Rapid response to dexamethasone intravitreal implant in diabetic macular edema

Abstract

Purpose:

To evaluate the early effects of dexamethasone (DEX) intravitreal implants in patients with diabetic macular edema (DME).

Methods:

This was a prospective, single-arm, interventional clinical series. Eighteen patients (18 eyes) with chronic/recalcitrant or naive DME were included. Patients underwent single DEX intravitreal implant. Clinical assessments, including ophthalmologic examination, central retinal thickness (CRT) measurement by spectral-domain optical coherence tomography (SD-OCT) scan, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were carried out at baseline, 1-3 hours, and then 3, 7, and 30 days after treatment. The main outcome was change in CRT on SD-OCT, while secondary outcome measures included visual acuity (VA) and changes in IOP following implant.

Results:

Mean CRT significantly decreased from 565 ± 171 µm at baseline to 310 ± 89 µm at end of follow-up (p<0.001), with reduction becoming evident 1-3 hours after injection. Mean BCVA also significantly improved 7 days and 30 days after treatment up to 0.14 logMAR (p<0.05). All patients had a controlled IOP after the injection with only 1/18 eyes having a transient increase in IOP during follow-up.

Conclusions:

This is the first study showing very early effects of DEX implants on CRT reduction and VA improvement in DME.

Keywords

Dexamethasone intravitreal implant Diabetic macular edema Diabetic retinopathy Inflammation

Get full access to this article

View all access options for this article.

References

Ciulla

Amador

Zinman

. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003;26(9):2653-2664.

Resnikoff

Pascolini

Etyaale

et al . Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82(11):844-851.

Kocur

Resnikoff

. Visual impairment and blindness in Europe and their prevention. Br J Ophthalmol. 2002;86(7):716-722.

Early Treatment Diabetic Retinopathy Study research group. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985;103(12):1796-1806.

Aiello

Avery

Arrigg

et al . Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994;331(22):1480-1487.

Avery

. Regression of retinal and iris neovascularization after intravitreal bevacizumab (Avastin) treatment. Retina. 2006;26(3):352-354.

Nguyen

Tatlipinar

Shah

et al . Vascular endothelial growth factor is a critical stimulus for diabetic macular edema. Am J Ophthalmol. 2006;142(6):961-969.

Al Dhibi

Arevalo

. Clinical trials on corticosteroids for diabetic macular edema. World J Diabetes. 2013;4(6):295-302.

Funatsu

Noma

Mimura

Eguchi

Hori

. Association of vitreous inflammatory factors with diabetic macular edema. Ophthalmology. 2009;116(1):73-79.

10.

Antcliff

Marshall

. The pathogenesis of edema in diabetic maculopathy. Semin Ophthalmol. 1999;14(4):223-232.

11.

Wang

Elliott

Zhu

. Müller cell-derived VEGF is essential for diabetes-induced retinal inflammation and vascular leakage. Diabetes. 2010;59(9):2297-2305.

12.

Tamura

Miyamoto

Kiryu

et al . Intravitreal injection of corticosteroid attenuates leukostasis and vascular leakage in experimental diabetic retina. Invest Ophthalmol Vis Sci. 2005;46(4):1440-1444.

13.

Wang

Gao

Guo

. Dexamethasone inhibits leukocyte accumulation and vascular permeability in retina of streptozotocin-induced diabetic rats via reducing vascular endothelial growth factor and intercellular adhesion molecule-1 expression. Biol Pharm Bull. 2008;31(8):1541-1546.

14.

Antonetti

Wolpert

DeMaio

Harhaj

Scaduto

Jr . Hydrocortisone decreases retinal endothelial cell water and solute flux coincident with increased content and decreased phosphorylation of occludin. J Neurochem. 2002;80(4):667-677.

15.

Gillies

Sutter

Simpson

Larsson

Ali

Zhu

. Intravitreal triamcinolone for refractory diabetic macular edema: two-year results of a double-masked, placebo-controlled, randomized clinical trial. Ophthalmology. 2006;113(9):1533-1538.

16.

Gillies

Simpson

Gaston

et al . Five-year results of a randomized trial with open-label extension of triamcinolone acetonide for refractory diabetic macular edema. Ophthalmology. 2009;116(11):2182-2187.

17.

Gillies

McAllister

Zhu

et al . Intravitreal triamcinolone prior to laser treatment of diabetic macular edema: 24-month results of a randomized controlled trial. Ophthalmology. 2011;118(5):866-872.

18.

Haller

Kuppermann

Blumenkranz

et al . Dexamethasone DDS Phase II Study Group. Randomized controlled trial of an intravitreous dexamethasone drug delivery system in patients with diabetic macular edema. Arch Ophthalmol. 2010;128(3):289-296.

19.

Boyer

Faber

Gupta

et al . Ozurdex CHAMPLAIN Study Group. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina. 2011;31(5):915-923.

20.

Augustin

Kuppermann

Lanzetta

et al . Ozurdex MEAD Study Group. Dexamethasone intravitreal implant in previously treated patients with diabetic macular edema: subgroup analysis of the MEAD study. BMC Ophthalmol. 2015;15:150.

21.

Callanan

Gupta

Boyer

et al . Ozurdex PLACID Study Group. Dexamethasone intravitreal implant in combination with laser photocoagulation for the treatment of diffuse diabetic macular edema. Ophthalmology. 2013;120(9):1843-1851.

22.

Escobar-Barranco

Pina-Marín

Fernández-Bonet

. Dexamethasone implants in patients with naïve or refractory diffuse diabetic macular edema. Ophthalmologica. 2015;233(3-4):176-185.

23.

Haller

Bandello

Belfort

Jr et al . OZURDEX GENEVA Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117(6):1134-1146.e3.

24.

Boyer

Yoon

Belfort

Jr et al . Ozurdex MEAD Study Group. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121(10):1904-1914.

25.

Gillies

Lim

Campain

et al . A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology. 2014;121(12):2473-2481.

26.

Guigou

Hajjar

Parrat

et al . Retrospective study of treatment with OZURDEX in diabetic macular edema: the MOZART study. J Fr Ophtalmol. 2014;37(6):480-485.

27.

Haller

Bandello

Belfort

Jr et al . Ozurdex GENEVA Study Group. Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011;118(12):2453-2460.

28.

Veritti

Macor

Lanzetta

. Early effects of dexamethasone implant on macular morphology and visual function in patients with macular edema secondary to retinal vein occlusion. Ophthalmologica. 2014;232(3):144-148.

29.

Uckermann

Kutzera

Wolf

et al . The glucocorticoid triamcinolone acetonide inhibits osmotic swelling of retinal glial cells via stimulation of endogenous adenosine signaling. J Pharmacol Exp Ther. 2005;315(3):1036-1045.