First Author: C.Kalogeropoulos GREECE
Co Author(s): I. Lamprinakis M. Moschos A. Karekla D. Kalogeropoulos A. Geka G. Pantelopoulou
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To evaluate the safety and effectiveness of dexamethasone intravitreal implant in eyes of patients with secondary macular edema due to retinal vein occlusion (RVO), diabetic macular edema (DME) and non-infectious uveitis.
Patients recruited from 4 centres in Greece: 1) Department of Ophthalmology, University of Ioannina, 2) Department of Ophthalmology, “Evangelismos” General Hospital in Athens, 3) 1st Department of Ophthalmology, University of Athens, 4) Olympion General Clinic, Patra.
A multicentre observational study was carried out in order to detect: 1) The safety of an interventional procedure concerning dexamethasone intravitreal implant 0.7mgr with regard to intraoperative and postoperative complications and side effects (i.e. cataract formation, increase of intraocular pressure) and 2) The effectiveness of this interventional pharmacotherapy concerning the outcome of visual acuity and the decrease of macular edema in eyes with either diabetic macular edema or secondary macular edema after RVO (CRVO: central retinal vein occlusion and BRVO: branch retinal vein occlusion) and the outcome of visual acuity in eyes with intermediate or posterior uveitis and also the effectiveness on the intraocular inflammation and uveitic macular edema in those eyes. The effectiveness of dexamethasone intravitreal implant was evaluated in a midterm basis (3-6 months) and in a long term basis (more than 6 months up to 1 year). Main measures were visual acuity measurements and central retinal thickness (CRT) before implantation, and monthly up to 12 months, and also the activity of uveitis using the vitreous haze grading scale.
Only 60 patients (66 eyes) with a complete follow up and data were finally included in the study. In 10 eyes the intravitreal treatment was administered for secondary macular edema after CRVO and in 14 eyes after BRVO. Concerning DME dexamethasone implant was used in 29 eyes. Dexamethasone implant was also used in 13 eyes with noninfectious intermediate or posterior uveitis. In a total of 29 eyes intravitreal implant was used twice during the period of 12 months and that because 4 months after the first implantation a recurrence of macular edema was observed along with a decrease of visual acuity. However, in uveitis, midterm beneficial effects were observed with regard of vitreous inflammation activity. Cataract evolution attributed to implant was obvious in 3 younger patients and in some patients with age more than sixty years an acceleration of cataract evolution was evident. Endophthalmitis or retinal detachment was not observed. Temporary increase of intraocular pressure was observed at 2 months in 28 eyes and prolonged in 12 eyes but only in 3 cases a surgical procedure was needed for the management of glaucoma. Concerning the cases with RVO and DME adjunctive treatment was necessary in about of 2/3 of eyes.
Even though dexamethasone intravitreal implant 0.7mgr is generally a safe treatment, its effectiveness as monotherapy in eyes with RVO, DME and noninfectious intermediate or posterior uveitis is quite limited. However, its use in cases of uveitis has a beneficial effect in the outcome regarding visual acuity and preservation of macula architecture and also in the protection from cumulative damages due to inflammation by reducing the period of high grade activity of uveitis. In addition, in cases of DME with multiple hard exudates a decrease of those exudates clearly should be attributed to the dexamethasone implant action, resulting in a better visual function. For both, either DME or secondary macular edema due to RVO intravitreal anti-VEGF (vascular endothelial growth factor) and/or laser photocoagulation is necessary. Finally, in a fair number of cases dexamethasone implant intravitreal intervention must be repeated even before 6 months after the initial implantation.