Single Injection Of Intravitreal Dexamethasone Research Articles

“INTRAVITREAL DEXAMETHASONE AN EFFECTIVE TREATMENT IN CASES OF RECURRENT MACULAR OEDEMA IN CRVO”

Retinal vein occlusion is second most common retinal vascular disease after diabetic retinopathy. Macular oedema secondary to RVO is the second most common retinal vascular disease after diabetic retinopathy. Various treatment options have been mentioned in literature i.e., Anti VEGF injections, retinal laser, corticosteroids, vitrectomy, etc. We here with report a case of CRVO with recurrent macular edema even after 2 monthly doses of intravitreal ranibizumab injections who responded very well by single intravitreal injection of dexamethasone implant (Ozurdex). Till 3 months post injection of single dexamethasone implant, visual acuity was stable at 6/12 with maintaining of central foveal thickness below 250 microns without requiring of any other further mode of treatment. So we conclude that dexamethasone intravitreal implant is a very good effective mode of treatment in such cases of CRVO with recurrent macular edema.

Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema.

Purpose:To evaluate the long-term safety and efficacy of the intravitreal dexamethasone implant in the treatment of diabetic macular edema (DME) as initial therapy.Methods:A hospital-based prospective, non-comparative case study of recently detected DME patients was conducted between July 2016 and December 2017, in which30 eyes of 30 patients were studied. Presenting vision, age, gender, duration of diabetes, general and ocular examination, intraocular pressure, indirect ophthalmoscopy, fundus fluorescein angiography, optical coherence tomography (OCT), and blood sugar levels were noted. Patients with increased central macular thickness (CMT) received an intravitreal dexamethasone implant as initial therapy. All were followed up at 1 week, 1 month, 3 months, 6 months, and 1 year, and the findings were recorded and analyzed using SPSS software.Results:30 eyes of 30 patients were studied which included 22 males and 8 females. The mean age of presentation was 58.7 ± 4.45 years. The mean decrease in CMT following intravitreal dexamethasone was 269.27 ± 112.002, 253.5 ± 108.294, and 286.73 ± 143.395 μm at the end of 3, 6, and 12 months, respectively, and the mean improvement in visual acuity (VA) was 2.27 ± 1.70 lines at 3 months, 2.27 ± 1.83 lines at 6 months, and 1.17 ± 2.00 lines at 12 months. Out of 30 cases, 4 had persistent DME and 6 had recurrence of DME at completion of 1 year of follow-up.Conclusion:Intravitreal dexamethasone as initial therapy in the treatment of DME is both safe and efficacious in the reduction of CMT and improvement of vision and can be considered as primary therapy for DME.

INTRAVITREAL DEXAMETHASONE IMPLANTATION IN PATIENTS WITH DIFFERENT MORPHOLOGICAL DIABETIC MACULAR EDEMA HAVING INSUFFICIENT RESPONSE TO RANIBIZUMAB.

To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant in resistant diabetic macular edema that have different morphological types. In this retrospective study, 31 patients (35 eyes) with persistent diabetic macular edema, who underwent a single injection of dexamethasone implant, were evaluated. Diabetic macular edema was classified into three types: diffuse retinal thickening (n = 10), cystoid macular edema (n = 13), and serous retinal detachment (n = 12). Primary outcome measures were best corrected visual acuity, and central macular thickness. The three subgroups were similar in terms of age and gender (P > 0.05). Total duration of diabetes was significantly less in the serous retinal detachment subgroup (P = 0.01). There were no differences in the best corrected visual acuity between the three subgroups until the sixth month. However, the best corrected visual acuity was significantly better in the diffuse retinal thickness subgroup at the sixth month (P = 0.008). Regarding the central macular thickness values, it was statistically better in serous retinal detachment than in diffuse retinal thickening and cystoid macular edema subgroups till the sixth month (P = 0.001). However, at the sixth month, there was not any statistical difference between subgroups regarding central macular thickness values. Antiglaucomatous agents were required in 4 (11.4%) patients throughout the study. Treatment algorithms should differ according to the morphology of diabetic macular edema; however, more data is needed to give specific recommendations.

