Efficacy and Safety of Intravitreal Dexamethasone Implants for Treatment of Refractory Diabetic Macular Edema
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Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone (IVD) implants in eyes with diabeticmacular edema that did not respond to previous treatment. Methods: We included 46 eyes of 46 patients in this retrospective study. Each month, we recorded patient visualacuity with logarithm of the minimum angle of resolution using the Early Treatment Diabetic RetinopathyStudy chart, central macular thickness measurements with optical coherence tomography, intraocular pressure(IOP), and posttreatment complication occurrence. Results: The mean follow-up time was 8.95 ± 1.33 months (range, 6 to 12). Best-corrected visual acuity improvedsignificantly in the first 4 months after IVD, but no statistically significant change was observed over the following2 months. Although a statistically significant decrease in central macular thickness was observed in thefirst 3 months, the change was not statistically significant in the following 3 months. There was a statisticallysignificant increase in IOP in the first 2 months, but no statistically significant change was observed in the followingmonths. IOP was controlled with medication in all patients with elevated IOP. Of the 26 phakic patients,two had cataracts requiring surgery. Conclusions: Cases of refractory diabetic macular edema that did not respond to previous treatment, such asanti-vascular endothelial growth factor injections and laser photocoagulation, exhibited improvements in visualacuity and decreases in retinal thickness after IVD implantation. Both functional and anatomical effects wereobserved in the first 3 months after injection. Repeat injections and frequent examination might be required forcontinued improvement. Side effects, such as cataracts and elevation of IOP, may require medical or surgicaltreatment.
Abstract
Purpose: To evaluate the safety and efficacy of intravitreal dexamethasone (IVD) implants in eyes with diabeticmacular edema that did not respond to previous treatment. Methods: We included 46 eyes of 46 patients in this retrospective study. Each month, we recorded patient visualacuity with logarithm of the minimum angle of resolution using the Early Treatment Diabetic RetinopathyStudy chart, central macular thickness measurements with optical coherence tomography, intraocular pressure(IOP), and posttreatment complication occurrence. Results: The mean follow-up time was 8.95 ± 1.33 months (range, 6 to 12). Best-corrected visual acuity improvedsignificantly in the first 4 months after IVD, but no statistically significant change was observed over the following2 months. Although a statistically significant decrease in central macular thickness was observed in thefirst 3 months, the change was not statistically significant in the following 3 months. There was a statisticallysignificant increase in IOP in the first 2 months, but no statistically significant change was observed in the followingmonths. IOP was controlled with medication in all patients with elevated IOP. Of the 26 phakic patients,two had cataracts requiring surgery. Conclusions: Cases of refractory diabetic macular edema that did not respond to previous treatment, such asanti-vascular endothelial growth factor injections and laser photocoagulation, exhibited improvements in visualacuity and decreases in retinal thickness after IVD implantation. Both functional and anatomical effects wereobserved in the first 3 months after injection. Repeat injections and frequent examination might be required forcontinued improvement. Side effects, such as cataracts and elevation of IOP, may require medical or surgicaltreatment.
