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      Efficacy and Safety of Combined Vitrectomy with Intravitreal Dexamethasone Implant for Advanced Stage Epiretinal Membrane

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          Abstract

          Purpose

          To evaluate the efficacy and safety of combined 25-gauge (G) pars plana vitrectomy (PPV) with intravitreal dexamethasone implant (DXI) for the treatment of advanced stage epiretinal membrane (ERM).

          Methods

          Forty consecutive pseudophakic eyes with idiopathic stage 3–4 ERM and intraretinal cysts were randomly assigned to two treatment groups. Twenty eyes underwent combined 25-G PPV, ERM peeling and slow-release DXI (DEX group), whereas 20 eyes underwent standard 25-G PPV with ERM peeling only (control group). Differences in postoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT) were evaluated.

          Results

          In all patients, BCVA significantly increased at 1, 3 and 6 months after surgery compared to baseline (all p < 0.05), but at 3 and 6 months, the visual gain was higher in the DEX group (respectively, p = 0.036, p = 0.006). CMT was significantly lower in DEX group compared to control group at 3 and 6 months after surgery (respectively, p = 0.042, p = 0.003). There was no statistically significant difference in IOP change over the course of the follow-up between groups ( p > 0.05).

          Conclusion

          Combined 25-G PPV with DXI is associated with better anatomical and functional outcomes in patients with advanced stage ERM.

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          Most cited references 19

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          Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients.

          To evaluate the safety and efficacy of Ozurdex (dexamethasone intravitreal implant) 0.7 mg in the treatment of diabetic macular edema in vitrectomized eyes. This was a prospective, multicenter, open-label, 26-week study. Fifty-five patients with treatment-resistant diabetic macular edema and a history of previous pars plana vitrectomy in the study eye received a single intravitreal injection of 0.7-mg dexamethasone intravitreal implant. The primary efficacy outcome measure was the change in central retinal thickness from baseline to Week 26 measured by optical coherence tomography. The mean age of patients was 62 years. The mean duration of diabetic macular edema was 43 months. The mean (95% confidence interval) change from baseline central retinal thickness (403 μm) was -156 μm (-190, -122 μm) at Week 8 (P < 0.001) and -39 μm (-65, -13 μm) at Week 26 (P = 0.004). The mean (95% CI) increase in best-corrected visual acuity from baseline (54.5 letters) was 6.0 letters (3.9, 8.1 letters) at Week 8 (P < 0.001) and 3.0 letters (0.1, 6.0 letters) at Week 26 (P = 0.046). At Week 8, 30.4% of patients had gained ≥10 letters in best-corrected visual acuity. Conjunctival hemorrhage, conjunctival hyperemia, eye pain, and increased intraocular pressure were the most common adverse events. Treatment with dexamethasone intravitreal implant led to statistically and clinically significant improvements in both vision and vascular leakage from diabetic macular edema in difficult-to-treat vitrectomized eyes and had an acceptable safety profile.
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            Pathology of cystoid macular edema.

             Mark O.M. Tso (1982)
            In order to define the pathology of cystoid macular edema (CME), 35 human cases with histopathologic features of CME were reviewed. The macular cysts appeared in different layers of the retina in eyes after cataract extraction, retinal vein occlusion, trauma, diabetes mellitus, and accelerated hypertension. The pathologic process varied from transudation, exudation to liquefaction necrosis. The experimental models of lens extraction and talc retinopathy in rhesus monkeys were examined. Disruption of the blood-retinal barrier at the retinal vasculature and retinal pigment epithelium were noted after lens extraction. Cystoid degeneration of the macula was seen in monkeys with talc retinopathy. The possibility that disruption of the blood-retinal barrier and microinfarction play important roles in the formation of the macular cysts is proposed.
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              Prevalence and risk factors for epiretinal membranes in a multi-ethnic United States population.

              To describe the prevalence of and risk factors for epiretinal membrane (ERM) in a multi-ethnic population and to evaluate possible racial or ethnic differences. Cross-sectional study. Participants of the Multi-Ethnic Study of Atherosclerosis (MESA), examined at the second visit of the MESA when retinal photography was performed. Data on 5960 participants aged 45 to 84 years from MESA, including white, black, Hispanic, and Chinese persons from 6 United States communities, were analyzed. Epiretinal membrane was assessed from digital nonstereoscopic fundus photographs and was defined as cellophane macular reflex (CMR) without retinal folds or preretinal macular fibrosis (PMF) with retinal folds. Risk factors were assessed from standardized interviews, clinical examinations, and laboratory investigations. Epiretinal membrane prevalence by ethnic or racial group and risk factors associated with ERM. The prevalence of any ERM was 28.9%, of which 25.1% were CMR cases and 3.8% were PMF cases. The prevalence of ERM was significantly higher in Chinese persons (39.0%), compared with Hispanic (29.3%), white (27.5%), or black (26.2%; P<0.001) persons. In multivariate models, increasing age (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06-1.34, per year increase in age), diabetes (OR, 1.92; 95% CI, 1.39-2.65), and hypercholesterolemia (OR, 1.33; 95% CI, 1.04-1.69) were significantly associated with CMR. This study showed that ERM was significantly more common in Chinese persons compared with whites, blacks, and Hispanics. Risk factors for ERM were increasing age, presence of diabetes, and hypercholesterolemia. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                DDDT
                dddt
                Drug Design, Development and Therapy
                Dove
                1177-8881
                03 December 2019
                2019
                : 13
                : 4107-4114
                Affiliations
                [1 ]Department of Surgical Sciences, Eye Clinic, University of Cagliari , Cagliari, Italy
                [2 ]Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna , Bologna, Italy
                [3 ]Department of Ophthalmology, Ospedale Careggi , Firenze, Italy
                [4 ]Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari , Cagliari, Italy
                Author notes
                Correspondence: Enrico Peiretti Eye Clinic, University of Cagliari , Via Ospedale 48, Cagliari09124, ItalyTel\Fax +390706092319 Email enripei@hotmail.com
                Article
                229031
                10.2147/DDDT.S229031
                6899066
                © 2019 Iovino et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, Tables: 3, References: 23, Pages: 8
                Categories
                Original Research

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