scholarly journals Subthreshold Diode Micropulse Laser Combined with Intravitreal Therapy for Macular Edema—A Systematized Review and Critical Approach

2021 ◽  
Vol 10 (7) ◽  
pp. 1394
Author(s):  
Maciej Gawęcki
Keyword(s):  
Vascular Disease ◽  
Macular Edema ◽  
Combined Treatment ◽  
Intravitreal Injections ◽  
Clinical Approach ◽  
Inclusion Criteria ◽  
Intravitreal Therapy ◽  
Micropulse Laser ◽  
Anti Vegf ◽  
Retinal Vascular Disease

Objective: intravitreal therapy for macular edema (ME) is a common clinical approach to treating most retinal vascular diseases; however, it generates high costs and requires multiple follow-up visits. Combining intravitreal anti–vascular endothelial growth factor (VEGF) or steroid therapy with subthreshold diode micropulse laser (SDM) application could potentially reduce the burden of numerous intravitreal injections. This review sought to explore whether this combination treatment is effective in the course of ME secondary to retinal vascular disease, and in particular, determine whether it is comparable or superior to intravitreal therapy alone. Materials and methods: the following terms and Boolean operators were used to search the PubMed literature database: subthreshold micropulse laser, subthreshold diode micropulse OR micropulse laser treatment AND anti-VEGF, anti-VEGF treatment, intravitreal steroids, OR combined therapy.This analysis included all studies discussing the combination of SDM and intravitreal anti-VEGF or steroid treatment. Results: the search revealed nine studies that met the inclusion criteria, including five comparing combined treatment and anti-VEGF treatment alone, four covering diabetic ME, and one covering ME secondary to branch retinal vein occlusion. All of these five studies suggested that combination therapy results in fewer intravitreal injections than anti-VEGF monotherapy with non-inferior functional and morphological outcomes. The remaining four studies report functional and morphological improvements after combined treatment; however, SDM alone was never superior to intravitreal-alone or combined treatment. There were substantial differences in treatment protocols and inclusion criteria between the studies. Conclusions: the available material was too scarce to provide a reliable assessment of the effects of combined therapy and its relation to intravitreal monotherapy in the treatment of ME secondary to retinal vascular disease. One assumption of note is that it is possible that SDM plus anti-VEGF might require fewer intravitreal injections than anti-VEGF monotherapy with equally good functional and morphological results. However, further randomized research is required to confirm this thesis.

scholarly journals Efficacy of Psychiatric Treatment to Treat a Specific Phobia of Intravitreal Injections in a Patient with Neovascular Age-Related Macular Degeneration

2021 ◽  
pp. 48-56
Author(s):  
Atsuta Ozaki ◽  
Hisashi Matsubara ◽  
Masahiko Sugimoto ◽  
Manami Kuze ◽  
Mineo Kondo ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Macular Edema ◽  
Psychiatric Treatment ◽  
Early Stage ◽  
Behavioral Therapy ◽  
Specific Phobia ◽  
Age Related Macular Degeneration ◽  
Intravitreal Injections ◽  
Anti Vegf ◽  
Age Related

Intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) is essential for the treatment of macular diseases such as wet age-related macular degeneration and macular edema. Although continued treatment is needed to maintain good vision, some patients cannot continue such injections for various reasons, including specific phobias. Here, we report a case of a patient with a specific phobia of intravitreal injections who could resume treatment after undergoing combined drug and cognitive-behavioral therapy (CBT). A 74-year-old Japanese man diagnosed with retinal angiomatous proliferation by fluorescein angiography and indocyanine green angiography was treated with intravitreal anti-VEGF injection. However, at 8 months after the first treatment, he became difficult to treat because of a phobia of injections. He was treated with photodynamic therapy, but his macular edema did not improve. After a psychiatric consultation, he was diagnosed with a specific phobia of intravitreal injections. Combined drug and CBT enabled him to resume receiving intravitreal injections. This case demonstrates that a specific phobia of intravitreal injections may benefit from combined drug and CBT. In this regard, some patients with high anxiety and fear of intravitreal injections should be referred to a psychiatrist at an early stage.

Topical interferon in recurrent inflammatory macular edema following a cat bite

2021 ◽  
pp. 112067212110248
Author(s):  
Ankush Kawali ◽  
Sanjay Srinivasan ◽  
Padmamalini Mahendradas ◽  
Rohit Shetty
Keyword(s):  
Macular Edema ◽  
Interferon Therapy ◽  
Close Contact ◽  
Invasive Treatment ◽  
Intravitreal Therapy ◽  
Therapeutic Trials ◽  
Anti Vegf ◽  
Vascular Growth Factor ◽  
History Of ◽  
Steroid Responsiveness

Introduction: Treating chronic macular edema (CME) post endophthalmitis is a challenge. Use of steroids may reactivate the infection and repeated intravitreal therapy with anti-vascular growth factor inhibitors (Anti-VEGF) puts the patient again at the risk of exacerbation of inflammation or endophthalmitis. We describe a case of CME post traumatic endophthalmitis successfully treated with topical interferon therapy. Case description: A 34-year-old Asian Indian lady with a history of cat bite to her right eye and treated elsewhere as traumatic endophthalmitis with recurrent macular edema, presented to us 1 year after the injury. She had received anti-VEGF injection for same. Her medical history was non-contributory except for close contact with her cat. Therapeutic trials with oral doxycycline followed by oral albendazole with steroids, as well as repeated anti-VEGF therapy failed to prevent recurrence of CME. Patient’s steroid responsiveness and reluctance for injections, made us to opt for a novel topical Interferon therapy. Macular edema resolved in 2 months. Interruption of interferon therapy due to COVID-lock down resulted in recurrence of the CME, which again responded well to interferon monotherapy. Conclusion: Topical interferon may have a role in the treatment of inflammatory macular edema and can serve as a, safer, economical and non-invasive treatment option compared to intravitreal steroids and anti-VEGFs.

