHg at month 3). No other ocular or systemic side effects were noted.Conclusion Radiation macular edema is a common vision threatening complication following proton beam therapy. The available therapeutic options are limited. Intravitreal injections of dexamethasone implant can be of benefit in selected cases.

In Vivo Gene Expression Profiling of Retina Postintravitreal Injections of Dexamethasone and Triamcinolone at Clinically Relevant Time Points for Patient Care

To identify retinal genes and their relevant expression pathways affected by intravitreal injections of dexamethasone (Dex) and triamcinolone acetonide (TAA) in mice at clinically relevant time points for patient care. Differential gene expressions of over 34,000 well-characterized mouse genes, in the retinas of 6-week-old C57BL/6J mice, were analyzed after intravitreal steroid injections at 1 week and 1 month time points, using mouse genome microarrays. The data were analyzed using commercial microarray analysis software for biologically relevant changes in gene expression pathways. A common gene pathway, with differentially activated genes for both steroids and time points, was "Semaphorin Signaling in Neurons," a member of the "Axonal Guidance Signaling System." At 1 week postinjection a common theme was activation of genes expressed in retinal glial cells, tumor necrosis factor-α, and transforming growth factor-β signaling pathways and upregulation of stress response proteins (Serpina3n, Cebpd), as well as neuropeptide signaling somatostatin receptor (Sstr2). Unique for Dex was the upregulation of acute phase proteins (Gfap, Cp, Edn2) as well as Plexna2, a semaphorin signaling receptor, whereas EphrinB receptor ephexin 1 (Argef15) was downregulated. Folate signaling appears to be unique for TAA at 1 week (Folh1, Cubn), whereas aryl-hydrocarbon receptor signaling might be important for both steroids at 1 month postinjection. Understanding the molecular and genetic effects of intraocular steroid treatments is of clinical relevance. This in vivo study has elucidated several genes and pathways that are potentially altering the neuroprotective/neurodegenerative balance between glial and retinal ganglion cells during intravitreal steroid treatment.

Intravitreal Ganciclovir and Dexamethasone as Adjunctive Therapy in the Management of Acute Retinal Necrosis Caused by Varicella Zoster Virus

A 40-year-old man presented with a visual acuity of 20/400 in his right eye due to acute retinal necrosis involving two inferior quadrants. Diagnostic vitreous tap was positive for varicella zoster virus and he received intravitreal injections of ganciclovir (2 mg/0.1 mL) and dexamethasone (400 mcg/0.1 mL). Oral prednisone was added on day 3 and tapered over 3 months. Lesions showed pigmentation around day 5 and healed by day 9. He developed vitreous hemorrhage 5 months after presentation and was treated with 25-gauge pars plana vitrectomy combined with panretinal photocoagulation. Final follow-up at 7 months showed a visual acuity of 20/30, mild optic atrophy, narrow arteries, healed retinal lesions, and good panretinal photocoagulation. Intravitreal injections of dexamethasone and ganciclovir may have a role as an adjunctive therapy in the management of patients with acute retinal necrosis, particularly those caused by varicella zoster virus.

Quadruple Therapy Leads to a Sustained Improvement of Vision in Patients with Wet Age-Related Macular Degeneration

Aim: To investigate the efficacy of a combined intravitreal therapy with prior photodynamic therapy (PDT) in patients with wet age-related macular degeneration. Methods: Fifty-two patients (mean age: 72.7 years) with predominantly classic choroidal neovascularization received low-fluence PDT (42 J/cm² for 72 s), followed 24 h later by a 0.4-ml core pars plana vitrectomy with intravitreal injection of dexamethasone (0.8 mg) and bevacizumab (1.25 mg). The best-corrected visual acuity (BCVA; 6 m Snellen), central macular thickness (optical coherence tomography), intraocular pressure and the need for retreatment were assessed. Results: BCVA changed significantly (vs. baseline) at 3 months (+0.11), 9 months (+0.19) and 14 months (+0.16). At the end of the follow-up period, BCVA had improved by >0.1 in the majority of the patients (72.9%), and the mean central retinal thickness had decreased by –44.3% (–211 µm). The retreatment rate was 25%. No increase in intraocular pressure or other adverse event was reported. Conclusions: The pharmacological effects of the drugs, the low-fluence PDT, and the physiological effects of the therapy may have contributed to the sustainability of the therapeutic benefits.

Intravitreal Dexamethasone for Diabetic Macular Edema: A Pilot Study

To determine the response and safety profile of intravitreal dexamethasone in treating diabetic macular edema. In this prospective pilot study, 12 eyes of 12 patients with diabetic macular edema were randomized to receive a single injection of 0.4 mg (n = 6) or 0.8 mg (n = 6) of intravitreal dexamethasone. The outcome measures were changes in best-corrected visual acuity and central foveal thickness on optical coherence tomography. Side effects were monitored. The 3-month results were reported. In both dosage groups, there were transient improvements in best-corrected visual acuity and central foveal thickness, but the changes were not significant at any time point (best-corrected visual acuity: P > or = 0.14; central foveal thickness: P > or = .08). No significant side effects were observed, except one eye developed a peak intraocular pressure of greater than 21 mm Hg. A single injection of intravitreal dexamethasone (0.4 or 0.8 mg) did not have significant beneficial effects on diabetic macular edema within 3 months from injection in this small pilot study.

