Management of Patients with Diabetic Macular Edema Switched from Dexamethasone Intravitreal Implant to Fluocinolone Acetonide Intravitreal Implant.

To assess anatomical and functional outcomes after switching from dexamethasone implant (DEXi) to fluocinolone acetonide implant (FAci) in 113 diabetic macular edema eyes, a multicentric retrospective observational study was conducted. Seventy-five eyes (73.5%) were switched 1−8 weeks after their last DEXi. The mean best-corrected visual acuity improved to 59.8 letters at month 4 and remained stable during the follow-up. The mean central macular thickness (CMT) significantly decreased during the follow-up, with a minimum of 320.9 µm at month 3. The baseline CMT was higher in eyes that received the last DEXi >8 weeks versus <8 weeks before the first FAci (p < 0.021). After FAci injection, additional treatments were needed in 37 (32.7%) eyes. A longer diabetes duration (p = 0.009), a longer time between the last DEXi and the first FAci (p = 0.035), and a high baseline CMT (p = 0.003) were risk factors for additional treatments. The mean intraocular pressure was <19 mmHg at all timepoints, with no difference between eyes receiving the last DEXi ≤8 weeks or >8 weeks before the switch. Switching from DEXi to FAci in DME is effective and safe. A short time between the last DEXi and the first FAci reduced CMT fluctuations and the need for early additional treatments.

RECURRENCES OF RETINAL DETACHMENT AFTER RETINECTOMY: Causes and Outcomes.

PURPOSE: To evaluate the different mechanisms of retinal detachment recurrence after retinectomy for rhegmatogenous retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) and to study its outcome and prognosis. METHODS: Retrospective, multicenter study conducted between January 2009 and November 2016. Retrospective review of 56 patients with recurrent RD (RRD) after a first relaxing retinectomy. RESULTS: The secondary retinal attachment rate was 58.9% (33/56 cases). The various mechanisms of RRD were mainly related to PVR (52/56 cases: 93%). This PVR was anterior in 10 cases (21%), posterior in 31 cases (60%), and combined anterior and posterior in 11 cases (21%). The RRD mechanism was not PVR in 4 of the 56 cases. Some of the RRD mechanisms were specific to retinectomy: fibrosis of the edge of the retinectomy (26 cases: 46.4%), beyond-the-edge proliferation (8 cases: 14.3%), and severe inferior retinal folding (2 cases: 3.6%). In the 2 cases of severe inferior retinal folding, the retina could not be reattached. The anatomical outcome and the mechanism of RRD (anterior PVR, posterior PVR, or combined anterior and posterior PVR) were not correlated (P = 0.12). Visual acuity was significantly better only in patients with complete secondary success, that is, having an attached retina after silicone oil removal: mean preoperative visual acuity was 2.01 logarithm of the minimum angle of resolution versus 1.01 logarithm of the minimum angle of resolution postoperatively (P = 0.019). CONCLUSION: Proliferative vitreoretinopathy caused most of the recurrences, and the anatomical outcome did not depend on the type of PVR involved. Only complete secondary success (attached retina after silicone oil removal) was accompanied by visual acuity improvement.

Long-Term Real-Life Efficacy and Safety of Repeated Ozurdex® Injections and Factors Associated with Macular Edema Resolution after Retinal Vein Occlusion: The REMIDO 2 Study.

PURPOSE: The objective was to study long-term real-life efficacy and safety of repeated Ozurdex® injections and factors associated with macular edema (ME) resolution after retinal vein occlusion. METHODS: Patients with ME after retinal vein occlusion, receiving Ozurdex®, were included to assess the following endpoints: visual acuity and central retinal thickness, retreatment, number of injections, side effects and ME resolution. ME resolution was defined as permanent discontinuation of intravitreal injections (IVTs) for at least 6 months after the last IVT. RESULTS: A total of 94 eyes were included with an average of 2.6 IVTs (max 6 IVTs). 58.6% of patients gained ≥15 letters and 51.1% of patients showed ME resolution. Among the resolved patients, 64.6% were treatment-naïve, 60.4% had branch retinal vein occlusion, and 78.1% gained ≥15 letters. CONCLUSIONS: Ozurdex® seemed to be a valuable treatment which may allow to achieve long-term anatomical and functional improvements and ME resolution with a minimum number of IVTs.

Long-term efficacy and safety of intravitreal dexamethasone implant for the treatment of diabetic macular edema.

PURPOSE: To evaluate the long-term efficacy and safety of the dexamethasone intravitreal implant Ozurdex® in the treatment of diabetic macular edema (DME). METHODS: This was a retrospective noncomparative study. A total of 23 patients with DME followed for at least 12 months were included. All patients were treated with at least 2 Ozurdex® injections for the treatment of DME. Best-corrected visual acuity, central retinal thickness, intraocular pressure (IOP), and cataract progression were recorded over 12 months. RESULTS: From baseline, the mean decrease in central retinal thickness was 315.9 µm at the 12th month and the mean best-corrected visual acuity improvement from baseline was 8.7 letters. Ozurdex® is administered via the extended release system Novadur®. Its efficacy extends beyond 4 months with a single injection and permits allows good stabilization until the 12th month, with 2.13 injections during this period. An increase in IOP was observed in 13.1% of patients and all were managed using topical IOP-lowering medications. No glaucoma or cataract surgery was necessary, and no endophthalmitis was reported. CONCLUSIONS: In real-life clinical practice, Ozurdex® has anatomical and functional effectiveness for the treatment of DME. Side effects were rare and manageable in our practice.

Efficacy and Safety of Intravitreal Dexamethasone Implant in Patients with Diabetic Macular Edema.

PURPOSE: To evaluate the efficacy and safety of intravitreal implant of dexamethasone (Ozurdex®) in diabetic macular edema (DME). METHODS: This was a retrospective multicenter noncomparative study. Seventy-eight patients with DME followed for at least 6 months were included (P1.5 Network). Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure (IOP) and cataract progression were studied at baseline and then at 1, 2, 4 and 6 months. RESULTS: The mean CRT decrease from baseline was 145.2 µm at 6 months. The mean BCVA improvement from baseline was 6.7 at 6 months. An increase in IOP was observed for 11.7% of patients, and all patients were managed by topical treatment. No glaucoma or cataract surgery was necessary, and no endophthalmitis was reported. CONCLUSIONS: One injection of Ozurdex has an anatomical and functional effectiveness for the treatment of DME. Side effects were rare and manageable in our practice. © 2015 S. Karger AG, Basel.