Protection of Glial Müller Cells by Dexamethasone in a Mouse Model of Surgically Induced Blood-Retinal Barrier Breakdown.

Breakdown of the inner blood-retinal barrier (iBRB) occurs in many retinal disorders and may cause retinal edema often responsible for vision loss. Dexamethasone is used in clinical practice to restore iBRB. The aim of this study was to characterize the impact of a surgically induced iBRB breakdown on retinal homeostatic changes due to dystrophin Dp71, aquaporin-4 (AQP4), and Kir4.1 alterations in Müller glial cells (MGC) in a mouse model. The protective effect of dexamethasone was assessed in this model. Moreover, retinal explants were used to control MGC exposure to a hypoosmotic solution containing barium. Partial lens surgery was performed in C57BL6/J mice. Dystrophin Dp71, AQP4, and Kir4.1 expression was analyzed by quantitative RT-PCR, Western blot, and immunohistochemistry. Twenty-four hours after surgery, mice received a single intravitreal injection of dexamethasone or of vehicle. After partial lens surgery, iBRB permeability increased while Dp71 and AQP4 were downregulated and Kir4.1 was delocalized. These effects were partially prevented by dexamethasone injection. In the retinal explant model, MGC were swollen and Dp71, AQP4, and Kir4.1 were downregulated after exposure to a hypoosmotic solution containing barium, but not in the presence of dexamethasone. Heat shock factor protein 1 (HSF1) was overexpressed in dexamethasone-treated retinas. Partial lens surgery induces iBRB breakdown and molecular changes in MGC, including a downregulation of Dp71 and AQP4 and the delocalization of Kir4.1. Dexamethasone seems to protect retina from these molecular changes by upregulating HSF1.

Morphological changes in the macular area at post-thrombotic maculopathy after intravitreal injection of a dexamethasone implant (evidence from 5 clinical cases)

Purpose. To evaluate the effect of intravitreal implant with dexamethasone on the morphological changes of macular area in patients with central retinal vein occlusion.Materials and methods. Results of optical coherence tomography of the central retinal area of 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema (ME) are presented. All the patients underwent single intravitreal injection of dexamethasone implant. Maximal follow-up period – 12 months.Results. In 1 month after dexamethasone implant injection, we observed a decrease of foveal retinal thickness from 425.36 ± 57.87 to 273.75 ± 36.65 µm. In 1 year after treatment, foveal retinal thickness increased by 1.2 times compared to results got in 1 month after dexamethasone implant injection. The transformation of the macular area under the implant action was mainly due to changes in thickness and structure in the outer and inner nuclear and plexiform retinal layers.Conclusion. Intravitreal injection of dexamethasone implant provides a decrease in post-thrombotic macular edema in 1 month since implantation. Retinal layers transform selectively at various pathological conditions of the retina, including macular edema. Retinal thickness changes in post-thrombotic ME, including those occurring under the dexamethason implant action are mainly related to changes in the outer and inner nuclear and plexiform retinal layers. The duration of morpho-functional effect persists not less than 12 months after treatment.

Efficacy of dexamethasone intravitreal implant for the treatment of persistent diffuse diabetic macular edema.