EFFECTS OF INTRAVITREAL CORTICOSTEROID IN THE TREATMENT OF STAPHYLOCOCCUS AUREUS–INDUCED EXPERIMENTAL ENDOPHTHALMITIS

To investigate whether intravitreal injection of dexamethasone in addition to antibiotics can minimize intraocular tissue injury caused by Staphylococcus aureus endophthalmitis. Albino rabbits were infected with an intravitreal injection of 1000 colony-forming units of S. aureus. The rabbits were randomized to receive no treatment (control group; n = 2), intravitreal vancomycin and amikacin (n = 5), or a combination of intravitreal vancomycin, amikacin, and dexamethasone (n = 5) 20 hours following inoculation of bacteria. All rabbits except for the control group also received intravenous imipenem every 8 hours for 4 days. The eyes were evaluated by clinical examination, electroretinogram (ERG), and histologic studies. Eyes treated with intravitreal dexamethasone demonstrated less inflammation on clinical examination compared with eyes that received antibiotics alone. The ERG responses of eyes that received both intravitreal antibiotics and steroid were significantly better at 45 hours, 7 and 14 days following inoculation (P < 0.05) compared to eyes that received antibiotics alone. Histologic studies 14 days following infection demonstrated less tissue destruction for eyes treated with dexamethasone. Compared to intravitreal antibiotics alone, intravitreal corticosteroids may improve visual outcome of S. aureus endophthalmitis by reducing inflammation and preserving electrophysiologic retinal function.

Dexamethasone Inhibits Leukocyte Accumulation and Vascular Permeability in Retina of Streptozotocin-Induced Diabetic Rats via Reducing Vascular Endothelial Growth Factor and Intercellular Adhesion Molecule-1 Expression

Intravitreal injection of corticosteroid has been used to treat diabetic macular edema, however, the exact mechanism remains unknown. In the present experiment, four weeks after streptozotocin administration, intravitreal injection of dexamethasone (50 microg/10 microl) was performed. After 2 d injection, we investigated the effect of dexamethasone on leukocyte accumulation, vascular permeability and the expression of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) in streptozotocin-diabetic rats. Accumulated leukocytes were counted in vivo by acridine orange leukocyte fluorography, the retinal vascular permeability was measured by the Evans blue assay. The mRNA and protein level of VEGF and ICAM-1 were analyzed with real-time quantitative polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) respectively. Dexamethasone downregulated VEGF and ICAM-1 expression in diabetic rats which correlated with its effect on leukocytes accumulation and retinal vascular permeability. The present data revealed that dexamethasone may inhibit retinal accumulation and leukostasis accumulation and vascular permeability through its blockage on VEGF and ICAM-1 expression.

PROSPECTIVE, RANDOMIZED CLINICAL TRIAL OF INTRAVITREAL TRIAMCINOLONE TREATMENT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

To investigate the effect of intravitreal injection of high-dose (20-25 mg) triamcinolone acetonide on minimally classic or occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). A prospective, double-masked, placebo-controlled, randomized clinical trial included 39 eyes with minimally classic or occult CNV secondary to AMD. The treatment group (21 eyes) received intravitreal injection (20-25 mg) of triamcinolone acetonide and the control group (18 eyes) received intravitreal injection (500 mug) of dexamethasone at 6-month intervals. Best-corrected ETDRS (Early Treatment Diabetic Retinopathy Study) score, contrast sensitivity score, and central macular volume were measured at 1 month, 3 months, 6 months, and 12 months. Mean baseline best-corrected visual acuity (BCVA [logarithm of the minimal angle of resolution]) was 0.64 (Snellen equivalent, 20/80) in each group. At 1 month, 3 months, and 6 months after the injection, neither group had a significant change in BCVA. At 12 months, mean BCVA +/- SD significantly decreased to 1.06 +/- 0.34 (Snellen equivalent, 20/200) in the treatment group (paired t-test, P < 0.001), whereas it was 0.78 +/- 0.52 (Snellen equivalent, 20/125) in the control group (P = 0.23). The difference was marginally significant (P = 0.06, Student's t-test). All phakic eyes in the treatment group developed marked cataract progression. Intravitreal injection of high-dose triamcinolone had no beneficial effect on eyes with minimally classic or occult CNV secondary to AMD and was associated with outcomes similar to those associated with intravitreal injection of dexamethasone, which was used as placebo.

Intravitreal Injection of Corticosteroid Attenuates Leukostasis and Vascular Leakage in Experimental Diabetic Retina

Recently, intravitreal injection of corticosteroids has been in wide use as a treatment for diabetic macular edema, and the outcomes have been favorable. However, the exact mechanism remains unclear. The hypothesis for the current study was that intravitreal corticosteroids may improve diabetic retinal edema by amelioration of blood-retinal barrier (BRB) breakdown, by inhibiting leukocyte stasis (leukostasis). Diabetes was induced in 6-week-old male Long-Evans rats by intraperitoneal injection of streptozotocin (75 mg/kg). Three weeks after induction of diabetes, intravitreal injection of dexamethasone (40 microg/10 microL) was performed. At 2 days after intravitreal injection, accumulated leukocytes were counted in vivo by acridine orange leukocyte fluorography, and BRB breakdown was evaluated by measurement of retinal vascular permeability. The mRNA expression and protein levels of intercellular adhesion molecule (ICAM)-1 in the retina were also studied. The number of leukocytes accumulated in the retina, once increased in the diabetic group, was decreased by 31.6% (P = 0.0001) after dexamethasone injection. The level of BRB breakdown, also elevated in the diabetic group, was suppressed by 61.1% (P = 0.0046) after dexamethasone injection. The level of ICAM-1 mRNA expression and its protein, upregulated in the diabetic group, were downregulated by dexamethasone treatment by 70.0% (P < 0.0001) and 56.4% (P = 0.0003). Intravitreal injection of corticosteroids improves diabetic retinal edema through inhibiting leukocyte recruitment in the diabetic retina.