AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHOD...AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHODS:The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),anterior chamber reaction,central macular thickness(CMT),intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively.RESULTS:A successful surgery was performed in all patients.The average follow-up period was 12mo.The female/male ratio was 13/13.Mean age was 45.65±3.83y(range 26 to 65y).Etiologically,rheumatic arthritis occurred in 6 patients(18.75%),ankylosing spondylitis in 4(12.50%),HLA-B27 associated uveitis in 3(9.38%),Vogt-KoyanagiHarada-associated uveitis in 4(12.50%),Behcet’s disease in 2(6.25%),and 7(21.88%)suffered from unknown diseases.All 32 eyes had varying degrees of improvement at 12mo after surgery,with 2 eyes showing BCVA of 0.1 or below(6.25%),6 having 0.1-0.5(18.75%),18 of 0.5-1.0(56.25%),and 6 of 1.0 or above(18.75%).No cases with increased IOP were observed.The values of mean CMT was increased at day 1,decreased at 1,3mo after surgery and increased at 6,12mo after surgery.No severe uveitis reactions,such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL,were observed after surgery.CONCLUSION:The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.展开更多
AIM: To evaluate the long-term efficacy and safety of dexamethasone implants in subjects affected by diabetic macular edema(DME) resistant to anti-vascular endothelial growth factor(VEGF) therapy.METHODS: Thirty...AIM: To evaluate the long-term efficacy and safety of dexamethasone implants in subjects affected by diabetic macular edema(DME) resistant to anti-vascular endothelial growth factor(VEGF) therapy.METHODS: Thirty-two DME patients were enrolled.A700 microgram slow release Intravitreal Dexamethasone Implant(Ozurdex~) was placed in the vitreous cavity.All patients were followed for 18 mo.Best-corrected visual acuity(BCVA) measured with Early Treatment Diabetic Retinopathy Study(ETDRS) and central macular thickness(CMT) exams were carried out at baseline(T0)and after 1(T1),3(T3),4(T4),6(T6),9(T9),12(T12),15(T15),and 18mo(T18) post injection. RESULTS: Repeated measures ANOVA showed an effect of treatment on ETDRS(P〈0.0001).Post hoc analyses revealed that ETDRS values were significantly increased at T1,T3,T4,T9,and T15(P 〈0.001) as compared to baseline value(T0).At T6,T12,and T18,ETDRS values were still statistically higher than baseline(P〈0.001 vs T0).However,at these time points,we observed a trend to return to baseline conditions.ANOVA also showed an effect of treatment(P 〈0.0001).CMT decreased significantly at T1,T3,T4,T9,and T15(P〈0.001).At T6(P〈0.01),T12 and T18(P〈0.001) CMT was also significantly lower than T0 although a trend to return to the baseline conditions was also observed.CONCLUSION: Our findings demonstrate that Intravitreal Dexamethasone Implant is a good option to improveBCVA and CMT in DME patients resistant to anti-VEGF therapy.Our data also show that the use of drugs administered directly into the vitreous allows achieving appropriate and long-lasting concentration at the site of disease without systemic side effects.展开更多
AIM: To compare safety and efficacy of intravitreal dexamethasone(IVD) implant with topical nepafenac(TN) 0.1% in previously untreated Irvine-Gass syndrome(IGS) in clinical practice. METHODS: This was a retrospective ...AIM: To compare safety and efficacy of intravitreal dexamethasone(IVD) implant with topical nepafenac(TN) 0.1% in previously untreated Irvine-Gass syndrome(IGS) in clinical practice. METHODS: This was a retrospective study of 62 eyes with IGS after phacoemulsification with posterior chamber intraocular lens(IOL) implantation. None of the patients used treatment before IVD or TN. Best-corrected visual acuity(BCVA) with Early Treatment Diabetic Retinopathy Study chart(ETDRS), slit-lamp, intraocular pressure(IOP) measurement, fundus examination, spectral-domain optical coherence tomography(OCT) and fundus florescein angiography were performed to all subjects at baseline, 1, 3 and 6 mo. RESULTS: The mean BCVA of the IVD group was 49.3±6.8, and the mean BCVA of the TN group was 32.9±7.3 ETDRS letters in post-treatment month 6. The mean central macular thickness(CRT) of IVD group was 266.6±53.5 μm and the mean CRT of TN group was 364.9±56.3 μm in posttreatment month 6. Baseline BCVA has correlation with final BCVA in TN group however there was no correlation between baseline BCVA and final BCVA in IVD group. CONCLUSION: IVD is found to be better than TN in controlling pseudophakic macular edema and improving visual acuity. IVD group also has significantly lower CRT however IOP is not significantly different between two groups in post-treatment month 6.展开更多
