INTRAOCULAR PRESSURE IN PATIENTS WITH DIABETIC MACULAR EDEMA TREATED WITH DEXAMETHASONE INTRAVITREAL IMPLANT IN THE 3-YEAR MEAD STUDY.

PURPOSE: To evaluate the occurrence, management, and clinical significance of increases in intraocular pressure (IOP) in patients with diabetic macular edema treated with dexamethasone intravitreal implant (DEX implant). METHODS: Randomized, multicenter, 3-year, Phase III study. Patients (N = 1,048) with diabetic macular edema were randomized to DEX implant 0.7-mg, DEX implant 0.35-mg, or sham procedure with retreatment allowed at ≥6-month intervals (seven injections maximum). RESULTS: In the DEX implant 0.7-mg, DEX implant 0.35-mg, and sham groups, respectively, ≥10-mmHg IOP increases from baseline occurred in 27.7%, 24.8%, and 3.7% of patients, and their frequency did not increase with repeat injections. IOP-lowering medication was used by 41.5%, 37.6%, and 9.1% of patients. Only one patient (0.3%) in each DEX implant group had filtering surgery to manage a steroid-induced IOP increase. Among DEX implant 0.7-mg-treated patients with and without a ≥10-mmHg IOP increase, 21.9% (21 of 96) and 22.4% (57 of 255), respectively, achieved ≥15-letter best-corrected visual acuity gain at the end of the study, and mean average change in central retinal thickness from baseline was -127 µm and -106 µm, respectively. CONCLUSION: DEX implant demonstrated clear benefit of treatment despite increases in IOP. Sequential implants had no cumulative effect on IOP.

Survey: technique of performing intravitreal injection among members of the Brazilian Retina and Vitreous Society (SBRV).

PURPOSE: To evaluate and describe the precautions involved in the technique of intravitreal injection of antiangiogenic drugs adopted by the ophthalmologists who are members of the Brazilian Society of Retina and Vitreous (SBRV). METHODS: A questionnaire containing 22 questions related to precautions taken before, during, and after intravitreal injection was sent electronically to 920 members of SBRV between November 15, 2013 and April 31, 2014. RESULTS: 352 responses (38%) were obtained. There was a predominance of men (76%) from the southwest region of Brazil (51%). The professional experience varied between 6 and 15 years after medical specialization (50%). Most professionals (76%) performed an average of 1 to 10 intravitreal injections a week, and 88% of the procedures were performed in the operating room using povidone iodine (99%), sterile gloves, and blepharostat (94%). For inducing topical anesthesia, usage of anesthetic eye drops was the most used technique (65%). Ranibizumab (Lucentis®) was the most common drug (55%), and age-related macular degeneration (AMD) was the most treated disease (57%). Regarding the complications treated, 6% of the ophthalmologists had treated at least one case of retinal detachment, 20% had treated cases of endophthalmitis, 9% had treated cases of vitreous hemorrhage, and 12% had encountered cases of crystalline lens touch. CONCLUSION: Intravitreal injection is a procedure routinely performed by retina specialists and has a low incidence of complications. Performing the procedure in the operating room using an aseptic technique was preferred by most of the respondents. Ranibizumab was the most used drug, and AMD was the most treated disease.

Survey: technique of performing intravitreal injection among members of the Brazilian Retina and Vitreous Society (SBRV) / Survey: técnica para realização de injeção intravítrea pelos membros da Sociedade Brasileira de Retina e Vítreo (SBRV)

Purpose: To evaluate and describe the precautions involved in the technique of intravitreal injection of antiangiogenic drugs adopted by the ophthalmologists who are members of the Brazilian Society of Retina and Vitreous (SBRV). Methods: A questionnaire containing 22 questions related to precautions taken before, during, and after intravitreal injection was sent electronically to 920 members of SBRV between November 15, 2013 and April 31, 2014. Results: 352 responses (38%) were obtained. There was a predominance of men (76%) from the southwest region of Brazil (51%). The professional experience varied between 6 and 15 years after medical specialization (50%). Most professionals (76%) performed an average of 1 to 10 intravitreal injections a week, and 88% of the procedures were performed in the operating room using povidone iodine (99%), sterile gloves, and blepharostat (94%). For inducing topical anesthesia, usage of anesthetic eye drops was the most used technique (65%). Ranibizumab (Lucentis®) was the most common drug (55%), and age-related macular degeneration (AMD) was the most treated disease (57%). Regarding the complications treated, 6% of the ophthalmologists had treated at least one case of retinal detachment, 20% had treated cases of endophthalmitis, 9% had treated cases of vitreous hemorrhage, and 12% had encountered cases of crystalline lens touch. Conclusion: Intravitreal injection is a procedure routinely performed by retina specialists and has a low incidence of complications. Performing the procedure in the operating room using an aseptic technique was preferred by most of the respondents. Ranibizumab was the most used drug, and AMD was the most treated disease. .

Objetivo: Avaliar e descrever os cuidados envolvidos durante o procedimento de injeção intravítrea de drogas antiangiogênicas realizado pelos oftalmologistas membros da Sociedade Brasileira de Retina e Vítreo (SBRV). Métodos: Foi enviado um questionário aos 920 membros da SBRV, por meio de correio eletrônico, entre o período de 15/11/2013 a 31/04/2014, contendo 22 questões, relacionado aos cuidados pré, intra e pós-operatório da injeção intravítrea. Resultados: Foram obtidas 352 respostas (38% dos sócios). Houve um predomínio do sexo masculino (76%), procedentes da região Sudeste (51%). O tempo de experiência profissional se concentrou entre 6 a 15 anos após o término da especialização (50%). A maioria dos participantes tem média semanal de 1 a 10 (76%), sendo 88% das vezes realizado dentro do centro cirúrgico, utilizando iodopovidona (99%), luvas e blefarostato estéreis (94%). A anestesia tópica com colírio anestésico foi a técnica mais utilizada (65%). Entre os participantes, ranibizumabe (Lucentis®) é a droga mais utilizada (55%) e a degeneração macular relacionada a idade (DMRI) é a doença mais tratada (57%). Das complicações citadas pelos oftalmologistas, 6% já vivenciaram pelo menos um caso de descolamento de retina, 20% endoftalmite, 9% hemorragia vítrea e 12% toque cristaliniano. Conclusão: A injeção intravítrea é um procedimento realizado rotineiramente por retinólogos, com baixo índice de complicações. A realização do procedimento no centro cirúrgico com técnica asséptica é preferida pelos pesquisados. A droga mais utilizada foi o ranibizumabe e a doença mais tratada foi a DMRI. .