Management of Pre-existing Macular Edema With Intravitreal Dexamethasone Implant in Eyes Undergoing Cataract Surgery

2019 ◽  
Vol 3 (4) ◽  
pp. 223-228
Author(s):  
Bradley T. Smith ◽  
Himanshu K. Banda
Keyword(s):  
Cataract Surgery ◽  
Macular Edema ◽  
Ocular Hypertension ◽  
Antihypertensive Agents ◽  
Cataract Extraction ◽  
Dexamethasone Implant ◽  
Intravitreal Dexamethasone Implant ◽  
History Of ◽  
The Mean ◽  
Intravitreal Dexamethasone

Purpose: The purpose of this study was to assess the efficacy and safety of intraocular dexamethasone implant (IDI) for pre-existing macular edema due to retinal vein occlusion (RVO), diabetes, and uveitis in eyes undergoing cataract surgery. Methods: A retrospective, noncomparative study was conducted. The medical record database was searched for patients meeting criteria of macular edema treated with IDI prior to cataract surgery. Results: Twenty-two patients had macular edema due to RVO (14 or 63.6%), diabetes (5 or 22.7%), or uveitis (3 or 13.6%). None had complications during cataract surgery. Thirteen (60%) were female with a mean age of 64 years (range, 25-82 years). The mean interval of dexamethasone implantation to cataract extraction was 49 days. The mean interval to follow-up optical coherence tomography was 65 days. Mean logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) improved from .94 (20/150–) to .56 (20/70+) ( P = .004), with an average gain in VA measuring +0.37 logMAR (3 line gain). Mean central retinal thickness decreased from 474 to 378 μm ( P = .006) with an average reduction of 96 μm ( P = .006). Mean macular volume decreased from 10.29 mm3 to 9.78 mm3 ( P = .0002) with an average reduction of 0.51 mm3. Two patients developed postoperative ocular hypertension requiring treatment with topical antihypertensive agents. One had a combined glaucoma filtering procedure at the time of cataract surgery because of a history of ocular hypertension. Conclusions: The majority of this cohort had improved macular edema due to RVO, diabetes, and noninfectious uveitis while undergoing cataract surgery. IDI is an effective and safe treatment in these at-risk eyes.

scholarly journals Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Eduardo A. Novais ◽  
Mauricio Maia ◽  
Paulo Augusto de Arruda Mello Filho ◽  
João Rafael de Oliveira Dias ◽  
José Maurício B. B. Garcia ◽  
...  
Keyword(s):  
Macular Edema ◽  
Safety Data ◽  
Common Adverse Event ◽  
Dexamethasone Implant ◽  
Intravitreal Dexamethasone Implant ◽  
The Mean ◽  
Pro Re Nata ◽  
Intravitreal Dexamethasone

Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes.Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded.Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P<0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P<0.001) 12 months after one (P=0.001), two (P=0.041), and three (P<0.001) implants but not four implants (P=0.068). The mean baseline CRT decreased significantly (P<0.001) from 463 to 254 microns after 12 months with one (P<0.001), two (P=0.002), and three (P=0.001) implants but not with four implants (P=0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%).Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes.

scholarly journals EFFECT OF AN INTRAVITREAL DEXAMETHASONE IMPLANT ON DIABETIC MACULAR EDEMA AFTER CATARACT SURGERY

Retina ◽  
2018 ◽  
Vol 38 (3) ◽  
pp. 490-496 ◽  
Author(s):  
Pilar Calvo ◽  
Antonio Ferreras ◽  
Fadwa Al Adel ◽  
Wantanee Dangboon ◽  
Michael H. Brent
Keyword(s):  
Cataract Surgery ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Dexamethasone Implant ◽  
Intravitreal Dexamethasone Implant ◽  
Intravitreal Dexamethasone

Intravitreal Dexamethasone Implant for the Treatment of Postoperative Macular Edema

2016 ◽  
Vol 236 (4) ◽  
pp. 181-185 ◽  
Author(s):  
André Klamann ◽  
Katharina Böttcher ◽  
Philipp Ackermann ◽  
Gerd Geerling ◽  
Marc Schargus ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Macular Edema ◽  
Clinical Findings ◽  
Results Of Treatment ◽  
Intravitreal Dexamethasone Implant ◽  
Pars Plana ◽  
The Mean ◽  
Intravitreal Dexamethasone ◽  
Evidence Based Guidelines