scholarly journals Ranibizumab Treatment and Protocols in Diabetic Retinopathy and Diabetic Macular Edema

2018 ◽  
pp. 143-146
Keyword(s):  
Diabetic Retinopathy ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Treatment Efficacy ◽  
Combined Treatment ◽  
Optimal Dose ◽  
Intravitreal Ranibizumab ◽  
Anti Vegf ◽  
Common Causes ◽  
Ranibizumab Treatment

Diabetic macular edema (DME) is one of the most common causes of visual loss in patients with diabetic retinopathy (DRP). The prognosis of central involved diabetic macular edema has improved after anti-VEGF treatments. Intravitreal ranibizumab was the first anti-VEGF agent approved by the FDA for the treatment of diabetic macular edema. Despite the fact that it is a pathogenic treatment, it has brought some challenging situations on its own. In most studies, optimal dose and combined treatment were evaluated in terms of treatment efficacy. Recent studies revealed that ranibizumab treatment is effective in DRP and proliferative DRP regression as well as in diabetic macular edema treatment. In this article, we aimed to review the effects of Ranibizumab treatment on visual acuity, central macular thickness in patients with diabetic retinopathy, and diabetic macular edema through studies.

scholarly journals Incomplete Treatment Response, Treatment Resistance, Pharmaceutical Changes and Combined Treatments in Branch Retinal Vein Occlusion and Macular Edema

2019 ◽  
pp. 108-111
Keyword(s):  
Macular Edema ◽  
Treatment Response ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Vision Loss ◽  
Combined Treatment ◽  
Treatment Resistance ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Incomplete Treatment

Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disease after diabetic retinopathy. Vision loss varies depending on the affected area. The main causes of vision loss in BRVO are macular edema and macular ischemia. Anti-VEGF agents are preferred in the treatment of macular edema due to BRVO because of the increase in visual acuity. Although anti-VEGF therapy provides an early response, in some cases macular edema is resistant to the treatment. In this review, incomplete treatment response, treatment resistance, pharmaceutical changes, and combined treatment are mentioned in cases with BRVO and macular edema.

scholarly journals The Role of Steroids in the Management of Macular Edema from Retinal Vein Occlusion

2019 ◽  
Vol 16 (1) ◽  
pp. 95-101
Author(s):  
M. V. Budzinskaya ◽  
A. V. Shelankova ◽  
A. A. Plukhova ◽  
N. M. Nuriyeva ◽  
A. S. Sorokin
Keyword(s):  
Macular Edema ◽  
Intravitreal Injection ◽  
Retinal Vein Occlusion ◽  
Intravitreal Injections ◽  
Ophthalmological Examination ◽  
Dexamethasone Implant ◽  
Duration Of Treatment ◽  
Vein Occlusion ◽  
Anti Vegf ◽  
Group 1

Aim: To analyze the effectiveness of intravitreal injection of an anti-VEGF agent (ranibizumab) and an dexametazon implant for the intravitreal injection, in real clinical life.Patients and Methods. 137 patients with MO due to retinal venous occlusion were included in the study. Patients were retrospectively divided into groups: patients who received monotherapy with ranibizumab 94 people; and monotherapy with dexamethasone implant — 15 patients; patients who initially were injected with a dexamethasone implant, but due the study transferred to ranibizumab 15 patients; patients who initially received ranibizumab, but then transferred to the dexamethasone implant -13. For the treatment of macular edema were used an anti-VEGF agent — ranibizumab (Lucentis) 0.05 ml (0.5 mg) manufactured by Novartis (Switzerland) or glucocorticosteroid — dexamethasone implant for intravitreal injection of 0.7 mg (Ozurdex) manufactured by Allergan Pharmaceutical Ireland (Ireland). The injections were administered on a pro re nata basis (the presence of macular edema). Standard ophthalmological examination and fluorescent angiography (PAG), optical coherent tomography (OCT), optical coherence tomography angiography (OCT-A) were used. Visual acuity changes (BCVA), central retinal thickness (CRT) and intraocular pressure (IOP) were analyzed depending on the study group (group 1–4), the duration of treatment and the number of injections. Results: In group 1, from 1 to 8 IVVs were performed in 24 months, an average of 3.77. In group 2, from 1 to 4 intravitreal injections were performed in 24 months, an average of 1.37. In group 3, from 1 to 2 of intravitreal injections Ozurdex and from 1 to 4 intravitreal injections of ranibizumab for 24 months. In group 4, from 1 to 4 intravitreal injections of anti-VEGF drug and from 1 to 4 intravitreal dexamethasone implant were performed in 24 months of follow-up. Monotherapy with the Ozurdex drug (12 months) had the most stable effect, with a relapse of the process, repeated injections were required, conducted only in 3 out of 15 patients. Conclusion: In real clinical practice, the dexamethasone implant showed a good safety profile and high efficacy in the resorption of macular edema in patients with retinal vein occlusion, which corresponds to the clinical trials that was made earlier. 

Sign in / Sign up

Export Citation Format

Share Document