To investigate the efficiency and safety of a single injection of intravitreal dexamethasone implant in eyes with persistent diffuse diabetic macular edema (DME). In this retrospective study, 25 eyes of 20 patients, who underwent a single injection of intravitreal dexamethasone implant for the treatment of persistent diffuse DME, were reviewed. Main outcome measures included the changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) from baseline at scheduled visits following injection. The mean BCVA showed improvement from baseline (0.97±0.26 logMAR) at every visit; the difference was significant at day 7 (0.85±0.3 logMAR, p=0.003), month 1 (0.77±0.32 logMAR, p<0.001), month 3 (0.77±0.34 logMAR, p=0.001), and month 4 (0.85±0.31 logMAR, p=0.014). The mean CMT was significantly lower than baseline (616±132μm) at day 1 (518±144μm), day 7 (414±134μm), month 1 (306±95μm), month 3 (339±88μm), month 4 (420±116μm), and month 6 (494±128μm) following the injection (p<0.001, for all). Thirteen eyes on the 4-month follow-up and ten eyes on the 6-month follow-up experienced recurrence of macular edema requiring retreatment. No serious ocular and systemic adverse events were observed. In patients with persistent DME, switching to intravitreal dexamethasone implant injection provides functional and anatomical improvement, and might be an effective therapeutic option for long-standing diffuse DME.

Intravitreal Dexamethasone Implant for Treatment of Refractory Behçet Posterior Uveitis: One-year Follow-up Results

ABSTRACTPurpose: To investigate the results of dexamethasone (DEX) implant in the treatment of eyes with refractory Behçet posterior uveitis.Methods: A total of 17 eyes of 12 patients with active Behçet posterior uveitis were enrolled in the study. A single intravitreal injection of DEX implant was applied to each eye. Best corrected visual acuity (BCVA), central macular thickness (CMT), vitreous haze score, and intraocular pressure (IOP) were determined, at baseline and control visits of months 1, 3, 6, and 12.Results: The mean BCVA was significantly increased from baseline at each control visit (all p < 0.05). The mean CMT and vitreous haze score were significantly decreased from baseline at each control visit (all p < 0.05). Three eyes showed IOP spikes requiring topical anti-glaucomatous treatment.Conclusions: A single injection of DEX implant was safe and effective, as an additional treatment to systemic immunomodulatory drugs, in the treatment of refractory Behçet posterior uveitis, for a 6-month period.

Dexamethasone Intravitreal Implant for Treatment of Patients With Recalcitrant Macular Edema Resulting From Irvine-Gass Syndrome

To evaluate the effectiveness of a single intravitreal injection of dexamethasone implant, over 6 months in patients with recalcitrant CME due to Irvine-Gass syndrome. Retrospective review of the medical records of nine patients with refractory macular edema (ME) due to Irvine-Gass syndrome, who underwent a single intravitreal injection of dexamethasone implant, Ozurdex, between November 2010 and January 2012, at the Instituto de Microcirurgia Ocular, Barcelona, Spain. All patients underwent a complete ophthalmic evaluation, including best-corrected visual acuity (BCVA) using standardized ETDRS charts, tonometry, fluorescein angiography, and spectral-domain optical coherence tomography with foveal thickness (FT) measurement. The mean duration of CME before treatment with Ozurdex was 9.1 months (range, 6-13 months). At baseline, the mean FT was 542.22 ± 134.78 μm. Mean (SD) values of FT did decrease to 350.88 ± 98.71 μm (P = 0.001) at month 1 and 319.22 ± 60.96 μm (P = 0.002) at month 3. Data on the 6-month follow-up showed a mild increase 398.33 ± 127.89 μm (P = 0.031). The mean (SD) change from baseline FT was 191.33 μm (a decrease value of 35%) at month 1, and 223.00 μm (decrease value of 41%) and 143.89 μm (decrease value of 26%) at month 3 and month 6, respectively. The baseline BCVA data were 0.62 ± 0.15 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.47 ± 0.21 logMAR (P = 0.008) and 0.37 ± 0.24 logMAR (P = 0.001) after month 1 and month 3, respectively. At the last visit (6-month follow-up), the mean BCVA was 0.37 ± 0.26 logMAR (P = 0.002). In this study, both mean FT and mean BCVA had improved from baseline by 1 month after treatment with a dexamethasone implant, and the improvement remained statistically significant throughout the 6-month study.

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&gt;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.

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.