AIM:To report the effectiveness of intravitreal implantation of dexamethasone implant(Ozurdex)after phacoemulsification and intraocular lens implantation in refractory uveitis patients.METHODS:This single-center retro...AIM:To report the effectiveness of intravitreal implantation of dexamethasone implant(Ozurdex)after phacoemulsification and intraocular lens implantation in refractory uveitis patients.METHODS:This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation.The main outcome measurements were bestcorrected visual acuity(BCVA),central retinal thickness(CRT),grade of anterior chamber cell(AAC),intraocular pressure(IOP),and systemic/ocular adverse events.RESULTS:Ten eyes of 7 patients were included.BCVA showed significant improvement at 1 mo(P=0.004),3 mo(P=0.0004),and 6 mo(P=0.001)post operation.There were no statistically significant differences in the postoperative CRT among follow-up groups(P>0.05).No significant differences were observed in the baseline IOP when compared to 1,3,and 6 mo(all P>0.05)post operation.One patient developed a transient elevated IOP post injection.Two eyes(20%)developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy.In six patients(8 eyes,71.4%),the systemic steroid usage was reduced to below 10 mg/d.The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6 mo before operation and 0.7±0.48 in the 6 mon post operation.The mean recurrence time was 13±0.58 wk(range 12-14 wk)post operation.In five of seven patients(7 out of 10 eyes),inflammation relapse was developed postoperatively.Only one patient(2 eyes)needed increased amounts of oral corticosteroids.Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids.CONCLUSION:Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study.After the disappearance of Ozurdex’s antiinflammatory effects over time,in most cases the recurrent inflammation can be controlled by topical steroids.展开更多
Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density ...Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density is exacerbated over time after intraocular surgery(1)Descemet stripping automated endothelial keratoplasty(DSAEK)is considered the primary procedure for patients with only endothelial dysfunction.展开更多
BACKGROUND Posterior scleritis is one of the most easily missed and misdiagnosed diseases in ophthalmology.In this case we treated a patient with intravitreal dexamethasone implant that has not been extensively studie...BACKGROUND Posterior scleritis is one of the most easily missed and misdiagnosed diseases in ophthalmology.In this case we treated a patient with intravitreal dexamethasone implant that has not been extensively studied before.CASE SUMMARY A 40-year-old female patient who had anxiety,palpitation,and insomnia presented with eye pain and decreased vision in the left eye.An eye examination indicated that her visual acuity(VA)was 40/100.Her left eye presented conjunctival edema,mild exophthalmos,clear cornea,KP(-),and clear aqueous humor.In the fundus,there was a cinerous retinal protuberance.Ultrasonography showed“T-sign”and no systemic association was detected in laboratory examination.One month after injection of dexamethasone implant,the patient exhibited VA of 20/20,fundus serous retinal detachment disappeared,and intraocular pressure of both eyes was at the normal level.CONCLUSION Intravitreal injection of dexamethasone implant may be a safe and effective treatment for patients with idiopathic posterior scleritis.展开更多
AIM: To investigate the safety and efficacy of intravitreal dexamethasone implants(Ozurdex?/DEX) in patients with diabetic macular edema(DME) either na?ve or nonna?ve to anti-VEGF therapies who switched to DEX implant...AIM: To investigate the safety and efficacy of intravitreal dexamethasone implants(Ozurdex?/DEX) in patients with diabetic macular edema(DME) either na?ve or nonna?ve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors(anti-VEGFs).METHODS: This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients na?ve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity(BCVA), central macular thickness(CMT), and intraocular pressure(IOP) was collected over 6 mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients(57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment na?ve before receiving DEX implant, was collected.RESULTS: Improvement in mean BCVA was observed from 1-4 mo after injection with a decreased effect at month 6 as expected, with better outcomes in na?ve compared to non-na?ve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2 mo after DEX therapy. The mean number of injections of the overall population during the 6 mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported.CONCLUSION: This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in na?ve patients.展开更多
