scholarly journals Factors associated with the duration of action of dexamethasone intravitreal implants in diabetic macular edema patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Young Gun Park ◽  
Moon Young Choi ◽  
Jin-woo Kwon
Keyword(s):  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Aqueous Humor ◽  
Average Duration ◽  
Vascular Endothelial ◽  
Duration Of Action ◽  
Hyperreflective Foci ◽  
Intravitreal Dexamethasone ◽  
Endothelial Growth Factor

AbstractWe designed this study to determine the association between the duration of action of intravitreal dexamethasone implants and aqueous humor biomarkers or optical coherence tomography (OCT) findings of diabetic macular edema (DME) patients. We measured the concentrations of interleukin (IL)-1β, -8, -10, -17; placental growth factor; and vascular endothelial growth factor in the aqueous humor, and identified the number of hyperreflective foci (HF), grades of ellipsoid zone disruptions, and baseline central subfield thicknesses (CSTs) using OCT of patients with DME. The average duration of action of dexamethasone implants was 4.32 ± 1.18 months. In multivariate linear regression analyses, the duration of action was associated with aqueous IL-8 levels and the number of HF (β = −0.016, p = 0.037 and β = −0.073, p = 0.035, respectively). Multivariate logistic regression showed that the number of HF (>10) was significantly associated with a shorter duration (<4 months) of action (odds ratio: 17.17, p = 0.010). The duration of action of intravitreal dexamethasone implants in DME patients was associated with the level of aqueous IL-8 and the number of HF using OCT. Specifically, higher number of HF in the OCT was associated with a shorter duration of action.

Management of diabetic macular edema with intravitreal dexamethasone implants: Expert recommendations using a Delphi-based approach

2018 ◽  
Vol 29 (1) ◽  
pp. 82-91 ◽  
Author(s):  
Alfonso Giovannini ◽  
Mariacristina Parravano ◽  
Federico Ricci ◽  
Francesco Bandello
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Daily Practice ◽  
Steering Committee ◽  
Vascular Endothelial ◽  
First Choice ◽  
Intravitreal Dexamethasone ◽  
Endothelial Growth Factor

Objectives: Despite being approved and effective, steroids, and especially dexamethasone intravitreal implants, still have a poorly-defined role in management of diabetic macular edema. In order to overcome some of the limitations in current recommendations, a group of experts met to define consensus on some of the most controversial issues on the use of dexamethasone intravitreal implants in daily management of diabetic macular edema. Methods: A Delphi-based approach was utilized to develop clinically relevant statements applicable to routine treatment settings. A Steering Committee composed of four experts formulated 30 relevant statements, which were voted upon by a panel of 40 ophthalmologists/retinal specialists from across Italy. Results: Dexamethasone intravitreal implants were considered to be a valid first-line alternative to treatment with an anti–vascular endothelial growth factor agent and should be the first choice in pseudophakic and vitrectomized patients. A Pro Re Nata regimen was felt to be appropriate for retreatment with dexamethasone intravitreal implants while a 6-month waiting period was not considered suitable. Among steroid treatments, dexamethasone intravitreal implants were considered to have the best ocular tolerability. In patients with persistent macular edema after the loading-phase treatment with an anti–vascular endothelial growth factor, consensus was reached that clinicians should consider switching therapy to dexamethasone intravitreal implants. Moreover, dexamethasone intravitreal implants can reduce the treatment burden for individuals who are not able to cope with the more intensive treatment regimen required by anti–vascular endothelial growth factor therapy. Conclusions: While further studies are needed, this survey provides some key recommendations for clinicians treating diabetic macular edema that may be useful when choosing dexamethasone intravitreal implants in daily practice.

scholarly journals Glucose-Regulated Protein 78 in the Aqueous Humor of Patients with Diabetic Macular Edema

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Moon Young Choi ◽  
Jin-woo Kwon
Keyword(s):  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Aqueous Humor ◽  
Intravitreal Bevacizumab ◽  
Multivariate Regression Analysis ◽  
Vascular Endothelial ◽  
Short Term ◽  
Endothelial Growth Factor ◽  
Glucose Regulated Protein

Purpose. We identified the associations between levels of aqueous glucose-regulated protein 78 (GRP78) and systemic or ocular factors in patients with center-involving diabetic macular edema (CIDME). Methods. We measured the aqueous concentrations of GRP78, interleukin- (IL-) 1β, IL-2, IL-8, IL-10, and IL-17, placental growth factor, and vascular endothelial growth factor (VEGF). We explored the associations between aqueous GRP78 levels and those of other aqueous factors, optical coherence tomography (OCT) findings, and systemic parameters in CIDME patients. Results. In multivariate regression analysis, aqueous GRP78 levels were associated with aqueous VEGF levels (p=0.007), length of EZ disruption (p<0.001), and duration of diabetes (p=0.002). However, no significant relationship was observed between GRP78 levels and those of other systemic and ocular factors including inflammatory cytokines in the aqueous humor. In terms of responsiveness, the number of hyperreflective foci (≥8) was significantly associated with the responsiveness of three consecutive monthly intravitreal bevacizumab injections (OR=0.34, p=0.046), but not the aqueous GRP78 levels. Conclusions. Aqueous GRP78 levels correlated with VEGF levels in the aqueous humor and EZ disruption on OCT. However, GRP78 levels were not associated with those of inflammatory biomarkers in the aqueous humor or OCT findings. Additionally, GRP78 could not serve as a biomarker to predict short-term prognosis of anti-VEGF agent.

Intravitreal dexamethasone insert in diabetic macular edema super-refractory to anti-vascular endothelial growth factor therapy

2021 ◽  
pp. 112067212110043
Author(s):  
Carl S Wilkins ◽  
Ethan K Sobol ◽  
Gareth MC Lema ◽  
Jessica G Lee ◽  
Richard B Rosen ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Pre Treatment ◽  
Intravitreal Dexamethasone ◽  
Growth Factor Therapy ◽  
Endothelial Growth Factor

Background: Some patients with diabetic macular edema (DME) fail to completely respond to anti-vascular endothelial growth factor (VEGF) therapy. These patients have a high treatment burden in the absence of significant improvement. We investigate the role of intravitreal dexamethasone insert (IDI) in eyes with super-refractory DME. Methods: A non-randomized interventional study was performed among eyes with super-refractory DME refractory to anti-VEGF therapy. Eyes were treated with IDI after failing clinical response to anti-VEGF, with a minimum of 15 prior. Failure to respond was defined as failure of vision to improve at least one line on Snellen Acuity chart, central subfield thickness (CST) greater than 320 μm, or failure of CST to improve by 10% or more. Eyes with glaucoma or prior uncontrolled steroid-responsive ocular hypertension were excluded. Patient outcomes were analyzed at weeks 6, 12, 24, and year 1. Results: Six eyes of four patients were identified. All patients had failed aflibercept. The mean number of prior anti-VEGF injections was 34.5. Eyes received an average of 2.92 dexamethasone injections per person-year (PY) and required breakthrough anti-VEGF injection at 1.95/PY. Mean pre-treatment visual acuity was 0.475 LogMAR, improving to 0.342 at week 6, and 0.375 at 1 year. Mean CST pre-injection was 386.5 mm, improving to 315 mm at 1 year. No glaucoma developed. Conclusions: Intravitreal dexamethasone insert appears effective in eyes with super-refractory DME. IDI resulted in excellent anatomic improvement on SD-OCT as well as modest visual improvement. Injection burden was reduced in those who may otherwise receive years of monthly treatments.

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