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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.
Graefes Arch Clin Exp Ophthalmol. 2018 Aug; 256(8):1441-1448.GA

Abstract

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] μm and - 224.0 [- 405.0; - 83.8] μm (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.

Authors+Show Affiliations

Department of Ophthalmology, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France.Department of Ophthalmology, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France.La Croix-Rousse Hospital, University Hospital of Lyon, Lyon, France.Department of Ophthalmology, Desgenettes Military Hospital, Lyon, France.Department of Ophthalmology, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France. alain.bron@chu-dijon.fr. Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Burgundy, Dijon, France. alain.bron@chu-dijon.fr.Department of Ophthalmology, University Hospital, 14 rue Paul Gaffarel, 21079, Dijon, France. Eye and Nutrition Research Group, CSGA, UMR1324 INRA, 6265 CNRS, Burgundy, Dijon, France.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

29855706

Citation

Blanc, Julie, et al. "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." Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, vol. 256, no. 8, 2018, pp. 1441-1448.
Blanc J, Deschasse C, Kodjikian L, et al. 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. Graefes Arch Clin Exp Ophthalmol. 2018;256(8):1441-1448.
Blanc, J., Deschasse, C., Kodjikian, L., Dot, C., Bron, A. M., & Creuzot-Garcher, C. (2018). 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. Graefe's Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie, 256(8), 1441-1448. https://doi.org/10.1007/s00417-018-4016-7
Blanc J, et al. 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. Graefes Arch Clin Exp Ophthalmol. 2018;256(8):1441-1448. PubMed PMID: 29855706.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Blanc,Julie, AU - Deschasse,Clémence, AU - Kodjikian,Laurent, AU - Dot,Corinne, AU - Bron,Alain-Marie, AU - Creuzot-Garcher,Catherine, Y1 - 2018/05/31/ PY - 2018/03/02/received PY - 2018/05/21/accepted PY - 2018/04/27/revised PY - 2018/6/2/pubmed PY - 2018/7/24/medline PY - 2018/6/2/entrez KW - Dexamethasone KW - Intravitreal injection KW - Macular edema KW - Retinal vein occlusion SP - 1441 EP - 1448 JF - Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie JO - Graefes Arch Clin Exp Ophthalmol VL - 256 IS - 8 N2 - 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] μm and - 224.0 [- 405.0; - 83.8] μm (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. SN - 1435-702X UR - https://www.unboundmedicine.com/medline/citation/29855706/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_ L2 - https://dx.doi.org/10.1007/s00417-018-4016-7 DB - PRIME DP - Unbound Medicine ER -