Ozurdex in age-related macular degeneration as adjunct to ranibizumab (The OARA Study)

Chaudhary, Varun; Barbosa, Joshua; Lam, Wai Ching; Mak, Michael; Mavrikakis, Emmanouil

doi:10.1016/j.jcjo.2016.04.020

Cited by 32 publications

(20 citation statements)

References 5 publications

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“…After the approval of the DEX implant, several authors evaluated its efficacy in nAMD 22 – 25 ( Table 1 ). Compared with ranibizumab monotherapy, studies showed no long-term improvement of best corrected visual acuity (BCVA) and reduction of CMT; 22 – 25 however, DEX implant in some cases allowed a reduced number of anti-VEGF injections. 23 , 24 …”

Section: Namdmentioning

confidence: 99%

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Widening use of dexamethasone implant for the treatment of macular edema

Bonfiglio¹,

Reibaldi²,

Fallico³

et al. 2017

DDDT

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Sustained-release intravitreal 0.7 mg dexamethasone (DEX) implant is approved in Europe for the treatment of macular edema related to diabetic retinopathy, branch retinal vein occlusion, central retinal vein occlusion, and non-infectious uveitis. The implant is formulated in a biodegradable copolymer to release the active ingredient within the vitreous chamber for up to 6 months after an intravitreal injection, allowing a prolonged interval of efficacy between injections with a good safety profile. Various other ocular pathologies with inflammatory etiopathogeneses associated with macular edema have been treated by DEX implant, including neovascular age-related macular degeneration, Irvine–Gass syndrome, vasoproliferative retinal tumors, retinal telangiectasia, Coats’ disease, radiation maculopathy, retinitis pigmentosa, and macular edema secondary to scleral buckling and pars plana vitrectomy. We undertook a review to provide a comprehensive collection of all of the diseases that benefit from the use of the sustained-release DEX implant, alone or in combination with concomitant therapies. A MEDLINE search revealed lack of randomized controlled trials related to these indications. Therefore we included and analyzed all available studies (retrospective and prospective, comparative and non-comparative, randomized and nonrandomized, single center and multicenter, and case report). There are reports in the literature of the use of DEX implant across a range of macular edema-related pathologies, with their clinical experience supporting the use of DEX implant on a case-by-case basis with the aim of improving patient outcomes in many macular pathologies. As many of the reported macular pathologies are difficult to treat, a new treatment option that has a beneficial influence on the clinical course of the disease may be useful in clinical practice.

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Section: Namdmentioning

confidence: 99%

“…One study 24 reported an incidence of cataract surgery of 9% in ranibizumab-treated eyes and 33% in eyes receiving 2 DEX implants. The incidence of ocular hypertension ranged from 15% to 42%, 22 – 25 all treated with topical hypotonizing therapy.…”

Section: Namdmentioning

confidence: 99%

Widening use of dexamethasone implant for the treatment of macular edema

Bonfiglio¹,

Reibaldi²,

Fallico³

et al. 2017

DDDT

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“…[ 3 , 22 – 28 ] Recently, numerous recent studies have evaluated the degree and management for the postoperative SIOH induced by DEX. [ 12 – 19 ] Concerning the elevation of IOP, only 1 patient (7.7%) in our study experienced an IOP elevation of 10 mmHg from baseline, and no IOP measurements of more than 30 mmHg were recorded. The preliminary management revealed a much safer outcome compared to other studies with the percentage of SIOH ranged from 14.9% to 32.8%).…”

Section: Discussionmentioning

confidence: 72%

“…[ 15 , 18 ] Furthermore, only 1 study has revealed similar effects between combined DEX and anti-angiogenic therapy and ranibizumab monotherapy, which demonstrate similar outcomes, while multiple injections of the combined therapy did not show an advantage over monotherapy, considering the convenience and cost. [ 19 ]…”

Section: Introductionmentioning

confidence: 99%

Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema

et al. 2017

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To evaluate the safety and efficiency in macular edema patients who concurrently received a single injection of a dexamethasone intravitreal implant (DEX, 0.7 mg) and ranibizumab (2.3 mg).A retrospective cohort study was conducted, and medical records from 2012 to 2016 were reviewed. Patients who received concurrent DEX and ranibizumab injections with a follow-up period of at least 3 months were enrolled in the study group. An age and gender-matched group received ranibizumab injections and was designated the control group. The best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were included in the analysis. Steroid-induced ocular hypertension (SIOH) is defined as either an elevation of more than 10 mmHg from baseline or a single IOP measurement of more than 30 mmHg.A total of 26 patients were enrolled in the current study with 13 patients in each group. Both the BCVA (P = .04) and CMT (P < .01) achieved significant improvement after the follow-up period in the study group. The IOP increased after the injection but no significant elevation was observed throughout the follow-up period in the study group (P = .15). For SIOH, 1 patient in the study group had an elevated IOP of 10 mmHg (7.7%) at 2 postoperative months, and no single IOP measurement of more than 30 mmHg was obtained. Five patients (38.5%) in the study group received medical treatment that successfully retarded their IOP elevation, and no individuals required surgical management. In the control group, there were no significant fluctuations concerning BCVA, CMT, and IOP, and no ocular hypertension was observed. According to the inter-group analysis, the CMT and BCVA recovered more significantly in the study group than in the control group.Concurrent injection of DEX and ranibizumab is a preliminary method that shows effectiveness in treating ME. Furthermore, safety is also guaranteed, with moderate levels of severity and transient IOP elevation being observed. A future large-scale study is necessary to evaluate the long-term effects and safety of this combined treatment.

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“…Other publications however, consider its potential benefit as uncertain, and generally inadequate 11. Recent publications have found the dexamethasone implant to have some benefit in the treatment of wet AMD recalcitrant to anti-VEGF therapy,12 but clearly the role of intravitreal steroids in improving vision is under investigation13 14 and given that it can induce cataract in a patient with a clear lens, it can reserved be for use once its role becomes clearly established…”

Section: Discussionmentioning

confidence: 99%

Systemic steroids for the management of choroidal neovascular membrane with pigment epithelial tear and recalcitrant subretinal fluid

Bilgic¹,

Sudhalkar

2019

BMJ Case Rep

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A 67-year-old man was diagnosed to have dry age related macular degeneration in the right eye and a choroidalneovascular membrane (CNVM) with a large pigment epithelial detachment in the left eye, confirmed with clinical examination, angiography and optical coherence tomography scans. He received an intravitreal injection of bevacizumab in the right eye and developed a retinal pigment epithelial (RPE) tear 3 weeks later. 3 consecutive ranibizumab injections failed to clear the subretinal fluid (SRF). A course of systemic steroids was administered and this improved the vision. Subsequently, the patient received one more ranibizumab injection and the disease process resolved. The left eye corrected distance visual acuity (LE CDVA) was 20/30 at the final visit (1 year after the last injection). Systemic steroids may be a management option in patients with CNVM and RPE tear with recalcitrant SRF if there is no contraindication to their use.

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Ozurdex in age-related macular degeneration as adjunct to ranibizumab (The OARA Study)

Cited by 32 publications

References 5 publications

Widening use of dexamethasone implant for the treatment of macular edema

Widening use of dexamethasone implant for the treatment of macular edema

Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema

Systemic steroids for the management of choroidal neovascular membrane with pigment epithelial tear and recalcitrant subretinal fluid

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