<p>Efficacy and Safety of Combined Vitrectomy with Intravitreal Dexamethasone Implant for Advanced Stage Epiretinal Membrane</p>

Abstract

PurposeTo evaluate the efficacy and safety of combined 25-gauge (G) pars plana vitrectomy (PPV) with intravitreal dexamethasone implant (DXI) for the treatment of advanced stage epiretinal membrane (ERM).MethodsForty consecutive pseudophakic eyes with idiopathic stage 3–4 ERM and intraretinal cysts were randomly assigned to two treatment groups. Twenty eyes underwent combined 25-G PPV, ERM peeling and slow-release DXI (DEX group), whereas 20 eyes underwent standard 25-G PPV with ERM peeling only (control group). Differences in postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) were evaluated.ResultsIn all patients, BCVA significantly increased at 1, 3 and 6 months after surgery compared to baseline (all p < 0.05), but at 3 and 6 months, the visual gain was higher in the DEX group (respectively, p = 0.036, p = 0.006). CMT was significantly lower in DEX group compared to control group at 3 and 6 months after surgery (respectively, p = 0.042, p = 0.003). There was no statistically significant difference in IOP change over the course of the follow-up between groups (p > 0.05).ConclusionCombined 25-G PPV with DXI is associated with better anatomical and functional outcomes in patients with advanced stage ERM.

Intravitreal Dexamethasone Implant as a Sustained Release Drug Delivery Device for the Treatment of Ocular Diseases: A Comprehensive Review of the Literature

“…Iovino et al, reported favorable anatomical and functional outcomes of the Dex implant as adjuvant to PPV in advanced stage ERMs with CME [150]. In this study, both visual recovery and reduction in macular thickness were higher in the Ozurdex-treated cohort up to 6 months after surgery, if compared to the non-Ozurdex treated control group.…”

“…This aspect may represent an advantage of Ozurdex over anti-VEGF agents, whose half-life is significantly reduced in a vitrectomized eye. Different reports have explored the safety and efficacy of Ozurdex as adjuvant to PPV in distinct retinal pathologies with a special focus on DR, rhegmatogenous and tractional retinal detachment (RD) and epiretinal membrane (ERM) [149][150][151][152][153][154].…”

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

“…Two studies presented a randomized design ( Guidi et al, 2018 ; Iovino et al, 2019 ); of the two non-randomized studies, one was prospective ( Sane et al, 2020 ) and one was retrospective ( Savastano et al, 2020 ). All studies except one had a follow-up of 6 months ( Guidi et al, 2018 ; Iovino et al, 2019 ; Sane et al, 2020 ); the report from Savastano and co-workers featured a 3-months follow-up ( Savastano et al, 2020 ). All studies based ERM diagnosis on sd-OCT. A CMT greater than 250 and 300 µm was considered for eligibility by Guidi et al (2018) and Sane et al (2020) , respectively.…”

“…Several authors have already described an intraoperative use of the intravitreal dexamethasone implant in patients undergoing vitrectomy for ERM ( Guidi et al, 2018 ; Iovino et al, 2019 ; Sane et al, 2020 ; Savastano et al, 2020 ). However, the outcomes of ERM vitrectomy combined with intravitreal dexamethasone implant appear still controversial ( Guidi et al, 2018 ; Iovino et al, 2019 ; Sane et al, 2020 ; Savastano et al, 2020 ).…”

“…Several authors have already described an intraoperative use of the intravitreal dexamethasone implant in patients undergoing vitrectomy for ERM ( Guidi et al, 2018 ; Iovino et al, 2019 ; Sane et al, 2020 ; Savastano et al, 2020 ). However, the outcomes of ERM vitrectomy combined with intravitreal dexamethasone implant appear still controversial ( Guidi et al, 2018 ; Iovino et al, 2019 ; Sane et al, 2020 ; Savastano et al, 2020 ). Even if a greater visual gain featured those patients receiving the implant, almost all reports failed to demonstrated a significant difference between ERM vitrectomy with and without intraoperative dexamethasone implant ( Guidi et al, 2018 ; Sane et al, 2020 ; Savastano et al, 2020 ).…”