Safety and long-term efficacy of repeated dexamethasone intravitreal implants for the treatment of cystoid macular edema secondary to retinal vein occlusion with or without a switch to anti-VEGF agents: a 3-year experience

Autor: Laurent Kodjikian, Clémence Deschasse, Catherine Creuzot-Garcher, Corinne Dot, Julie Blanc, Alain-Marie Bron
Přispěvatelé: Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL), Hop Instruct Armees Desgenettes, Partenaires INRAE, Centre des Sciences du Goût et de l'Alimentation [Dijon] (CSGA), Institut National de la Recherche Agronomique (INRA)-Université de Bourgogne (UB)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Centre National de la Recherche Scientifique (CNRS), Department of Ophthalmology
Rok vydání: 2018
Předmět:
Male
Vascular Endothelial Growth Factor A
Time Factors
Visual acuity
genetic structures
Visual Acuity
030204 cardiovascular system & hematology
0302 clinical medicine
Central retinal vein occlusion
Interquartile range
Aged
80 and over
Drug Implants
education.field_of_study
Drug Substitution
intravitreal injection
Middle Aged
Sensory Systems
Treatment Outcome
retinal vein occlusion
Intravitreal Injections
Drug Therapy
Combination
Female
medicine.symptom
Tomography
Optical Coherence
medicine.drug
medicine.medical_specialty
Population
dexamethasone
03 medical and health sciences
Cellular and Molecular Neuroscience
Ophthalmology
medicine
Humans
[SDV.MHEP.OS]Life Sciences [q-bio]/Human health and pathology/Sensory Organs
education
Glucocorticoids
Macular edema
Dexamethasone
Aged
Retrospective Studies
macular edema
business.industry
medicine.disease
eye diseases
030221 ophthalmology & optometry
Branch retinal vein occlusion
Implant
business
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Follow-Up Studies
Zdroj: Graefe's Archive for Clinical and Experimental Ophthalmology
Graefe's Archive for Clinical and Experimental Ophthalmology, Springer Verlag, 2018, pp.1-8. ⟨10.1007/s00417-018-4016-7⟩
ISSN: 1435-702X
0721-832X
DOI: 10.1007/s00417-018-4016-7
Popis: Article de 8 p.; PURPOSE: To evaluate the safety and efficacy of repeated dexamethasone intravitreal implants (DEX implants) over 3 years in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). METHODS: We conducted a 3-year, retrospective, multicenter study that included adult patients with ME secondary to BRVO or CRVO treated with first-line DEX implants. Patients were divided into two different subgroups: patients who received DEX implant injections only (group 1) and those who received DEX implants first and then were switched to anti-VEGF agents (group 2). Primary endpoints were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 6 and month 36. Secondary endpoints included changes in both BCVA and CRT after each DEX implant and adverse events, particularly cataract extraction and elevated intraocular pressure (IOP). RESULTS: Sixty-six patients with a median [IQR (interquartile ratio)] age of 72 [65.0; 81.1] years were included (40.9% BRVO, 59.1% CRVO), who received a median of 5.0 [min, 1.0; max, 10.0] DEX implants over 3 years. Median [IQR] time to retreatment was 4.8 [4.2; 6.0] months. The median [IQR] improvements in BCVA from baseline until months 6 and 36 were respectively + 10.0 [0; + 20.0] letters (P = 0.040) and + 10.0 [- 8.7; + 20.0] letters (P = 0.364) in the whole population. In group 1, the results were similar, whereas in group 2, BCVA significantly increased at M36 compared with baseline (P = 0.003). The median [IQR] CRT reductions from baseline to months 6 and 36 were respectively - 227.5 [- 337.0; - 52.7] mum and - 224.0 [- 405.0; - 83.8] mum (P < 0.001) in the whole population. Results were similar in both groups. The most common adverse events were cataract extraction (70.4%) and elevated IOP (54.5%). No other serious local complications were observed. Treatment was switched to anti-VEGF agents in 16 (24.2%) patients. CONCLUSIONS: DEX implants are an effective treatment for BRVO and CRVO-associated ME over 3 years. It is a valid treatment even though complications remain frequent. However, functional efficacy seems to decrease with time and repeated injections.
Databáze: OpenAIRE
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