참고문헌 (31)
- Williams GA, "ESASO course series. Vol. 1", pp.99~104 (2012), Karger
- Klein R, "The Wisconsin Epidemiologic Study of Diabetic Retinopathy. XV:the long-term incidence of macular edema", Ophthalmology, 102, pp.7~16 (1995)
- "Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group", Arch Ophthalmol, 103, pp.1796~1806 (1985)
- Adamis AP, "Is diabetic retinopathy an inflammatory disease?", Br J Ophthalmol, 86, pp.363~365 (2002)
- Grant MB, "The role of growth factors in the pathogenesis of diabetic retinopathy", Expert Opin Investig Drugs, 13, pp.1275~1293 (2004)
- Nguyen QD, "Supplemental oxygen improves diabetic macular edema: a pilot study", Invest Ophthalmol Vis Sci, 45, pp.617~624 (2004)
- Nauck M, "Corticosteroids inhibit the expression of the vascular endothelial growth factor gene in human vascular smooth muscle cells", Eur J Pharmacol, 341, pp.309~315 (1998)
- Heiss JD, "Mechanism of dexamethasone suppression of brain tumor-associated vascular permeability in rats: involvement of the glucocorticoid receptor and vascular permeability factor", J Clin Invest, 98, pp.1400~1408 (1996)
- McGhee CN, "Pharmacokinetics of ophthalmic corticosteroids", Br J Ophthalmol, 76, pp.681~684 (1992)
- Parke DW 3rd, "Ocular hypertension after intravitreal triamcinolone with vitrectomy and phacoemulsification", Clin Ophthalmol, 6, pp.925~931 (2012)
- Massin P, "Intravitreal triamcinolone acetonide for diabetic diffuse macular edema:preliminary results of a prospective controlled trial", Ophthalmology, 111, pp.218~224 (2004)
- Park CH, "Intravitreal triamcinolone acetonide in eyes with cystoid macular edema associated with central retinal vein occlusion", Am J Ophthalmol, 136, pp.419~425 (2003)
- Edelman JL, "Corticosteroids inhibit VEGF-induced vascular leakage in a rabbit model of blood-retinal and blood-aqueous barrier breakdown", Exp Eye Res, 80, pp.249~258 (2005)
- Haller JA, "Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion", Ophthalmology, 117, pp.1134~1146 (2010)
- Goldfein A, "Basic and clinical pharmacology", pp.592~607 (1995), Prentice Hall
- Chang-Lin JE, "Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant", Invest Ophthalmol Vis Sci, 52, pp.80~86 (2011)
- Yau JW, "Global prevalence and major risk factors of diabetic retinopathy", Diabetes Care, 35, pp.556~564 (2012)
- Bhagat N, "Diabetic macular edema: pathogenesis and treatment", Surv Ophthalmol, 54, pp.1~32 (2009)
- American Diabetes Association, "Standards of medical care in diabetes--2009", Diabetes Care, (32 Suppl 1), pp.S13~S61 (2009)
- Brown DM, "Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials. RISE and RIDE", Ophthalmology, 120, pp.2013~2022 (2013)
- Gillies MC, "Intravitreal triamcinolone for refractory diabetic macular edema: twoyear results of a double-masked, placebo-controlled, randomized clinical trial", Ophthalmology, 113, pp.1533~1538 (2006)
- Jonas JB, "Safety of intravitreal high-dose reinjections of triamcinolone acetonide", Am J Ophthalmol, 138, pp.1054~1055 (2004)
- Thakur A, "Trabecular meshwork and lens partitioning of corticosteroids: implications for elevated intraocular pressure and cataracts", Arch Ophthalmol, 129, pp.914~920 (2011)
- Boyer DS, "Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema", Ophthalmology, 121, pp.1904~1914 (2014)
- Zucchiatti I, "Intravitreal dexamethasone implant in patients with persistent diabetic macular edema", Ophthalmologica, 228, pp.117~122 (2012)
- Scaramuzzi M, "Repeated intravitreal dexamethasone implant (Ozurdex) for diabetic macular edema", Retina, 35, pp.1216~1222 (2015)
- Dutra Medeiros M, "Dexamethasone intravitreal implant for treatment of patients with persistent diabetic macular edema", Ophthalmologica, 231, pp.141~146 (2014)
- Callanan DG, "Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema", Ophthalmology, 120, pp.1843~1851 (2013)
- Haller JA, "Randomized controlled trial of an intravitreous dexamethasone drug delivery system in patients with diabetic macular edema", Arch Ophthalmol, 128, pp.289~296 (2010)
- Rishi P, "Short-term results of intravitreal dexamethasone implant (OZURDEX(®)) in treatment of recalcitrant diabetic macular edema: a case series", Oman J Ophthalmol, 5, pp.79~82 (2012)
- Badala F, "The treatment of branch retinal vein occlusion with bevacizumab", Curr Opin Ophthalmol, 19, pp.234~238 (2008)