A Comparison of Intraoperative Dexamethasone Intravitreal Implant and Triamcinolone Acetonide Used During Vitrectomy and Epiretinal Membrane Peeling: A Case Control Study

Yonekawa, Yoshihiro; Mammo, Danny A.; Thomas, Benjamin; Wolfe, Jeremy D.; Hassan, Tarek

doi:10.3928/23258160-20160229-05

Cited by 15 publications

(16 citation statements)

References 31 publications

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“…compared the visual and anatomic outcomes of idiopathic ERM eyes undergoing PPV with intraoperative use of either intravitreal dexamethasone implants or IVTA found no differences between the two treatments. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

“…Besides the study by Yonekawa et al . [ 11 ] only one other study by Guidi et al . investigated the effects of simultaneous injections of dexamethasone implants during PPVs for ERM.…”

Section: Discussionmentioning

confidence: 99%

“…[ 3 4 ] However, improvement in VA and macular thickness are often slow with only 70% of operated patients experiencing a significant improvement in vision in the operated eye over 6 months to 1 year. [ 5 6 7 ] Various studies have reported the differing efficacies of concomitant use of steroids—intravitreal triamcinolone acetonide (IVTA) and dexamethasone—to control chronic inflammation in the hope of improving VA.[ 8 9 10 11 ] While most of these studies have reported improvements in VA and CRT at 6 months post-surgery, none have investigated the early effects (1-month post-surgery) of steroid therapy.…”

mentioning

confidence: 99%

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Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane

Sane

Ali

Kuppermann

et al. 2020

Indian J Ophthalmol

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Purpose: To investigate if use of adjunctive intravitreal dexamethasone implant during pars plana vitrectomy (PPV) leads to faster visual recovery and reduction of retinal thickness in idiopathic epiretinal membrane (ERM). Methods: In this non-randomized, comparative, interventional study 30 eyes (from 30 patients with idiopathic ERM) were enrolled. In the control group ( n = 15), patients underwent 25-G pars plana vitrectomy (PPV) and ERM peeling. In the study group ( n = 15), each patient underwent the same procedure as those in the control group, and also received an additional dexamethasone implant. Primary outcome after treatment was mean gain in best corrected visual acuity (BCVA), and secondary outcome was reduction in central retinal thickness (CRT). Data were analyzed using Fisher's exact test, Wilcoxon rank sum test, and two-sample t -test. Results: The mean gain in BCVA (logMAR) from baseline at 1-month follow-up was significantly higher in the study group (median = - 0.3, IQR = - 0.4, - 0.1) than in the control group (median = 0, IQR = - 0.1, 0.3; P < 0.008). However, no significant difference in mean gain in BCVA between the two groups was detectable at the 6-month follow-up ( P < 0.55). At 1-month follow-up, one and seven patients in the control and study groups gained ≥15 letters of BCVA ( P < 0.05), respectively. The mean reductions in CRT at the 1-month follow-up were significantly higher in the study group than in the control group (Mean = - 60 μm, SD = 92.1; P < 0.014; 95% CI = 19.75–156.54). The difference in mean reduction of CRT at 6 months was not significant ( P < 0.24). Conclusion: Adjunctive dexamethasone implant can aid faster visual recovery after PPV in idiopathic ERM, although the implants do not affect long-term gains in visual acuity.

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Section: Discussionmentioning

confidence: 99%

“…Besides the study by Yonekawa et al . [ 11 ] only one other study by Guidi et al . investigated the effects of simultaneous injections of dexamethasone implants during PPVs for ERM.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane

Sane

Ali

Kuppermann

et al. 2020

Indian J Ophthalmol

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“…Noticeably, triamcinolone has been found to last approximately 113 days in vitrectomized eyes [15], while intravitreal dexamethasone implant has been shown to be 6 times more effective than triamcinolone [24]. However, Yonekawa et al [26] reported a similar trend between triamcinolone and intravitreal dexamethasone implant regarding anatomical and functional outcomes in patients affected by macular pucker and treated with PPV, although this was a retrospective study without a control group. On the other hand, in a case series of 5 patients, Taney et al [20] showed that intravitreal dexamethasone implant was beneficial for persistent macular edema after PPV for ERM, although repeated injections were needed.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Macular Edema after Pars Plana Vitrectomy for Idiopathic Epiretinal Membrane Using Intravitreal Dexamethasone Implant: Long-Term Outcomes

