Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results

Busch, Catharina; Fraser‐Bell, Samantha; Iglicki, Matías; Lupidi, Marco; Couturier, Aude; Chaikitmongkol, Voraporn; Giancipoli, Ermete; Rodríguez‐Valdés, Patricio J.; Gabrielle, Pierre‐Henry; Laíns, Inês; Santos, Ana Rita; Cebeci, Zafer; Amphornphruet, Atchara; Degenhardt, Valentin; Unterlauft, Jan-Darius; Cagini, Carlo; Mané-Tauty, Valérie; Ricci, Giuseppe D’Amico; Hindi, Isaac; Agrawal, Kushal; Chhablani, Jay; Loewenstein, Anat; Zur, Dinah; Rehák, Matúš

doi:10.1007/s00592-019-01416-4

Cited by 53 publications

(45 citation statements)

References 16 publications

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“…A retrospective study by Busch et al [357], reported that dexamethasone implant had a beneficial effect in early switch (after 3 injections of monthly anti-VEGF therapy) in eyes that were unresponsive to anti-VEGF therapy. A switch to dexamethasone later at 12 months still resulted in significant VA improvements-but less than those who were switched earlier, whereas eyes that continued to receive anti-VEGF therapy for the 24 months exhibited a delayed response.…”

Section: Evidence Reviewmentioning

confidence: 99%

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Amoaku

Ghanchi

Bailey

et al. 2020

Eye

134

121

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The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.

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Section: Evidence Reviewmentioning

confidence: 99%

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Amoaku

Ghanchi

Bailey

et al. 2020

Eye

134

121

View full text Add to dashboard Cite

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“…Favorable results have also been reported with Dex implant in patients non-responsive to anti-VEFG or in vitrectomized eyes with DME [91][92][93][94].…”

Section: Evidence Of the Efficacy Of Dex In Diabetic Macular Edemamentioning

confidence: 99%

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

et al. 2020

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Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.

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“…(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. We excluded studies: (1) not available in English, (2) published in books or grey literature, conference abstracts, review, comments, letter to editor, case series (<5 subjects) (3) with insufficient quality (4) where the results of DME were combined with other causes of macular edema like vein occlusion (5) where additional interventions were done during the study period like laser, vitrectomy, etc. (6) performed in non-human subjects (7) where time domain OCT machines were used.…”

Section: Selection Criteriamentioning

confidence: 99%

“…3,4 Intravitreal steroids in the form of dexamethasone implants are being used in such patients not responding to anti-VEGF injections. 5,6 The rationale behind using steroids stems from the assumption that inflammation plays a significant role in some eyes with DME. 7,8 However, a small subset of patients can show suboptimal response to dexamethasone implants as well.…”

Section: Introductionmentioning

confidence: 99%

Role of hyper-reflective spots in predicting outcomes of intravitreal therapy in diabetic macular edema: A systematic review and meta-analysis

Ganne

Krishnappa

Chaitanya

et al. 2021

Preprint

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Purpose: Predicting response to intravitreal therapy in DME has become a challenging task. Individual studies have shown that HRS could be a reliable biomarker. This systematic review aimed to determine if there was a quantitative reduction in hyperreflective spots (HRS) following intravitreal therapy in diabetic macular edema (DME), if the type of intravitreal therapy (anti-VEGF versus steroid) had differential effects on quantitative HRS change and finally, if HRS at the start of therapy was associated with improvement in visual acuity (VA) or reduction in central macular thickness (CMT). We also aimed at bringing out the lacunae in the existing literature on HRS in DME and propose goals for future studies. Methods: PubMed/MEDLINE, Scopus, ProQuest, CINAHL, Wiley online and Web of Science were searched based on MOOSE guidelines for non-randomized studies evaluating HRS as a biomarker in DME (between 1st January 2011 and 1st July 2020). Publication bias was analyzed using Begg and Mazumdar rank correlation test and funnel plots. Heterogeneity was assessed using the I2 statistic. Meta-analysis was done using a random-effects model. Results: A total of 1168 eyes from 19 studies were eligible for inclusion. Pooled standardized mean differences showed that intravitreal therapy was associated with a reduction in quantitative HRS (z=-6.3, CI95%=-1.09 to -0.55, p<0.0001). Extreme between-study heterogeneity was observed (I2=93.2%) with significant publication bias. There was no difference in outcomes between anti-VEGF and steroid therapies (p=0.23). No definite conclusions could be drawn regarding the predictive value of HRS in determining the final VA and CMT. Conclusion: This review could conclude that there is a definite reduction in quantitative HRS following either form of intravitreal therapy. Our conclusion about the role of HRS in predicting visual outcome and CMT change was limited by the number of analyzable studies owing to the wide variation in the study designs, methods and reporting.

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Real-world outcomes of non-responding diabetic macular edema treated with continued anti-VEGF therapy versus early switch to dexamethasone implant: 2-year results

Cited by 53 publications

References 16 publications

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group

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

Role of hyper-reflective spots in predicting outcomes of intravitreal therapy in diabetic macular edema: A systematic review and meta-analysis

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