Phaco-non-penetrating deep sclerectomy in ocular hypertension secondary to dexamethasone intravitreal implant

Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics.

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“…50 A recent study also reports the successful results of phaco-non-penetrating deep sclerectomy in OHT secondary to DEX intravitreal implant. 51…”

Section: Ophthalmological Considerationsmentioning

confidence: 99%

First-line treatment algorithm and guidelines in center-involving diabetic macular edema

Kodjikian

Bellocq

Bandello

et al. 2019

European Journal of Ophthalmology

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“…Vié et al found that the 5 patients included in their study with a history of conventional filtering surgery had a profile close to that of the control patients (33% of patients required an additional IOP-lowering therapy) [21]. Another study reported that IOP in 2 patients who required additional treatment with DEX-I after combined phakosclerectomy surgery was kept under control without treatment [22]. Moreover, our team has previously reported the short-term efficacy of XEN ® gel stent on IOP when treating DEX-I induced OHT [16].…”

Section: Discussionmentioning

confidence: 90%

Intra-Ocular Pressure Response to Dexamethasone Implant Injections in Patients with a History of Filtering Surgery: The TRABEX Study

et al. 2022

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Patients with both macular edemas, of various etiologies such as diabetes and glaucoma, may suffer serious loss of vision if either disease goes untreated. Where no effective alternative therapies are available, dexamethasone implant (DEX-I) injections may be the only choice of treatment, despite the risk of a possible increase in intraocular pressure (IOP) when using steroids. Although many studies have reported on IOP evolution in eyes treated with DEX-I, little is known specifically about eyes with a history of filtering surgery. The aim of this observational series was to evaluate the IOP response following DEX-I injection in eyes presenting conventional filtering surgeries or microinvasive glaucoma surgeries (MIGS). Twenty-five eyes were included in this study. A total of 64% of the eyes did not experience OHT during follow-up. Additional IOP-lowering therapy was needed for 32% of eyes, and 20% of eyes (all showing bleb fibrosis) required further filtering surgery: 50% of eyes in the MIGS group and 10.5% of eyes in the conventional filtering surgery group. A significant positive correlation was found between IOP at baseline and the maximum IOP throughout follow-ups after DEX-I (r = 0.45, p = 0.02). In conclusion, if DEX-I is used when there are no alternative therapies for treating macular edema, IOP in eyes with a history of filtering surgery is generally manageable. Those eyes which previously underwent conventional therapy with effective blebs obtained better IOP control after DEX-I injections and mostly did not require any additional IOP-lowering therapy or surgery.

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“…The majority of cases of IOP elevation after the Ozurdex implant were generally transient and successfully managed with topical treatment, whereas filtration surgery was needed in 0–1.7% of cases [ 42 , 100 , 101 , 110 , 114 , 117 ], and the surgical options include trabeculectomy, shunts implant, and minimally invasive glaucoma surgery [ 118 ].…”

Section: Corticosteroids For the Management Of Dmementioning

confidence: 99%

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

Salvetat,

Pellegrini,

Spadea

et al. 2024

JCM

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Diabetic macular edema (DME) is a common complication of diabetes mellitus and a leading cause of visual impairment worldwide. It is defined as the diabetes-related accumulation of fluid, proteins, and lipids, with retinal thickening, within the macular area. DME affects a significant proportion of individuals with diabetes, with the prevalence increasing with disease duration and severity. It is estimated that approximately 25–30% of diabetic patients will develop DME during their lifetime. Poor glycemic control, hypertension, hyperlipidemia, diabetes duration, and genetic predisposition are recognized as risk factors for the development and progression of DME. Although the exact pathophysiology is still not completely understood, it has been demonstrated that chronic hyperglycemia triggers a cascade of biochemical processes, including increased oxidative stress, inflammation, activation of vascular endothelial growth factor (VEGF), cellular dysfunction, and apoptosis, with breakdown of the blood-retinal barriers and fluid accumulation within the macular area. Early diagnosis and appropriate management of DME are crucial for improving visual outcomes. Although the control of systemic risk factors still remains the most important strategy in DME treatment, intravitreal pharmacotherapy with anti-VEGF molecules or steroids is currently considered the first-line approach in DME patients, whereas macular laser photocoagulation and pars plana vitrectomy may be useful in selected cases. Available intravitreal steroids, including triamcinolone acetonide injections and dexamethasone and fluocinolone acetonide implants, exert their therapeutic effect by reducing inflammation, inhibiting VEGF expression, stabilizing the blood-retinal barrier and thus reducing vascular permeability. They have been demonstrated to be effective in reducing macular edema and improving visual outcomes in DME patients but are associated with a high risk of intraocular pressure elevation and cataract development, so their use requires an accurate patient selection. This manuscript aims to provide a comprehensive overview of the pathology, epidemiology, risk factors, physiopathology, clinical features, treatment mechanisms of actions, treatment options, prognosis, and ongoing clinical studies related to the treatment of DME, with particular consideration of intravitreal steroids therapy.

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Phaco-non-penetrating deep sclerectomy in ocular hypertension secondary to dexamethasone intravitreal implant

Cited by 3 publications

References 20 publications

First-line treatment algorithm and guidelines in center-involving diabetic macular edema

First-line treatment algorithm and guidelines in center-involving diabetic macular edema

Intra-Ocular Pressure Response to Dexamethasone Implant Injections in Patients with a History of Filtering Surgery: The TRABEX Study

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

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