Objetivo Evaluar la incidencia de desgarro del epitelio pigmentario cuando se administra un implante intravítreo de dexametasona de liberación retardada (uso off-label) previo al tratamiento antiangiogénico en desprendimientos del epitelio pigmentario (DEP) secundarios a degeneración macular neovascular asociada a la edad (DMAEn) con características de alto riesgo de rotura e investigar si provoca una disminución del tamaño del DEP. Métodos Se incluyeron pacientes con DMAEn, altura del DEP >500micras e implante de Ozurdex previo a la terapia antiangiogénica. Se registró la presencia de rotura del epitelio pigmentario en tomografías de coherencia óptica, agudeza visual mejor corregida (AVMC) y medidas del DEP (altura y diámetro máximos). Resultados El estudio incluyó a 14 ojos de 14 pacientes: edad media 77±7 años, 11 (79%) mujeres. 25±13 días después del Ozurdex los pacientes comenzaron con al menos 3 inyecciones mensuales de anti-VEGF. La AVMC mejoró de 64±14 a 69±11 letras después de la terapia anti-VEGF (p>0,05). La altura media inicial del DEP fue de 817±269μm, siendo 639±268μm después de Ozurdex y 370±260μm después de las inyecciones de anti-VEGF (p=0,035 y p=0,009). Se produjo un desgarro del epitelio pigmentario de la retina (7%). No se hallaron otros efectos adversos. Conclusione El implante de dexametasona antes de la terapia anti-VEGF puede representar una modalidad terapéutica prometedora para los DEP grandes en la DMAEn, reduciendo las dimensiones del DEP y el riesgo de desgarros del epitelio pigmentario antes de la terapia anti-VEGF (AU)
Objective Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. Methods Patients with nAMD, PED height >500microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. Results The study included 14 eyes of 14 patients: mean age 77±7 years, 11 (79%) females. 25±13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64±14 to 69±11 letters after anti-VEGF therapy (P>.05). Mean baseline PED height was 817±269μm, being 639±268μm after Ozurdex and 370±260μm after anti-VEGF injections (P=.035 and P=.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. Conclusions Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy (AU)
Humans , Male , Female , Aged , Aged, 80 and over , Retinal Detachment/drug therapy , Retinal Detachment/etiology , Macular Degeneration/complications , Dexamethasone/administration & dosage , Anti-Inflammatory Agents/administration & dosage , Tomography, Optical Coherence , Retrospective Studies , Intravitreal Injections , Treatment Outcome
OBJECTIVE: Evaluate the incidence of pigment epithelial tear when intravitreal delayed-release dexamethasone implant is administered (off-label use) prior to antiangiogenic treatment in pigment epithelium detachments (PED) secondary to neovascular age-related macular degeneration (nAMD) with high-risk rupture characteristics and investigate if it causes a decrease in the PED size. METHODS: Patients with nAMD, PED height >500 microns and Ozurdex implant prior to the antiangiogenic therapy were included. The presence of pigment epithelium rupture in optical coherence tomography scans, best-corrected visual acuity (BCVA) and PED measurements (maximum height and diameter) were registered. RESULTS: The study included 14 eyes of 14 patients: mean age 77⯱â¯7 years, 11 (79%) females. 25⯱â¯13 days after the Ozurdex, patients started with at least 3 anti-VEGF monthly injections. BCVA improved from 64⯱â¯14-69⯱â¯11 letters after anti-VEGF therapy (pâ¯>â¯0.05). Mean baseline PED height was 817⯱â¯269⯵m, being 639⯱â¯268⯵m after Ozurdex and 370⯱â¯260⯵m after anti-VEGF injections (pâ¯=â¯0.035 and pâ¯=â¯0.009). One retinal pigment epithelium tear occurred (7%). No other adverse effects were reported. CONCLUSIONS: Dexamethasone implant prior to anti-VEGF therapy may represent a promising therapeutic modality for large PED in nAMD, reducing PED dimensions and the risk of pigment epithelium tears prior to anti VEGF therapy.
Macular Degeneration , Retinal Detachment , Female , Humans , Aged , Aged, 80 and over , Male , Ranibizumab/therapeutic use , Intravitreal Injections , Visual Acuity , Retinal Detachment/etiology , Retinal Detachment/complications , Angiogenesis Inhibitors/adverse effects , Vascular Endothelial Growth Factors , Antibodies, Monoclonal/therapeutic use , Macular Degeneration/complications , Macular Degeneration/drug therapy , Dexamethasone/therapeutic use , Epithelium
Lens Implantation, Intraocular/adverse effects , Lenses, Intraocular/adverse effects , Macular Edema/therapy , Prosthesis Failure , Retinal Vein Occlusion/therapy , Absorbable Implants/adverse effects , Administration, Topical , Aged, 80 and over , Cataract/complications , Cataract/diagnosis , Cataract/therapy , Cataract Extraction/methods , Dexamethasone/administration & dosage , Female , Glucocorticoids/administration & dosage , Humans , Lens Implantation, Intraocular/methods , Lens, Crystalline/diagnostic imaging , Macular Edema/diagnosis , Macular Edema/etiology , Phacoemulsification/methods , Retinal Vein Occlusion/diagnosis , Retinal Vein Occlusion/etiology , Tobramycin/administration & dosage , Tomography, Optical Coherence