Introduction: Macular edema after cataract surgery (Irvine-Gass syndrome) or pars plana vitrectomy is a postoperative complication which can lead to permanent visual loss. Increased inflammatory substances, such as prostaglandins and cytokines, are discussed to be causative. Currently, there are no evidence-based guidelines for the treatment of postoperative macular edema. Intravitreal dexamethasone (DEX) could be effective by its anti-inflammatory effect. We examined the functional and morphological results of treatment with 0.7 mg intravitreal DEX implant (Ozurdex®). Methods: In an observational study, we analyzed visual acuity (logMAR), intraocular pressure (IOP), clinical findings, and the central macular thickness (CMT, optical coherence tomography [OCT] Spectralis®, Heidelberg Engineering, 30° macular scan, 19 scans) of 12 eyes before and 1 month after the last DEX implantation (off-label use, Ozurdex®, Allergan, Inc., Irvine, CA, USA) for macular edema after cataract surgery or vitrectomy. Re-implantation was performed when OCT showed new intraretinal fluid along with a decrease in the patient's visual acuity. The mean follow-up was 14.4 ± 10.6 months. Results: Twelve eyes of 12 patients (4 female, 8 male) with a mean age of 62.6 ± 11.9 years were treated with a mean of 2.5 ± 1.6 intravitreal DEX implant injections. Prior to injection, the visual acuity was 0.74 ± 0.34 logMAR and the CMT was 608 ± 129 µm. One month after the last injection (after a mean of 437 ± 322 days), the CMT normalized (300 ± 90 µm, p < 0.01) in all cases with a visual acuity of 0.49 ± 0.43 logMAR (p < 0.01). After 8.1 ± 5.3 months, recurring macular edema could be completely reduced by re-injection in 66% (8 patients). Four patients had no recurrence. Postinjection, the mean IOP was 17.4 ± 6.8 mm Hg. Postinjection, 7 patients required topical antiglaucomatous therapy. Conclusions: Treatment with an intravitreal DEX implant is an effective therapy for postoperative macular edema. Each injection leads to a complete resorption of the edema with a significant increase in visual acuity.

scholarly journals Switching to Aflibercept in Diabetic Macular Edema Not Responding to Ranibizumab and/or Intravitreal Dexamethasone Implant

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Antoine Herbaut ◽  
Franck Fajnkuchen ◽  
Lise Qu-Knafo ◽  
Sylvia Nghiem-Buffet ◽  
Bahram Bodaghi ◽  
...  
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Retinal Thickness ◽  
Dexamethasone Implant ◽  
Short Term ◽  
Intravitreal Dexamethasone Implant ◽  
Refractory Diabetic Macular Edema ◽  
The Mean ◽  
Intravitreal Dexamethasone ◽  
Anatomical Outcomes

Purpose. To assess short-term functional and anatomical outcomes of refractory diabetic macular edema (DME) following a switch from ranibizumab or dexamethasone to aflibercept. Methods. We included retrospectively eyes with persistent DME after at least 3 ranibizumab and/or one dexamethasone implant intravitreal injections (IVI). The primary endpoint was the mean change in visual acuity (VA) at month 6 (M6) after switching. Results. Twenty-five eyes were included. Before switching to aflibercept, 23 eyes received a median of 9.5 ranibizumab, and among them, 6 eyes received one dexamethasone implant after ranibizumab and 2 eyes received only one dexamethasone implant. Baseline VA, before any IVI, was 52.9 ± 16.5 letters, and preswitch VA was 57.1 ± 19.6 letters. The mean VA gain was +8 letters (p=0.01) between preswitch and M6. The mean central retinal thickness was 470.8 ± 129.9 μm before the switch and 303.3 ± 59.1 μm at M6 (p=0.001). Conclusion. Switching to aflibercept in refractory DME results in significant functional and anatomical improvement. The study was approved by the France Macula Federation ethical committee (FMF 2017-138).

scholarly journals Combined Intravitreal Dexamethasone Implant And Micropulse Yellow Laser For Treatment Of Anti-VEGF Resistant Diabetic Macular Edema

2017 ◽  
Vol 11 (1) ◽  
pp. 164-172 ◽  
Author(s):  
Ahmed Hosni Abd Elhamid
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Secondary Outcome ◽  
Dexamethasone Implant ◽  
Micropulse Laser ◽  
Anti Vegf ◽  
Intravitreal Dexamethasone Implant ◽  
Yellow Laser ◽  
The Mean ◽  
Intravitreal Dexamethasone

