Effectiveness and Safety of Intravitreal Dexamethasone Implant (Ozurdex) in Patients with Diabetic Macular Edema: A Real-World Experience.

INTRODUCTION: There are few real-life studies on the intravitreal 0.7-mg dexamethasone implant for the treatment of diabetic macular edema (DME) conducted in Latin America. We aimed to assess the effectiveness and safety of this implant in clinical practice. METHODS: Twenty-seven centers from Brazil and one from Argentina provided information on patients with DME treated with Ozurdex. The efficacy outcome variables were best-corrected visual acuity (BCVA) in Snellen and central retinal thickness (CRT). Safety was assessed by the elevation in intraocular pressure (IOP), occurrence of cataracts, and adverse events. RESULTS: A total of 329 eyes (both treated cases and naïve eyes) from 282 patients underwent treatment. The time since diagnosis of DME ranged from 1 to 156 months. The median BCVA was 0.7 logMAR/50 letters at baseline and 0.3 logMAR/70 letters after treatment (both p < 0.001). Median CRT values decreased from 425 µm at baseline to 270 µm after treatment (p < 0.001). Increases in IOP of at least 10 mm Hg were observed in 7.4% of eyes, and 4% of eyes had cataract evolution. No cases of endophthalmitis were reported. CONCLUSION: These real-life results suggest that the intravitreal dexamethasone implant is effective and safe for eyes with DME.

Vitrectomy with and without scleral buckling for retinal detachment.

PURPOSE: To compare the surgical results of vitrectomy with and without scleral buckling for rhegmatogenous retinal detachment (RD). METHODS: Fifty-one patients with rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) at different stages were submitted to pars plana vitrectomy as the primary surgery, 23 patients (45.09%) with scleral buckle (group I) and 28 (54.90%) without scleral buckle (group II). Visual acuity, anterior segment complications, intraocular pressure, strabismus and retina reattachment rate were evaluated in both groups. RESULTS: The anatomical success and postoperative complications were similar in both groups. Retinal reattachment was achieved in 20 of 23 eyes (87%) of group I and in 24 of 28 eyes (85.7%) of group II after the initial surgery (p=1.000). Elevated intraocular pressure was noted in 2 eyes (8.7%) of group I and 1 eye (3.6%) of group II (p=0.583). Corneal abnormalities were seen in 3 eyes (13%) of group I and 2 eyes (7.19%) of the group II (p=0.647). Visual acuity improved from a preoperative median of 20/200 to a median of 20/100 in group 1 and from 20/400 to 20/100 in group 2; the difference between the two groups was statistically significant (p<0.05). The mean follow-up period was 10 months, ranging from 6 to 18 months. CONCLUSIONS: Both surgical procedures had similar reattachment rates. Intra- and postoperative complications were similar considering both procedures. Visual acuity improved significantly in group 2 (vitrectomy without scleral buckling).

Vitrectomy with and without scleral buckling for retinal detachment

PURPOSE: To compare the surgical results of vitrectomy with and without scleral buckling for rhegmatogenous retinal detachment (RD). METHODS: Fifty-one patients with rhegmatogenous retinal detachment with proliferative vitreoretinopathy (PVR) at different stages were submitted to pars plana vitrectomy as the primary surgery, 23 patients (45.09 percent) with scleral buckle (group I) and 28 (54.90 percent) without scleral buckle (group II). Visual acuity, anterior segment complications, intraocular pressure, strabismus and retina reattachment rate were evaluated in both groups. RESULTS: The anatomical success and postoperative complications were similar in both groups. Retinal reattachment was achieved in 20 of 23 eyes (87 percent) of group I and in 24 of 28 eyes (85.7 percent) of group II after the initial surgery (p=1.000). Elevated intraocular pressure was noted in 2 eyes (8.7 percent) of group I and 1 eye (3.6 percent) of group II (p=0.583). Corneal abnormalities were seen in 3 eyes (13 percent) of group I and 2 eyes (7.19 percent) of the group II (p=0.647). Visual acuity improved from a preoperative median of 20/200 to a median of 20/100 in group 1 and from 20/400 to 20/100 in group 2; the difference between the two groups was statistically significant (p<0.05). The mean follow-up period was 10 months, ranging from 6 to 18 months. CONCLUSIONS: Both surgical procedures had similar reattachment rates. Intra- and postoperative complications were similar considering both procedures. Visual acuity improved significantly in group 2 (vitrectomy without scleral buckling).

OBJETIVOS: Comparar os resultados cirúrgicos da vitrectomia com e sem "buckle" escleral para descolamento da retina regmatogênico (DR). MÉTODOS: Cinqüenta e um pacientes com descolamento da retina regmatogênico com proliferação vitreorretiniana (PVR) em diferentes estádios foram submetidos a vitrectomia pars plana como cirurgia primária; 23 pacientes (45,09 por cento) com buckle escleral (grupo 1) e 28 pacientes (54,90 por cento) sem "buckle" escleral (grupo 2). Acuidade visual, complicações do segmento anterior, pressão intra-ocular, estrabismo e razão do redescolamento da retina foram avaliados em ambos os grupos. RESULTADOS: O sucesso anatômico e complicações pós-operatórias foram semelhantes em ambos os grupos. A reaplicação da retina foi obtida em 20 dos 23 olhos (87 por cento) no grupo 1 e em 24 dos 28 olhos (85,7 por cento) no grupo 2 após a cirurgia inicial (p=1,000). Aumento da pressão intra-ocular foi notada em 2 olhos (8,7 por cento) no grupo 1 e em 1 olho (3,6 por cento) no grupo 2 (p=0,583). Anormalidades na córnea foram vistas em 3 olhos (13 por cento) no grupo 1 e em 2 olhos (7,19 por cento) no grupo 2 (p=0,647). A acuidade visual melhorou de uma média pré-operatória de 20/200 para uma média de 20/100 no grupo 1 e de 20/400 para 20/100 no grupo 2, com diferença estatisticamente significativa entre os grupos (p<0,05). O período médio de seguimento foi de 10 meses, variando entre 6 e 18 meses. CONCLUSÕES: Ambos procedimentos cirúrgicos tiveram razão semelhante de reaplicação da retina. Complicações intra- e pós-operatória foram semelhantes em ambos os procedimentos. A acuidade visual melhorou significativamente no grupo 2 (vitrectomia sem "buckle" escleral).