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Journal ArticleDOI

The clinical outcomes of intravitreal dexamethasone implant as the first-line treatment in retinal vein occlusion related macular edema

01 Jan 2018-pp 1
TL;DR: Intravitreal dexamethasone injection is an effective mode of treatment in patients with RVO-associated macular edema and its side effects are not severe or common, however the patients should be kept under follow-up for recurrences.
Abstract: Aim: To investigate the alterations in central macular thickness (CMT), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) after intravitreal dexamethasone implant (IDI; Ozurdex) injections in patients with treatment-naive central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-related macular edema in clinical practice. Material and Methods: Totally 41 eyes of 41 patients diagnosed with BRVO or CRVO, who were treatment-naive and treated with only intravitreal dexamethasone implants, were retrospectively investigated. Anterior and posterior segment examinations were performed with a slit lamp bio-microscope. BCVA was assessed using Snellen chart and then converted to logarithm of minimum angle of resolution (log MAR) units before statistical analysis and CMT measurements were performed with spectral domain optical coherence tomography. Results: The mean age of patients was 65.95 ±6.164 years (range: 51-78). Central retinal vein was occluded in 14 patients while branches were occluded in remaining 27 patients. The patients were followed for 14.93±1.942 months (median: 15, range: 12-20 months). The mean number of injections was 2.83±0.803 (median: 3, range: 1-4). BCVA was significantly better in all time periods after treatment (p: 0.001). There was a significant decrease in CMT in all time periods after treatment compared with pre-treatment values (p: 0.001). During follow-up period, IOP was determined to be higher than 25 mm-Hg in 5 patients, and cataract was diagnosed in 6 patients. Conclusion: Intravitreal dexamethasone injection is an effective mode of treatment in patients with RVO-associated macular edema. Its side effects are not severe or common. However the patients should be kept under follow-up for recurrences.
References
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Journal ArticleDOI
01 Jan 2008-Eye
TL;DR: The results suggest that the aqueous level of VEGF may reflect its vitreous level, which may be clinically useful to indicate the severity of macular oedema with BRVO.
Abstract: To investigate whether the aqueous levels of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) are correlated to the vitreous levels of these substances and to the severity of macular oedema in branch retinal vein occlusion (BRVO). Aqueous and vitreous samples were obtained during cataract and vitreous surgery from 24 patients (24 eyes) with macular oedema in BRVO. The VEGF and IL-6 levels in aqueous humour, vitreous fluid, and plasma were determined by enzyme-linked immunosorbent assay. The degree of retinal ischaemia was evaluated in terms of the area of capillary nonperfusion using the Scion Image. The severity of macular oedema was evaluated using the OCT. The aqueous level of VEGF was significantly correlated with the vitreous level of VEGF (P<0.0001). Vitreous levels of VEGF and IL-6 were significantly correlated with the nonperfusion area of BRVO (P<0.0001, P=0.0061, respectively), as were the aqueous levels of VEGF and IL-6 (P<0.0001, P=0.0267, respectively). Furthermore, the vitreous levels of VEGF and IL-6 and the aqueous level of VEGF were significantly correlated with the severity of macular oedema of BRVO (P=0.0001, P=0.0331, P=0.0272, respectively). Our results suggest that the aqueous level of VEGF may reflect its vitreous level. Measurement of the aqueous level of VEGF may be clinically useful to indicate the severity of macular oedema with BRVO.

251 citations

Journal ArticleDOI
TL;DR: In this article, a branch retinal vein occlusion (BRVO) is more prevalent than central retinal vessel occlusions (CRVO) due to its multifactorial nature, however, management of this condition remains a challenge.

183 citations


"The clinical outcomes of intravitre..." refers background in this paper

  • ...Proinflammatory cytokines are also involved in augmentation of macular edema (1,2)....

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  • ...8 (4, 2-6) months while cataract progression (70....

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  • ...Similarly, BCVA values significantly improved on the 1st month and although there were some alterations through the worse side on 5th-6th and 11th-12th months, these values were still significantly Ann Med Res 2019;26(2):255-9...

