Five-year Results of a Randomized Trial with Open-label Extension of Triamcinolone Acetonide for Refractory Diabetic Macular Edema

Gillies, Mark C; Simpson, Judy M.; Gaston, Christine; Hunt, Grace; Ali, Haipha; Zhu, Meidong; Sutter, Florian

doi:10.1016/j.ophtha.2009.04.049

Cited by 98 publications

(68 citation statements)

References 10 publications

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“…The triamcinolone group demonstrated a significant gain in vision at 2 years at the expense of increased cataract formation and elevated intraocular pressure (IOP), both common adverse events in trials evaluating intravitreal steroids [53]. Similar results have been found in other studies comparing triamcinolone with laser therapy [54,55]. The DRCR.net Protocol I compared ranibizumab in combination with prompt or delayed laser therapy vs triamcinolone and prompt laser therapy vs laser therapy and sham injections in a total of 854 eyes [56].…”

Section: Anti-inflammatory Therapysupporting

confidence: 54%

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Bahrami

Zhu

Hong³

et al. 2016

Diabetologia

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Diabetic macular oedema (DMO) is the leading cause of vision loss in patients living with diabetes. DMO results from hyperglycaemia-induced activation of pathways that lead to oxidative stress and release of cytokines, impairing the inner and outer blood-retinal barriers. Improved understanding of the pathophysiological mechanisms leading to DMO have led to the development of effective therapies, including vitreoretinal surgery, laser photocoagulation, intravitreal anti-vascular endothelial growth factor drugs and corticosteroids. Advances in imaging, including fluorescein angiography and optical coherence tomography, have also enhanced diagnosis and management of the condition. Despite these advances, there remain patients who do not respond completely to therapy, reflecting the complex pathophysiology of DMO. These patients may be considered treatment-resistant. In this review, we summarise the pathophysiology of DMO, as well as the available treatments and their mechanism of action. Additionally, we focus on treatment-resistant disease and review the literature on potential options for managing this complication of diabetes.

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Section: Anti-inflammatory Therapysupporting

confidence: 54%

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Bahrami

Zhu

Hong³

et al. 2016

Diabetologia

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“…12 At 5 years, BCVA increase ≥5 letters was observed in 42% of those initially in the IVTA group and 32% in the original placebo group, but this difference was not statistically significant (p=0.4). Similarly, no significant difference between the groups in mean CMT reduction was observed at 5 years.…”

mentioning

confidence: 85%

An Evidence-based Approach to Using Intravitreal Steroids in the Management of Diabetic Macular Oedema

Öztürk¹,

Harris²,

Mehta³

2017

European Ophthalmic Review

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Diabetic macular oedema (DMO) is the leading cause of acquired visual loss in the working age population. The landscape for DMO treatment has changed significantly over the past decade. Macular laser has been reported to reduce the risk of moderate visual loss in seminal clinical trials from the 1980s, but relatively few patients achieved visual gain. With the advent of intravitreal pharmacotherapy it is now possible to achieve visual gains in the majority of patients. Intravitreal anti-vascular endothelial growth factor (VEGF) agents are now a first-line treatment option in centre-involving DMO. This review assesses clinical trial and more recent real-world evidence to guide clinicians as to when intravitreal steroids should be considered in the management of DMO. In particular, intravitreal steroids can be considered in pseudophakic patients, or those due to undergo cataract surgery, in patients unable to attend for regular intravitreal procedures, and non-responders to intravitreal anti-VEGF therapy. Assessing clinical trial data, the dexamethasone implant appears to have a more predictable intraocular rise profile than triamcinolone or fluocinolone with a lower requirement for incisional glaucoma surgery. There is a need for consensus regarding real-world outcome measures for intravitreal steroids in the management of DMO to allow easier comparison across studies.

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“…The earlier use of triamcinolone did not reduce the need for retreatment between the third and fifth years. By 5 years, 9% of the initial triamcinolone group had required trabeculectomy and 71% had undergone cataract surgery [Gillies et al 2009]. …”

Section: Triamcinolonementioning

confidence: 99%

Perspective on the role of Ozurdex (dexamethasone intravitreal implant) in the management of diabetic macular oedema

Mehta

Gillies

Fraser‐Bell

2015

Therapeutic Advances in Chronic Disease

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Diabetic macular oedema (DMO) is the most common cause of visual loss in the working age population. Intravitreal therapy has superseded macular laser as the firstline treatment for the management of centre-involving DMO in most patients. As well as the proven efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents, phase II and III clinical trials of Ozurdex intravitreal dexamethasone implants for DMO have also demonstrated a mean increase in visual acuity and corresponding mean reduction in central macular thickness, particularly in pseudophakic eyes. Because of the risk of visual loss from cataract, glaucoma and intraocular infection with the use of intravitreal steroids, Ozurdex tends to be reserved for use in patients unresponsive to anti-VEGF therapy for centre-involving DMO. Situations where Ozurdex may be considered a first-line treatment option for eyes with centre-involving DMO include pseudophakia, impending cataract surgery, or in the context of a recent arterial thromboembolic event. Because of their stable pharmacokinetics, Ozurdex slow-release implants may also be considered in vitrectomized eyes.

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Five-year Results of a Randomized Trial with Open-label Extension of Triamcinolone Acetonide for Refractory Diabetic Macular Edema

Cited by 98 publications

References 10 publications

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

Diabetic macular oedema: pathophysiology, management challenges and treatment resistance

An Evidence-based Approach to Using Intravitreal Steroids in the Management of Diabetic Macular Oedema

Perspective on the role of Ozurdex (dexamethasone intravitreal implant) in the management of diabetic macular oedema

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