Epiretinal Membrane Vitrectomy With and Without Intraoperative Intravitreal Dexamethasone Implant: A Systematic Review With Meta-Analysis

Abstract

Purpose: To evaluate the efficacy of vitrectomy combined with intravitreal dexamethasone implant vs. vitrectomy without the implant in patients with epiretinal membrane (ERM) by conducting a systematic review and meta-analysis.Methods: Studies that compared ERM vitrectomy with and without intraoperative dexamethasone implant with a follow-up ≥3 months were included. The primary outcome was mean best corrected visual acuity (BCVA) change between eyes undergoing ERM vitrectomy combined with dexamethasone implant (DEX group) and eyes undergoing ERM vitrectomy alone (control group) at 3 months. Secondary outcomes included mean BCVA change at 6 months and mean optical coherence tomography central macular thickness (CMT) change at both 3-months and 6-months follow-up. Mean differences (MDs) with their 95% confidence interval (95%CI) were calculated. Meta-analyses were based either on random effect model or fixed effect model according to heterogeneity.Results: Four studies were included. At 3 months, ERM vitrectomy combined with dexamethasone implant yielded a greater visual gain compared to vitrectomy alone (MD = 9.7; 95%CI = 2.6–16.8; p = 0.01). However, significant heterogeneity was found. A sensitivity analysis excluding the only retrospective non-randomized study confirmed a greater visual gain in the DEX group (MD = 7.1; 95%CI = 2.7–11.6; p < 0.01), with no heterogeneity. At 6 months, a non-significant but borderline difference in visual gain was shown between in the two groups (MD = 5.1; 95%CI = −0.3–10.5; p = 0.06), with no heterogeneity. Three-month analysis of CMT revealed a greater reduction in the DEX group (MD = −80.2; 95%CI =−149.1–11.2; p = 0.02), but with significant heterogeneity. A sensitivity analysis excluding the only retrospective non-randomized study allowed to reduce heterogeneity, but no difference in 3-months CMT change was found between the two groups (MD = −50.0; 95%CI = −106.2–6.2; p = 0.08). At 6 months, no difference in CMT change was shown between the two groups (MD = −48.5; 95%CI = −120.5–23.5; p = 0.19), with significant heterogeneity.Conclusions: Intraoperative dexamethasone implant in eyes undergoing vitrectomy for ERM provided a better visual outcome at 3 months compared to ERM vitrectomy without the implant, with limited evidence of better anatomic outcome as well. Further studies are needed to ascertain whether dexamethasone implant would ensure a significant long-term visual benefit as a result of a faster reduction of macular thickening.

Efficacy and Safety of Subthreshold Micropulse Yellow Laser for Persistent Diabetic Macular Edema After Vitrectomy: A Pilot Study

“…Conversely, the main advantage of the treatment with a micropulse laser is represented by its safety profile. Indeed, as already demonstrated by previous studies, it does not cause any chorioretinal foveal damage ( Midena et al, 2019 ; Elfalah et al, 2021 ; Fallico et al, 2021 ). In our study no modifications on autofluorescence or on FFA have been detected, supporting its safety even when used on the macular area ( Gawecki, 2019 ; Midena et al, 2021 ).…”

“…PPV could decrease DME through multiple mechanisms, including the release of tractional elements, improvement of intravitreal oxygenation, removal of pathological cytokines from the vitreous cavity, and acceleration of the half-life of intravitreal cytokines ( Flikier et al, 2019 ). However, despite a functional improvement and a reduction of macular thickening, DME may not resolve completely up to 55% of treated eyes ( Gunay and Erdogan, 2021 ) or reoccur up to 22% of patients after PPV ( Pessoa et al, 2019 ; Fallico et al, 2021 ). The persistence or recurrence of macular edema can be explained by the vascular and inflammatory nature of the disease.…”

“…Currently, there are no guidelines for the treatment of persistent DME after PPV, although IVTs of anti-VEGF, corticosteroids such as DEX ( Reibaldi et al, 2012 ; Bonfiglio et al, 2017 ; Fallico et al, 2021 ) or FA ( Meireles et al, 2017 ; Ong et al, 2021 ) implants have been proved to be effective. It should be considered that the efficacy of IVTs of anti-VEGF drugs in vitrectomized eyes is significantly reduced due to the increased clearance of the drug in the vitreous cavity ( Edington et al, 2017 ), while DEX and FA implants have shown strong anti-inflammatory activity and good efficacy due to similar clearance in vitrectomized and non-vitrectomized eyes ( Edington et al, 2017 ; Augustin et al, 2021 ).…”

Deep learning-based postoperative visual acuity prediction in idiopathic epiretinal membrane

“…For visually signi cant iERM patients, a previous study demonstrated intravitreal injection of 0.7 mg dexamethasone (Ozurdex®) at the conclusion of vitrectomy could signi cantly decrease macular edema and improve visual outcomes [32]. When the prognosis assessment after vitrectomy and membrane peeling is unfavorable, more advanced surgical techniques, such as intraoperative intravitreal dexamethasone implant [33], can be recommended to patients.…”

New Therapeutic Perspectives in the Treatment of Uveal Melanoma: A Systematic Review

“…However, the possibility of using effective drug delivery still represents a big challenge, and further studies are needed to establish whether this new technology could help in the fight against uveal melanoma [100][101][102][103].…”