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      Factors associated with the duration of action of dexamethasone intravitreal implants in diabetic macular edema patients

      research-article
      1 , 2 , 2 ,
      Scientific Reports
      Nature Publishing Group UK
      Retinal diseases, Diseases

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          Abstract

          We designed this study to determine the association between the duration of action of intravitreal dexamethasone implants and aqueous humor biomarkers or optical coherence tomography (OCT) findings of diabetic macular edema (DME) patients. We measured the concentrations of interleukin (IL)-1β, -8, -10, -17; placental growth factor; and vascular endothelial growth factor in the aqueous humor, and identified the number of hyperreflective foci (HF), grades of ellipsoid zone disruptions, and baseline central subfield thicknesses (CSTs) using OCT of patients with DME. The average duration of action of dexamethasone implants was 4.32 ± 1.18 months. In multivariate linear regression analyses, the duration of action was associated with aqueous IL-8 levels and the number of HF (β = −0.016, p = 0.037 and β = −0.073, p = 0.035, respectively). Multivariate logistic regression showed that the number of HF (>10) was significantly associated with a shorter duration (<4 months) of action (odds ratio: 17.17, p = 0.010). The duration of action of intravitreal dexamethasone implants in DME patients was associated with the level of aqueous IL-8 and the number of HF using OCT. Specifically, higher number of HF in the OCT was associated with a shorter duration of action.

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          Most cited references35

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          Molecular basis of the inner blood-retinal barrier and its breakdown in diabetic macular edema and other pathological conditions.

          Breakdown of the inner endothelial blood-retinal barrier (BRB), as occurs in diabetic retinopathy, age-related macular degeneration, retinal vein occlusions, uveitis and other chronic retinal diseases, results in vasogenic edema and neural tissue damage, causing loss of vision. The central mechanism of altered BRB function is a change in the permeability characteristics of retinal endothelial cells caused by elevated levels of growth factors, cytokines, advanced glycation end products, inflammation, hyperglycemia and loss of pericytes. Subsequently, paracellular but also transcellular transport across the retinal vascular wall increases via opening of endothelial intercellular junctions and qualitative and quantitative changes in endothelial caveolar transcellular transport, respectively. Functional changes in pericytes and astrocytes, as well as structural changes in the composition of the endothelial glycocalyx and the basal lamina around BRB endothelium further facilitate BRB leakage. As Starling's rules apply, active transcellular transport of plasma proteins by the BRB endothelial cells causing increased interstitial osmotic pressure is probably the main factor in the formation of macular edema. The understanding of the complex cellular and molecular processes involved in BRB leakage has grown rapidly in recent years. Although appropriate animal models for human conditions like diabetic macular edema are lacking, these insights have provided tools for rational design of drugs aimed at restoring the BRB as well as for design of effective transport of drugs across the BRB, to treat the chronic retinal diseases such as diabetic macular edema that affect the quality-of-life of millions of patients. 2013 Elsevier Ltd. All rights reserved.
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            Prevalence of and risk factors for diabetic macular edema in the United States.

            Diabetic macular edema (DME) is a leading cause of vision loss in persons with diabetes mellitus. Although there are national estimates for the prevalence of diabetic retinopathy and its risk factors among persons with diabetes, to our knowledge, no comparable estimates are available for DME specifically.
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              A randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema: the BEVORDEX study.

              To report the 12-month results of the first head-to-head comparison of a dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, CA) versus bevacizumab (Avastin; Genentech, South San Francisco, CA) for center-involving diabetic macular edema (DME).
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                Author and article information

                Contributors
                krnjs99@catholic.ac.kr
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                20 December 2019
                20 December 2019
                2019
                : 9
                : 19588
                Affiliations
                [1 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Ophthalmology, Seoul St. Mary’s, Hospital, College of Medicine, , Catholic University of Korea, ; Seoul, South Korea
                [2 ]ISNI 0000 0004 0470 4224, GRID grid.411947.e, Department of Ophthalmology, St. Vincent’s, Hospital, College of Medicine, , Catholic University of Korea, ; Seoul, South Korea
                Author information
                http://orcid.org/0000-0003-2093-4284
                Article
                56143
                10.1038/s41598-019-56143-1
                6925102
                31862943
                1cdd7c53-742f-47ac-9de8-a481e1844ea1
                © The Author(s) 2019

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 8 August 2019
                : 7 December 2019
                Funding
                Funded by: Aju Pharm from Catholic Medical Center Research Foundation (2018)
                Categories
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                © The Author(s) 2019

                Uncategorized
                retinal diseases,diseases
                Uncategorized
                retinal diseases, diseases

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