Dear Editor,We present a case of dexamethasone(DEX)intravitreal implantation(Ozurdex~;Allergan,Irvine,CA,USA)to treat diabetic macular edema(DME)during pregnancy.According to Pescosolido et al,pregnancy may prom...Dear Editor,We present a case of dexamethasone(DEX)intravitreal implantation(Ozurdex~;Allergan,Irvine,CA,USA)to treat diabetic macular edema(DME)during pregnancy.According to Pescosolido et al,pregnancy may promote the onset of diabetic retinopathy in about 10%of cases and may contribute to its worsening when already present,causing macular edema.Although one report has indicated that DME during pregnancy spontaneously regresses after delivery,others have reported that DME can persist and be associated with severe and persistent visual dysfunction.展开更多
Lee SM, Jung JW, Park SW, Lee JE, Byon IS. Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye. Int J Ophthalmo12017; 10(6): 1019-1020
AIM: To investigate the efficacy and safety of ranibizumab(RZB group) and dexamethasone implant(DEX group) intravitreal treatments in patients with treatment-na?ve center involved diabetic macular edema(DME) by means ...AIM: To investigate the efficacy and safety of ranibizumab(RZB group) and dexamethasone implant(DEX group) intravitreal treatments in patients with treatment-na?ve center involved diabetic macular edema(DME) by means of functional and morphological assessments.METHODS: This retrospective cohort study included 50 eyes of 50 patients with DME treated either with RBZ or DEX. Best-corrected visual acuity(BCVA) and microperimetry were evaluated at baseline and during a 6-month follow-up. In addition, central macular thickness(CMT) by means of structural optical coherence tomography(OCT) and retinal capillary plexus density and choriocapillary density by means of OCT angiography were assessed in all cases.RESULTS: Functional and morphological parameters significantly improved during the study period in both groups. BCVA improved significantly in both groups witha greater increase in the DEX group compared to the RBZ group(P=0.030). Microperimetry significantly differed during follow-up between the two treatments(P=0.031). In both groups CMT significantly decreased(P<0.001) without statistically significant differences between the two groups. A statistically significant increase of deep capillary plexus density was detected in both groups at 30 d after therapy. The retreatment rate was 0.70±0.10 and 0.65±0.10 in the RBZ group and 0.65±0.10 and 0.50±0.11 in DEX group at 120 and 180 d respectively. Two out of 25 patients in DEX group showed intraocular pressure increase requiring hypotonic eye drops.CONCLUSION: Both treatments are very effective for DME treatment during 6 mo of follow-up with a lower retreatment rate in DEX group.展开更多
AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation...AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3 mo after the injection and optical coherence tomography(OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment(PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208(26.9%) eyes were statistically greater in comparison with the 12/129(9.3%) eyes that had not been injected(P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.展开更多
AIM:To evaluate major complications after intravitreal injection of dexamethasone implants(Ozurdex)and their clinical management.METHODS:In a retrospective observational study between 2014 and 2016 at two university h...AIM:To evaluate major complications after intravitreal injection of dexamethasone implants(Ozurdex)and their clinical management.METHODS:In a retrospective observational study between 2014 and 2016 at two university hospitals,we reviewed the clinical records of 1241 consecutive macular edema patients treated with the dexamethasone implant,and separated severe adverse events in the injection procedure from those that were post-injection complications.We evaluated the cause and the outcomes in each case.RESULTS:In twenty-one procedures(1.69%)we noticed significant complications during and after intravitreal injection of the dexamethasone implant.Complications related to the injection procedure were in one case,that a second implant was injected by mistake in the same eye on the same day.In another case,the implant lodged in the sclera during retraction of the injector needle.Leaking scleral tunnel