The efficacy of dexamethasone implants following anti-VEGF failure for macular oedema in retinal vein occlusion

Yap, Timothy E.; Husein, Salman; Imperial-Ollero, Juan Antonio Miralles de; Colizzi, Benedetta; Cordeiro, M. Francesca; Younis, Saad

doi:10.1177/1120672120978355

Cited by 4 publications

(1 citation statement)

References 45 publications

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“…However, the results of RCTs may not reflect real-world effectiveness, since the actual practices in clinics may differ from the conditions strictly controlled by RCTs. Inadequate or non-standard treatment in clinical practice often leads to unsatisfactory treatment outcomes, requiring additional injections or switching to a different anti-VEGF drug [9][10] or dexamethasone implants (DEX) [11][12] in followup visits. Several retrospective real-world studies [13][14][15] that used 1+PRN or 3+PRN treatment regimens reported mean numbers of injections in the first year of 3.7 to 7.6, and a mean improvement in visual acuity (VA) of 8.0 to 14.8 letters at month 12, indicating that fewer injections in real clinical practices may result in unsatisfied BCVA improvement.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

Ye,

Huang,

et al. 2023

Int J Ophthalmol

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AIM: To assess the long-term outcomes of treating macular edema (ME) associated with central retinal vein occlusion (CRVO) with a regimen of “5+pro re nata (PRN)”. METHODS: This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO (non-iCRVO group, n=15) and ischemic CRVO (iCRVO group, n=12). The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab, followed by reinjections as needed or PRN. Retinal laser photocoagulation or intravitreal dexamethasone implants (DEX) were implemented in both groups when necessary. The best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT) were recorded at baseline, at 1, 2, 3, 4, 5, 6, and 12mo, and at the final visit. The efficacy rates of BCVA and CRT before and after treatment were calculated. The number of injections at each visit and the incidence of adverse events were also recorded. RESULTS: The patients, aged 59.4±15.1y, were followed up for 24.7±8.8mo (range: 15-42mo). After treatment, BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR (P=0.038) at the final visit in all patients. Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points, but there was no statistical significance (P=0.197 and 0.33, respectively). The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups (all P<0.001). The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection, 48.15% for BCVA and 62.96% for CRT after 5 consecutive injections, and 74.08% for BCVA and 100% for CRT at the end of follow up. The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups (P>0.05). Laser treatment was applied to all eyes in the iCRVO group, while only 5 patients in the non-iCRVO group. Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch. DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group. CONCLUSION: The 5+PRN anti-vascular endothelial growth factor (VEGF) regimen is found to be safe and effective for both iCRVO and non-iCRVO, especially in the iCRVO group. The best regimen for such patients needs to be further investigated. Adjuvant laser therapy and DEX are necessary in some cases.

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Section: Introductionmentioning

confidence: 99%

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

Ye,

Huang,

et al. 2023

Int J Ophthalmol

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Three-Year Outcomes of VEGF Inhibitors in Naive Branch Retinal Vein Occlusion

Alforja,

Hunt,

Nguyen

et al. 2024

Ophthalmology Retina

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Long term efficacy and safety profile of dexamethasone intravitreal implant in retinal vein occlusions: a systematic review

Carnevali,

Bacherini,

Metrangolo

et al. 2024

Front. Med.

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Background/objectiveRetinal vein occlusion (RVO) is a common, sight-threatening vascular disorder affecting individuals of all ages, with incidence increasing with age. Due to its complex, multifactorial nature, treating RVO remains a clinical challenge. Currently, treatment strategies include laser photocoagulation (especially for branch RVO), anti-VEGF therapies, and intravitreal corticosteroids. This systematic review (without meta-analysis) aimed to update the evidence on the efficacy and safety of the sustained-release intravitreal dexamethasone implant (DEX-i) in managing macular edema (ME) secondary to central and branch RVO.MethodsA systematic review was conducted to assess current literature on DEX-i for ME secondary to RVO. Relevant studies were analyzed for outcomes related to visual acuity, retinal thickness, and the safety profile of DEX-i in RVO treatment.ResultsEvidence indicates that DEX-i substantially improves best-corrected visual acuity (BCVA) and reduces central retinal thickness (CRT) in ME associated with both branch and central RVO, demonstrating rapid and sustained effects. Common adverse events associated with DEX-i included manageable complications, such as medically controlled intraocular pressure elevation and progression of cataracts.ConclusionDEX-i offers effective and sustained improvements in both visual and anatomical outcomes for patients with ME secondary to RVO. Individualized treatment selection is essential to optimize patient outcomes. Future directions include identifying predictive biomarkers and adopting patient-centered approaches based on individual clinical characteristics, which may enhance treatment success in RVO.

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The efficacy of dexamethasone implants following anti-VEGF failure for macular oedema in retinal vein occlusion

Cited by 4 publications

References 45 publications

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

Three-Year Outcomes of VEGF Inhibitors in Naive Branch Retinal Vein Occlusion

Long term efficacy and safety profile of dexamethasone intravitreal implant in retinal vein occlusions: a systematic review

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