Intravitreal Injection of Ranibizumab During Cataract Surgery in Patients With Diabetic Macular Edema

Rauen, Paulo I.; Ribeiro, J.A.; Almeida, Felipe P.; Messias, André; Jorge, Rodrigo

doi:10.1097/iae.0b013e31824bebb8

Cited by 27 publications

(22 citation statements)

References 25 publications

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“…Although one prospective study found a benefit with BVB treatment with reduced CMT and improved BCVA in comparison to controls at up to three months post operatively, 36 two further prospective studies found that concurrent treatment with BVB or ranibizumab only prevented the worsening of DME post operatively in comparison to controls, with the actual CMT largely remaining unchanged from baseline, indicating that the anti-VEGF treatment failed to reduce the severity of the pre-existing DME post operatively. 19,37 Our pilot data supports these findings, as the CMT in our BVB group tended to increase slightly over the 6 month post-operative period, rather than improve, despite multiple re-treatments.…”

Section: Discussionsupporting

confidence: 71%

Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery – preliminary 6 month results

Morrison

Constantinou

Rogers

et al. 2016

Clinical Exper Ophthalmology

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Background: To compare visual and anatomical outcomes between intravitreous bevacizumab (BVB, Avastin) and triamcinolone (TA, Triesence) when administered at the time of cataract surgery in patients with diabetic macular oedema (DME).Design: Prospective, single-masked, randomized clinical trial at The Royal Victorian Eye and Ear Hospital, Melbourne.Participants: Patients with clinically significant cataract and either centre-involving DME or DME treated within the previous 24 months.Methods: Participants were randomized 1:1 to receive intravitreous BVB 1.25 mg or TA 4 mg during cataract surgery, and at subsequent review if required over 6 months.Main Outcome Measures: Change in central macular thickness (CMT) and best corrected visual acuity at 6 months.Results: Forty-one patients (mean age 66.4 years, 73.2% male) were recruited. Visual acuity and CMT were similar between groups at baseline (P > 0.2).After six months, both groups gained vision (mean +21.4 letters in TA group P < 0.0001, +12.5 letters in BVB, P = 0.002), with no significant difference between groups (P = 0.085). In addition, 60.9% of eyes receiving TA achieved a VA of ≥6/12 compared to 73.3% in the BVB group (P = 0.501). However, only TA was associated with a sustained reduction in CMT (À43.8-μm reduction TA vs. +37.3-μm increase BVB, P = 0.006 over 6 months). Following surgery, additional injections were required in 70.6% of participants in the BVB group, compared to 16.7% in the TA group (P < 0.0001). Three patients in the TA group experienced a rise of IOP over 21 mmHg (12.5%) during the 6-month follow-up; BVB had no cases (P = 0.130). There were no cases of endophthalmitis in either group.Conclusions: When administered at the time of cataract surgery in patients with DME, at 6 months both

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Section: Discussionsupporting

confidence: 71%

Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery – preliminary 6 month results

Morrison

Constantinou

Rogers

et al. 2016

Clinical Exper Ophthalmology

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“…The only factor found to be associated with visual outcome was the timing of intravitreal injections, with those receiving injections either at the time of surgery or within the 4 weeks preceding surgery being more likely to have a gain in VA, which is consistent with previous reports 8,10,11 . Although the vast majority of patients in this study received anti‐VEGF treatment, there was a slightly higher usage of corticosteroids in the cataract surgery group (8% vs 3%), which may reflect the increased rate of cataract formation from corticosteroid use, or a conscious switch to corticosteroids due to their longer lasting effect on DMO in this setting 11 .…”

supporting

confidence: 86%

“…Although, there have been advances in the treatment of DMO, the most efficacious treatment regime in the perioperative setting is still yet to be determined. Reports of the use of intravitreal anti‐VEGF agents either at the time of surgery or in the weeks preceding surgery generally show it to be an effective treatment in stabilizing or improving central subfoveal thickness (CST) and VA 8‐10 . Similarly, intravitreal corticosteroids have been shown to be effective in this clinical scenario 11,12 .…”

mentioning

confidence: 99%

Dealing with co‐existent cataract and diabetic macular oedema: An increasingly common conundrum now solved?