at the injection site led to hypotony in another case.There were 10 cases of post-injection displacement of the implant into the anterior chamber and one case with a migrated and trapped device between the intraocular lens and an artificial iris.Displacement typically occurred in patients with preexisting risk factors:eyes with complicated intraocular lens implantation,iris reconstruction or iris defects or pseudophakic eyes after vitrectomy were prone to develop this complication.Displacement led to secondary corneal decompensation with pseudohypopyon.One case developed an endophthalmitis,and we observed four cases of retinal detachment.Two eyes presented with long-lasting hypotony due to ciliary insufficiency.CONCLUSION:Treatment with the dexamethasone implant may cause various expected or unexpected complications that may have serious consequences for the patient and require further surgery.To reduce complications,clinicians should evaluate certain risk factors before scheduling patients for dexamethasone implant treatment and use proper injection techniques.展开更多
基金Supported by the Natural Science Basic Research Program in Shaanxi Province(No.2020JM-683)2020 Scientific Research Incubation Fund of Xi’an People’s Hospital(No.FZ-63)。
文摘AIM:To evaluate the long-term results of patients with chronic uveitis-induced cataract by phacoemulsification with IOL implantation and intravitreal injection of dexamethasone(DEX)intravitreal implant(Ozurdex).METHODS:The study included 32 eyes of 26 patients treated with DEX implant due to chronic uveitis-induced cataract and followed up for at least a year.Best-corrected visual acuity(BCVA),intraocular pressure(IOP),anterior chamber reaction,central macular thickness(CMT),intraoperative and postoperative complications and uveitis recurrence were analyzed retrospectively.RESULTS:A successful surgery was performed in all patients.The average follow-up period was 12mo.The female/male ratio was 13/13.Mean age was 45.65±3.83y(range 26 to 65y).Etiologically,rheumatic arthritis occurred in 6 patients(18.75%),ankylosing spondylitis in 4(12.50%),HLA-B27 associated uveitis in 3(9.38%),Vogt-KoyanagiHarada-associated uveitis in 4(12.50%),Behcet’s disease in 2(6.25%),and 7(21.88%)suffered from unknown diseases.All 32 eyes had varying degrees of improvement at 12mo after surgery,with 2 eyes showing BCVA of 0.1 or below(6.25%),6 having 0.1-0.5(18.75%),18 of 0.5-1.0(56.25%),and 6 of 1.0 or above(18.75%).No cases with increased IOP were observed.The values of mean CMT was increased at day 1,decreased at 1,3mo after surgery and increased at 6,12mo after surgery.No severe uveitis reactions,such as fibrinous exudates in the anterior chamber and exudative membrane formation on the anterior surface of the IOL,were observed after surgery.CONCLUSION:The present studies show that intravitreal injection of Ozudex during cataract operation can provide a new option for the clinical treatment of uveitis-induced cataract.
文摘AIM: To evaluate the long-term efficacy and safety of dexamethasone implants in subjects affected by diabetic macular edema(DME) resistant to anti-vascular endothelial growth factor(VEGF) therapy.METHODS: Thirty-two DME patients were enrolled.A700 microgram slow release Intravitreal Dexamethasone Implant(Ozurdex~) was placed in the vitreous cavity.All patients were followed for 18 mo.Best-corrected visual acuity(BCVA) measured with Early Treatment Diabetic Retinopathy Study(ETDRS) and central macular thickness(CMT) exams were carried out at baseline(T0)and after 1(T1),3(T3),4(T4),6(T6),9(T9),12(T12),15(T15),and 18mo(T18) post injection. RESULTS: Repeated measures ANOVA showed an effect of treatment on ETDRS(P〈0.0001).Post hoc analyses revealed that ETDRS values were significantly increased at T1,T3,T4,T9,and T15(P 〈0.001) as compared to baseline value(T0).At T6,T12,and T18,ETDRS values were still statistically higher than baseline(P〈0.001 vs T0).However,at these time points,we observed a trend to return to baseline conditions.ANOVA also showed an effect of treatment(P 〈0.0001).CMT decreased significantly at T1,T3,T4,T9,and T15(P〈0.001).At T6(P〈0.01),T12 and T18(P〈0.001) CMT was also significantly lower than T0 although a trend to return to the baseline conditions was also observed.CONCLUSION: Our findings demonstrate that Intravitreal Dexamethasone Implant is a good option to improveBCVA and CMT in DME patients resistant to anti-VEGF therapy.Our data also show that the use of drugs administered directly into the vitreous allows achieving appropriate and long-lasting concentration at the site of disease without systemic side effects.