Purpose:To report the efficacy and safety of combined intravitreal dexamethasone implant and micropulse laser for anti-VEGF resistant diabetic macular edema.Patients and Methods:Prospective, non-controlled study that was conducted for twenty eyes with center-involved diabetic macular edema not responding to anti-VEGF therapy. Ozurdex intravitreal implant was injected to all eyes with subsequent micropulse yellow laser one month after the injection. All eyes were followed up after one, three, four, six, nine and twelve months. The primary outcome measure is the change in best corrected visual acuity (BCVA) after one year and secondary outcome measures are central macular thickness (CMT) change and safety of both dexamethasone implant and micropulse laser. Reinjection was done for those eyes with recurrent edema.Results:The mean age was 58.8 ±7.94 years. The mean BCVA was 0.6± 0.14, 0.57 ±0.12, 0.51±0.15, 0.59±0.12, 0.6± 0.12 and 0.59±0.14 after one, three, four, six, nine and twelve months in comparison to 0.45± 0.14 as initial BCVA [SS,P<0.05]. The CMT was 302.5±30.01, 330.6±20.24, 357.6±32.15, 285.4±19.95, 292.9±25.07 and 285.2±14.99µm after one ,three, four ,six , nine and twelve months in comparison to initial CMT of 420.7 ±38.74µm [HS, P<0.01]. Cataract occurred in 6 eyes from 14 phakic eyes (42.8%). Transient ocular hypertension occurred in 6 eyes (30%). Reinjection was done for eight eyes (40%).Conclusion:Intravitreal dexamethasone implant and micropulse laser are both effective and safe treatment options for anti-VEGF resistant diabetic macular edema.

Intravitreal Dexamethasone Implant Versus Intravitreal Ranibizumab Injection for Treatment of Non-Proliferative Diabetic Macular Edema: A Prospective, Randomized and Blinded trial

2020 ◽  
Vol 17 ◽  
Author(s):  
Sanjay Kumar Mishra ◽  
Shruti Sinha ◽  
Ravi Chauhan ◽  
Ashok Kumar
Keyword(s):  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Tertiary Care ◽  
Large Sample Size ◽  
Dexamethasone Implant ◽  
Intravitreal Ranibizumab ◽  
Intravitreal Dexamethasone Implant ◽  
The Mean ◽  
Intravitreal Dexamethasone

Introduction: In the working age population, Diabetic Macular Edema (DME) is the most common cause of visual loss. Purpose: The present study is aimed to assess the safety and efficacy of intravitreal injection of Ranibizumab (IVR) versus intravitreal Dexamethasone implant (IVD) in patients with DME in a tertiary care centre over 4 months. Methods: This is a comparative, prospective, randomized study that was done on 140 patients with macular edema confirmed on optical coherence tomography (OCT). IVD group received Ozurdex® (Allergan, Inc, Ireland) while the IVR group received Lucentis® (Novartis, Basel, Switzerland) followed up at day-1 and weeks 4, 8, 12,16. Patients were divided into Group A: patients were given 3 doses (monthly) of IVR 0.3 mg in 0.05 ml (n=70). Group B: patients given a single dose of IVD implant 0.7 mg (n=70). Results: The mean number of injections given was 1 Ozurdex® per patient Vs 3 Lucentis® per patient. The maximum reduction in central macular thickness (CMT) with IVD was 167.8 µm and 138.8µm in the 2nd and 3rd months, respectively with IVR. The Mean best-corrected visual acuity (BCVA) in the 4th month was 0.34 logMAR and 0.33 logMAR, in IVD and IVR group, respectively with consistent improvement. Patients with 0-5 letters, 6-10 letters and 10-15 letters, and >15 letters visibility in IVD group were 9.5, 20.6, 4.8, 6.4 %, and 20.4, 18.8, 20.3 20.3 % in IVR groups, respectively. The maximum intraocular pressure (IOP) rise with IVD was found to be 16 mmHg in 2 patients (3.17 %). The patients with IOP rise >10 mmHg was observed in 14/63 patients (22.22 %), the majority of patients indicated a high rise at 2nd month and all returning to baseline by 4th month. No reports of infectious endophthalmitis or new cataracts were detected in either treated groups. Conclusion: Both intravitreal Ranibizumab injection and Dexamethasone implants were found to be safe and effective in lowering CMT and improving BCVA at the 4-month follow up in patients with DME. Since there was no recurrence in CMT in the Dexamethasone implant group, we suggest that early administration before the 4th month may indicate superior efficacy over the ranibizumab injection. Further randomized trials in a large sample size with a longer period follow-up would be performed to justify the obtained results in the present study.

Sign in / Sign up

Export Citation Format

Share Document