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Journal ArticleDOI
TL;DR: The intravitreal dexamethasone implant does not last the 6 months implied by the retreatment protocol in the GENEVA trial, and improved results can be achieved with an as-needed retreatment Protocol, particularly in CRVO, but visual outcomes remain similar to those previously seen with triamcinolone in the SCORE study and neovascular complications remain a feature of CRVO.
Abstract: Objective: To report the 12-month outcomes of the dexamethasone intravitreal implant in retinal vein occlusion (RVO), using an as-needed repeat injection protocol. Design: Retrospective consecutive case series of 51 eyes of 49 patients with macular oedema as a result of RVO that received an intravitreal dexamethasone implant and were followed up for at least 12 months. Results: 70% of patients responded to dexamethasone implant injection with an improvement in visual acuity (VA) and macular oedema within 3 months of injection, but only 30% of eyes gained ≥15 letters. The mean change in VA letter score at 12 months compared with baseline for branch RVO (BRVO) and central RVO (CRVO) was 5.7 ±2.3 and 11.5±11.0 EDTRS letters, respectively. 56% of patients relapsed, with the median time to relapse being 17 weeks for patients with branch RVO and 18 weeks for patients with CRVO. Repeat injections achieved similar VA gains, but the duration of effect of repeat dexamethasone implants was much shorter at 10 weeks. 14 eyes (27%) developed a significant rise in intraocular pressure, and three of these required treatment with oral acetazolamide. Four eyes with CRVO developed neovascular glaucoma during the study. Conclusions: The intravitreal dexamethasone implant does not last the 6 months implied by the retreatment protocol in the GENEVA trial, and improved results can be achieved with an as-needed retreatment protocol, particularly in CRVO. However, visual outcomes remain similar to those previously seen with triamcinolone in the SCORE study and neovascular complications remain a feature of CRVO.

51 citations


"The clinical outcomes of intravitre..." refers background in this paper

  • ...(13) reported that 56% of patients relapsed after first injection and the median time to relapse was 17 weeks....

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  • ...In another retrospective study on 51 eyes with RVO- associated macular edema, Joshi et al. (13) reported that 56% of patients relapsed after first injection and the median time to relapse was 17 weeks....

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Journal ArticleDOI
TL;DR: To investigate the influence of intravitreal dexamethasone implant on inflammatory and angiogenic cytokine levels in the aqueous of patients with retinal vein occlusion (RVO).
Abstract: Purpose To investigate the influence of intravitreal dexamethasone implant on inflammatory and angiogenic cytokine levels in the aqueous of patients with retinal vein occlusion (RVO). Methods Forty eyes of 40 consecutive patients with macular oedema (ME) due to branch and central retinal vein occlusion (BRVO/CRVO) were treated with an intravitreal dexamethasone implant (Ozurdex®) at baseline and evaluated until month 6. Retreatment was performed in case of recurrent ME earliest 4 months after the baseline treatment. Aqueous humour samples were taken at baseline, months 1, 3, 6 and at the time of each retreatment. Concentrations of 29 different cytokines were measured by Luminex® bead assays. The control group comprised healthy patients undergoing cataract surgery. Results At baseline concentrations of interleukin (IL)-8, angiopoietin (ANG)-2 and intercellular adhesion molecule (ICAM)-1 were highly elevated in patients with CRVO compared with controls (p = 0.006; p = 0.02; p = 0.03). Vascular endothelial growth factor (VEGF) concentrations were upregulated in patients with BRVO and CRVO (p = 0.003; p = 0.001). Retreatment with a dexamethasone implant was necessary after 4 months in 14/8 (BRVO/CRVO) patients, 5 months in 5/3 patients and 6 months in one patient (BRVO). After the initial treatment, macrophage chemo-attractant protein (MCP)-1 and IL17-E concentrations decreased in BRVO (p < 0.001; p = 0.01) and MCP-1 and IL1-α in CRVO (p = 0.01; p = 0.003). Vascular endothelial growth factor (VEGF) concentrations did not change during treatment in either group (p = 0.3). A mixed-effect model showed that cytokine concentrations positively correlated with central retinal thickness changes. Conclusions Intravitreal dexamethasone treatment resulted in alterations in the concentrations of pro-inflammatory cytokines MCP-1 and IL17-E in patients with BRVO and MCP-1 and IL1-α in patients with CRVO. These data highlight the important role of inflammatory mediators involved in ME due to RVO.

44 citations


"The clinical outcomes of intravitre..." refers background in this paper

  • ...8 (4, 2-6) months while cataract progression (70....

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  • ...Moreover, they have short-term effects and repeated injections may be required (3-5)....

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Journal ArticleDOI
TL;DR: In patients with chronic macular edema not responsive to repetitive anti-VEGF therapies, the outcome after dexamethasone implant treatment is encouraging, but these results are achieved at the expense of side effects typically associated with steroids.
Abstract: Purpose To review published data pertaining to the clinical experience with a dexamethasone intravitreal implant (Ozurdex®) with a view to establishing a clinically based therapeutic regime.

43 citations


"The clinical outcomes of intravitre..." refers background in this paper

  • ...7 mg (DEX implant; Ozurdex®, Allergan plc, Dublin, Ireland) has been shown to be effective in treating macular edema secondary to RVO (6,7)....

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