文摘AIM: To compare safety and efficacy of intravitreal dexamethasone(IVD) implant with topical nepafenac(TN) 0.1% in previously untreated Irvine-Gass syndrome(IGS) in clinical practice. METHODS: This was a retrospective study of 62 eyes with IGS after phacoemulsification with posterior chamber intraocular lens(IOL) implantation. None of the patients used treatment before IVD or TN. Best-corrected visual acuity(BCVA) with Early Treatment Diabetic Retinopathy Study chart(ETDRS), slit-lamp, intraocular pressure(IOP) measurement, fundus examination, spectral-domain optical coherence tomography(OCT) and fundus florescein angiography were performed to all subjects at baseline, 1, 3 and 6 mo. RESULTS: The mean BCVA of the IVD group was 49.3±6.8, and the mean BCVA of the TN group was 32.9±7.3 ETDRS letters in post-treatment month 6. The mean central macular thickness(CRT) of IVD group was 266.6±53.5 μm and the mean CRT of TN group was 364.9±56.3 μm in posttreatment month 6. Baseline BCVA has correlation with final BCVA in TN group however there was no correlation between baseline BCVA and final BCVA in IVD group. CONCLUSION: IVD is found to be better than TN in controlling pseudophakic macular edema and improving visual acuity. IVD group also has significantly lower CRT however IOP is not significantly different between two groups in post-treatment month 6.
基金Supported by National Natural Science Foundation of China(No.81870651No.81671642)。
文摘AIM:To report the effectiveness of intravitreal implantation of dexamethasone implant(Ozurdex)after phacoemulsification and intraocular lens implantation in refractory uveitis patients.METHODS:This single-center retrospective study conducted for refractory pan-uveitis patients who underwent cataract surgery combined with intravitreal Ozurdex implantation.The main outcome measurements were bestcorrected visual acuity(BCVA),central retinal thickness(CRT),grade of anterior chamber cell(AAC),intraocular pressure(IOP),and systemic/ocular adverse events.RESULTS:Ten eyes of 7 patients were included.BCVA showed significant improvement at 1 mo(P=0.004),3 mo(P=0.0004),and 6 mo(P=0.001)post operation.There were no statistically significant differences in the postoperative CRT among follow-up groups(P>0.05).No significant differences were observed in the baseline IOP when compared to 1,3,and 6 mo(all P>0.05)post operation.One patient developed a transient elevated IOP post injection.Two eyes(20%)developed posterior capsular opacifications and underwent neodymium-doped yttrium aluminum garnet(Nd:YAG)laser capsulotomy.In six patients(8 eyes,71.4%),the systemic steroid usage was reduced to below 10 mg/d.The patients experienced a mean of 1.4±0.52 recurrences of inflammation in the 6 mo before operation and 0.7±0.48 in the 6 mon post operation.The mean recurrence time was 13±0.58 wk(range 12-14 wk)post operation.In five of seven patients(7 out of 10 eyes),inflammation relapse was developed postoperatively.Only one patient(2 eyes)needed increased amounts of oral corticosteroids.Intraocular inflammation recurrence in the remaining patients was controlled by topical steroids.CONCLUSION:Ozurdex is considered a safe and effective approach to control postoperative inflammation in cataract surgery for patients with refractory uveitis in our study.After the disappearance of Ozurdex’s antiinflammatory effects over time,in most cases the recurrent inflammation can be controlled by topical steroids.