Goh

2020

Clinical Exper Ophthalmology

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“…We hypothesize that intravitreal triamcinolone administration may play a positive role in controlling the acute inflammatory factors that are released following cataract removal. The increase in the CST in the group of patients injected intraoperatively with bevacizumab is consistent with the results achieved by Rauen et al (17) , who did not find a positive anatomical response with intraoperative ranibizumab, in contrast to other similar studies (15)(16)(17)(18)(19) . These results may be related to the high percentage of patients (84.7%) previously treated for DME in this group, as it is known that the presence of DME before the cataract removal is a risk factor for developing macular thickening with this surgical procedure.…”

Section: Discussioncontrasting

confidence: 48%

“…Intravitreal anti-VEGF (bevacizumab or ranibizumab) (15)(16)(17)(18)(19)(20) and intravitreal steroids (triamcinolone acetonide or dexamethasone implant) (20)(21)(22) have been reported to achieve positive anatomical and functional results when injected immediately after the surgical procedure. More recently, the efficacy of topical non-steroidal anti-inflammatory drugs has also been reported (23) .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of cataract surgery in diabetic patients: results of the Pan American Collaborative Retina Study Group

Gallego-Pinazo¹,

Dolz-Marco²,

Berrocal³

et al. 2014

Arquivos Brasileiros De Oftalmologia

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Purpose: This study was designed to evaluate the visual and anatomical out co mes after cataract surgery in diabetic patients with different intraoperative therapeutic strategies. Methods:The research design comprised of a multicentric, retrospective, interventional study conducted at 6 centers in Argentina, Brazil, Costa Rica, Puerto Rico, Spain, and Venezuela. We included 138 diabetic patients with at least 6-month follow-up following phacoemulsification and intraocular lens implantation. Best-corrected visual acuity (BCVA) and central subfield thickness were collected at baseline and at 1-, 2-, 3-, and 6-month follow-up. Of these, 42 cases were not treated with any intraoperative coadjuvant medication (Group 1), 59 patients received intraoperative bevacizumab (Group 2) and 37 patients received intraoperative triamcinolone (4 mg/0.1 ml) (Group 3). Results: The mean logMAR [± standard deviation (SD)] BCVA improved from 0.82 (± 0.43) at baseline, to 0.14 (± 0.23) at 6-month follow-up (p<0.001) in Group 1; from 0.80 (± 0.48) to 0.54 (± 0.45) (p<0.001) in Group 2; and from 1.0 (± 0.40) to 0.46 (± 0.34) (p<0.001) in Group 3. The mean central subfield thickness increased from 263.57 µm (± 35.7) at baseline to 274.57 µm (± 48.7) at 6-month follow-up (p=0.088) in Group 1; from 316.02 µm (± 100.4) to 339.56 µm (± 145.3) (p=0.184) in Group 2; and from 259.18 µm (± 97.9) to 282.21 µm (± 87.24) (p=0.044) in Group 3. Conclusions: Diabetic patients may significantly benefit from cataract surgery. This study provides evidence to support the use of intravitreal triamcinolone or bevacizumab at the time of cataract surgery in cases with pre-existent diabetic macular edema or moderate-severe non-proliferative diabetic retinopathy. (± 100,4), para 339,56 µm (± 145,3) (p=0,184) no Grupo 2; e de 259,18 µm (± 97,9), para 282,21 µm (±87,24) (p=0,044) cases of severe loss of vision, but diabetic macular edema (DME) is the most prevalent cause of moderate vision loss (2) . It is known that hyperglycemia causes damage to the retinal vascular endothelium, resulting in increased vascular permeability, exudation, and accumulation of extracellular fluid and proteins within the macula, hemorrhages, Keywords

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Intravitreal Injection of Ranibizumab During Cataract Surgery in Patients With Diabetic Macular Edema

Cited by 27 publications

References 25 publications

Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery – preliminary 6 month results

Diabetic Macular Edema at the time of Cataract Surgery trial: a prospective, randomized clinical trial of intravitreous bevacizumab versus triamcinolone in patients with diabetic macular oedema at the time of cataract surgery – preliminary 6 month results

Dealing with co‐existent cataract and diabetic macular oedema: An increasingly common conundrum now solved?

Outcomes of cataract surgery in diabetic patients: results of the Pan American Collaborative Retina Study Group

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