Twelve-Month Follow-Up of Dexamethasone Implants for Macular Edema from Various Diseases in Vitrectomized and Nonvitrectomized Eyes

Abstract

Purpose. To evaluate the best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of dexamethasone implants needed to treat cystoid macular edema (CME) from various etiologies over 12 months in vitrectomized and nonvitrectomized eyes. Methods. This multicenter retrospective cohort study included 112 patients with CME secondary to retinal diseases treated pro re nata (PRN) with a 0.7 mg intravitreal dexamethasone implant for 12 months. The BCVA, CRT, adverse events, safety data, and number of implants were recorded. Results. Vitrectomized and nonvitrectomized eyes received means of three implants and one implant, respectively, over 12 months (P < 0.001). The mean BCVA of all patients improved from 0.13 at baseline to 0.33 (P < 0.001) 12 months after one (P = 0.001), two (P = 0.041), and three (P < 0.001) implants but not four implants (P = 0.068). The mean baseline CRT decreased significantly (P < 0.001) from 463 to 254 microns after 12 months with one (P < 0.001), two (P = 0.002), and three (P = 0.001) implants but not with four implants (P = 0.114). The anatomic and functional outcomes were not significantly different between vitrectomized and nonvitrectomized eyes. Increased IOP was the most common adverse event (23.2%). Conclusions. Dexamethasone implant administered PRN improved VA and decreased CRT in CME, with possible long-term clinically relevant benefits for treating CME from various etiologies. Vitrectomized eyes needed more implants compared with nonvitrectomized eyes.

Novel Triamcinolone Acetonide-Loaded Liposomes Topical Formulation for the Treatment of Cystoid Macular Edema After Cataract Surgery: A Pilot Study

“…28–30 For instance, studies have reported that the concentration of IVTA decreased faster in the vitrectomized eye than in the nonvitrectomized eye, 30 and that vitrectomized eyes needed more dexamethasone implants compared with nonvitrectomized eyes for the treatment of CME of various etiologies (1.35 vs. 3.2 dexamethasone implants). 60…”

Fluocinolone Acetonide Intravitreal Implant 190 μg (ILUVIEN®) in Vitrectomized versus Nonvitrectomized Eyes for the Treatment of Chronic Diabetic Macular Edema

“…Nevertheless, it is discussed that PPV could lead to more rapid drug diffusion and clearance from the vitreous cavity in vitrectomized eyes, therefore limiting the exposure of intravitreal therapies and reducing the treatment success [7] of therapies such as anti-VEGFs [8,[17][18][19] and maybe even dexamethasone implants [20][21][22][23][24][25][26], although the authors acknowledge that the treatment reg-imen and duration for a dexamethasone implant in vitrectomized eyes still remain controversial [27].…”

Efficacy of 0.2 μg/day fluocinolone acetonide implant (ILUVIEN) in eyes with diabetic macular edema and prior vitrectomy

“… 10 A recent paper reported opposite clinical results in 112 eyes with a significant increase in the required number of implants in vitrectomized eyes at month 12 and that no significantly differences were found in anatomical and functional outcomes. 12 ILUVIEN (Alimera Sciences, Inc., Alpharetta, GA, USA) is a micro-implant, which is constituted by a non-biodegradable matrix made of polyamide. It contains 190 μ g of fluocinolone acetonide (FAc) released during 3 years (0.2 μ g of FAc per day released in the vitreous).…”