文摘Dear Editor,Endothelial cell density decreases with age and in various ocular conditions,including corneal endotheliitis,uveitis,pseudoexfoliation syndrome,and birth injury(1)The reduction of endothelial cell density is exacerbated over time after intraocular surgery(1)Descemet stripping automated endothelial keratoplasty(DSAEK)is considered the primary procedure for patients with only endothelial dysfunction.
基金National Natural Science Foundation of China,No.81460088 and No.81860177.
文摘BACKGROUND Posterior scleritis is one of the most easily missed and misdiagnosed diseases in ophthalmology.In this case we treated a patient with intravitreal dexamethasone implant that has not been extensively studied before.CASE SUMMARY A 40-year-old female patient who had anxiety,palpitation,and insomnia presented with eye pain and decreased vision in the left eye.An eye examination indicated that her visual acuity(VA)was 40/100.Her left eye presented conjunctival edema,mild exophthalmos,clear cornea,KP(-),and clear aqueous humor.In the fundus,there was a cinerous retinal protuberance.Ultrasonography showed“T-sign”and no systemic association was detected in laboratory examination.One month after injection of dexamethasone implant,the patient exhibited VA of 20/20,fundus serous retinal detachment disappeared,and intraocular pressure of both eyes was at the normal level.CONCLUSION Intravitreal injection of dexamethasone implant may be a safe and effective treatment for patients with idiopathic posterior scleritis.
文摘AIM: To investigate the safety and efficacy of intravitreal dexamethasone implants(Ozurdex?/DEX) in patients with diabetic macular edema(DME) either na?ve or nonna?ve to anti-VEGF therapies who switched to DEX implant independent of response to anti-vascular endothelial growth factors(anti-VEGFs).METHODS: This was an audit retrospective review of medical records of patients with DME who switched to the DEX intravitreal implant. Patients were divided into 2 groups: patients na?ve to antiangiogenic therapy and patients who were previously treated with anti-VEGFs. Data regarding demographics, changes in mean best-corrected visual acuity(BCVA), central macular thickness(CMT), and intraocular pressure(IOP) was collected over 6 mo. The demographic data mean changes in BCVA, CMT, and IOP were compared. Six-month follow-up data of 47 patients(57 eyes), who either switched to DEX implant irrespective of response to previous treatments or were treatment na?ve before receiving DEX implant, was collected.RESULTS: Improvement in mean BCVA was observed from 1-4 mo after injection with a decreased effect at month 6 as expected, with better outcomes in na?ve compared to non-na?ve patients. A statistically relevant decrease in mean CMT was observed during the follow-up period. An increase in mean IOP was observed in the first 2 mo after DEX therapy. The mean number of injections of the overall population during the 6 mo was 1.3. A subgroup analysis showed no relevant difference between phakic versus pseudophakic patients relative to measured outcomes. There was no cataract progression during the follow-up period and no adverse events reported.CONCLUSION: This real-life setting study shows that intravitreal DEX implant is effective and safe. The timings of greater therapeutic impact are concordant with previous studies and suggest that earlier treatment with corticosteroids may have an additional benefit in na?ve patients.
基金Supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute(KHIDI)funded by the Ministry of Health&Welfare(No.HI14C1872)
文摘Dear Editor,We present a case of dexamethasone(DEX)intravitreal implantation(Ozurdex~;Allergan,Irvine,CA,USA)to treat diabetic macular edema(DME)during pregnancy.According to Pescosolido et al,pregnancy may promote the onset of diabetic retinopathy in about 10%of cases and may contribute to its worsening when already present,causing macular edema.Although one report has indicated that DME during pregnancy spontaneously regresses after delivery,others have reported that DME can persist and be associated with severe and persistent visual dysfunction.