et al. 2019

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Purpose: The aim of this study was to investigate the efficacy and safety of intravitreal dexamethasone implant for the treatment of macular edema after pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal. Methods: This prospective study included 27 patients who were diagnosed with macular edema after PPV for ERM removal and who were treated with either intravitreal dexamethasone implant (n = 15) or were observed without intervention (n = 12). Changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were assessed 1, 6, and 12 months after treatment. Results: Patients treated with intravitreal dexamethasone implant showed significant improvement in BCVA and reduction in CRT at months 1, 6, and 12 after treatment, while patients in the control group showed improvement that did not reach statistical significance. The two groups differed significantly in terms of BCVA and CRT at all time points of the follow-up period, in favor of the dexamethasone implant group. Eighty percent of the patients treated with intravitreal dexamethasone needed only one implant until month 12, while no serious adverse events were noticed in any group. Conclusions: Intravitreal dexamethasone implant was found to be effective and safe for the treatment of macular edema after PPV for ERM removal.

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“…However, both studies were limited by a relatively small sample size and lack of control group. Yonekawa et al reported that both dexamethasone intravitreal implant and triamcinolone acetonide are effective in improving central macular thickness and visual acuity while the intraoperative dexamethasone intravitreal implant or triamcinolone acetonide is used after vitrectomy and membrane peeling [40]. However, recently, Guidi et al reported that the intraoperative sustained-release dexamethasone implant did not result in a significant change in macular thickness and volume compared with the vitrectomy alone without dexamethasone implant at 6-month follow-up [42].…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Intravitreal Implant (Ozurdex) for Long-Term Macular Edema after Epiretinal Membrane Peeling Surgery

Chang

Liu

Kao

et al. 2018

Journal of Ophthalmology

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Purpose To investigate the functional and anatomical outcome of the 0.7 mg dexamethasone (Ozurdex) intravitreal implant (IVD) in eyes with long-term macular edema after macular epiretinal membrane removal. Methods We enrolled 40 eyes with persistent macular edema at least 12 months after epiretinal membrane removal. Twenty eyes in the IVD group received IVD and the other 20 eyes were in the control group. The main outcome measures were change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results For eyes in the IVD group, the mean BCVA improved by 3.45 lines to 0.47 logMAR one month after IVD. However, the mean BCVA improved by only 0.14 lines to 0.74 logMAR at the same time in eyes in the control group. Six months later, the mean BCVA improved to 0.31 and 0.74 logMAR in the IVD and control groups, respectively. In the IVD group, the mean CFT decreased rapidly by 116.8 μm to 333.9 μm one month after IVD. Thereafter the CFT decreased at a slower pace. In the control group, the CFT remained static during the follow-up period. However, in the IVD group, 6 months after IVD, the CFT seemed to have a tendency to increase. Conclusions Single IVD could significantly decrease macular edema and improve visual outcome for eyes with persistent long-term macular edema after macular ERM removal and the effect can be sustained as long as 6 months after the initial injection. However, in order to maintain the visual and anatomical outcome, repeat IVD might be considered if macular edema recurs.

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A Comparison of Intraoperative Dexamethasone Intravitreal Implant and Triamcinolone Acetonide Used During Vitrectomy and Epiretinal Membrane Peeling: A Case Control Study

Abstract: Both intraoperative DEX and IVTA, used at the completion of vitrectomy and at membrane peeling for epiretinal membrane, were effective in improving visual and anatomic outcomes, though there was a trend toward greater significance with IVTA.

Cited by 15 publications

References 31 publications

Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane

Comparative study of pars plana vitrectomy with or without intravitreal dexamethasone implant for idiopathic epiretinal membrane

Treatment of Macular Edema after Pars Plana Vitrectomy for Idiopathic Epiretinal Membrane Using Intravitreal Dexamethasone Implant: Long-Term Outcomes

Dexamethasone Intravitreal Implant (Ozurdex) for Long-Term Macular Edema after Epiretinal Membrane Peeling Surgery

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