文摘Lee SM, Jung JW, Park SW, Lee JE, Byon IS. Retinal injury following intravitreal injection of a dexamethasone implant in a vitrectomized eye. Int J Ophthalmo12017; 10(6): 1019-1020
文摘AIM: To investigate the efficacy and safety of ranibizumab(RZB group) and dexamethasone implant(DEX group) intravitreal treatments in patients with treatment-na?ve center involved diabetic macular edema(DME) by means of functional and morphological assessments.METHODS: This retrospective cohort study included 50 eyes of 50 patients with DME treated either with RBZ or DEX. Best-corrected visual acuity(BCVA) and microperimetry were evaluated at baseline and during a 6-month follow-up. In addition, central macular thickness(CMT) by means of structural optical coherence tomography(OCT) and retinal capillary plexus density and choriocapillary density by means of OCT angiography were assessed in all cases.RESULTS: Functional and morphological parameters significantly improved during the study period in both groups. BCVA improved significantly in both groups witha greater increase in the DEX group compared to the RBZ group(P=0.030). Microperimetry significantly differed during follow-up between the two treatments(P=0.031). In both groups CMT significantly decreased(P<0.001) without statistically significant differences between the two groups. A statistically significant increase of deep capillary plexus density was detected in both groups at 30 d after therapy. The retreatment rate was 0.70±0.10 and 0.65±0.10 in the RBZ group and 0.65±0.10 and 0.50±0.11 in DEX group at 120 and 180 d respectively. Two out of 25 patients in DEX group showed intraocular pressure increase requiring hypotonic eye drops.CONCLUSION: Both treatments are very effective for DME treatment during 6 mo of follow-up with a lower retreatment rate in DEX group.
文摘AIM: To determine whether intravitreal dexamethasone(DEX) implant induces posterior vitreous detachment or not. METHODS: We retrospectively reviewed 810 eyes of 405 patients who underwent intravitreal DEX implantation due to macular edema caused by diabetic and retinal venous occlusion in our clinic. The eyes having no injection were determined as the control group. The examination findings of the patients before the injection and 3 mo after the injection and optical coherence tomography(OCT) images were scanned. The pre-injection OCT findings and OCT findings of the patients having no posterior vitreous detachment(PVD) and determined to have partial PVD were compared. RESULTS: The separation in vitreoretinal adhesion and total PVD development of DEX-injected 56/208(26.9%) eyes were statistically greater in comparison with the 12/129(9.3%) eyes that had not been injected(P=0.001). PVD development was observed more in the patients that were younger, had larger macula thickness and lower visual acuity. CONCLUSION: It can be stated that intravitreal DEX implant induces PVD development. Prospective, controlled studies are required in order to determine prognosis of vitreoretinal disease in PVD-developed patients and in non-PVD-developed patients.
文摘AIM:To evaluate major complications after intravitreal injection of dexamethasone implants(Ozurdex)and their clinical management.METHODS:In a retrospective observational study between 2014 and 2016 at two university hospitals,we reviewed the clinical records of 1241 consecutive macular edema patients treated with the dexamethasone implant,and separated severe adverse events in the injection procedure from those that were post-injection complications.We evaluated the cause and the outcomes in each case.RESULTS:In twenty-one procedures(1.69%)we noticed significant complications during and after intravitreal injection of the dexamethasone implant.Complications related to the injection procedure were in one case,that a second implant was injected by mistake in the same eye on the same day.In another case,the implant lodged in the sclera during retraction of the injector needle.Leaking scleral tunnel at the injection site led to hypotony in another case.There were 10 cases of post-injection displacement of the implant into the anterior chamber and one case with a migrated and trapped device between the intraocular lens and an artificial iris.Displacement typically occurred in patients with preexisting risk factors:eyes with complicated intraocular lens implantation,iris reconstruction or iris defects or pseudophakic eyes after vitrectomy were prone to develop this complication.Displacement led to secondary corneal decompensation with pseudohypopyon.One case developed an endophthalmitis,and we observed four cases of retinal detachment.Two eyes presented with long-lasting hypotony due to ciliary insufficiency.CONCLUSION:Treatment with the dexamethasone implant may cause various expected or unexpected complications that may have serious consequences for the patient and require further surgery.To reduce complications,clinicians should evaluate certain risk factors before scheduling patients for dexamethasone implant treatment and use proper injection techniques.