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      Drug Design, Development and Therapy (submit here)

      This international, peer-reviewed Open Access journal by Dove Medical Press focuses on the design and development of drugs, as well as the clinical outcomes, patient safety, and programs targeted at the effective and safe use of medicines. Sign up for email alerts here.

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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.

          Most cited references19

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

          Xiao Li, Jean-Lou Cochon, Scott Whitcup … (2011)
          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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            Prevalence and risk factors for epiretinal membranes in a multi-ethnic United States population.

            Fakir M. Amirul Islam, Ronald Klein, Mary Frances Cotch … (2011)
            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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              Difference in clearance of intravitreal triamcinolone acetonide between vitrectomized and nonvitrectomized eyes.

              Hee Chin, Tae Park, Yeon Sung Moon … (2016)
              To study the difference in clearance of intravitreal triamcinolone acetonide quantitatively between vitrectomized and nonvitrectomized eyes. Eighty-four eyes of 42 rabbits were divided in 2 groups: 42 right eyes underwent standard pars plana vitrectomy (vitrectomized group), and 42 left eyes were not operated on (nonvitrectomized group). All eyes received intravitreal injections with 0.1 mL (0.3 mg) of triamcinolone acetonide. Every 12 eyes were obtained by killing 6 rabbits 1, 2, 4, 7, 12, 20, or 30 days after intravitreal injection. Each eye was enucleated and immediately frozen at -70 degrees C. The frozen vitreous was prepared for measuring the concentration of triamcinolone acetonide. Triamcinolone acetonide was quantified by high-performance liquid chromatography and ultraviolet absorbance detection. After 30 days, triamcinolone acetonide was detected only in 1 eye (0.22 microg/mL) in the vitrectomized group compared with 4 of 6 eyes (0.92 +/- 1.25 microg/mL) in the nonvitrectomized group. The coefficient of logarithmic regression was -0.12 in the vitrectomized group and -0.08 in the nonvitrectomized group. Triamcinolone acetonide decreased 1.5 times more rapidly in the vitrectomized group than in the nonvitrectomized group. The half-life of triamcinolone acetonide was 1.57 days in the vitrectomized group and 2.89 days in the nonvitrectomized group. Intravitreal triamcinolone acetonide decreases more rapidly in the vitrectomized eye than in the nonvitrectomized eye. Therefore, the faster clearance of intravitreal triamcinolone acetonide must be considered when planning intravitreal injection of triamcinolone acetonide in the vitrectomized eye.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Drug Des Devel Ther
                Journal ID (iso-abbrev): Drug Des Devel Ther
                Journal ID (publisher-id): DDDT
                Journal ID (pmc): dddt
                Title: Drug Design, Development and Therapy
                Publisher: Dove
                ISSN (Electronic): 1177-8881
                Publication date (Electronic): 03 December 2019
                Publication date Collection: 2019
                Volume: 13
                Pages: 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
                Author information
                http://orcid.org/0000-0003-1984-0555
                http://orcid.org/0000-0002-6419-6941
                http://orcid.org/0000-0003-1025-7822
                Article
                Publisher ID: 229031
                DOI: 10.2147/DDDT.S229031
                PMC ID: 6899066
                PubMed ID: 31819377
                SO-VID: 4d1bf0ec-0ffa-4187-95f8-af8e7eb4d786
                Copyright © © 2019 Iovino et al.
                License:

                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).

                History
                Date received : 28 August 2019
                Date accepted : 14 November 2019
                Page count
                Figures: 2, Tables: 3, References: 23, Pages: 8
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: epiretinal membrane,intravitreal dexamethasone,macular pucker,intraretinal cysts
                Data availability:
                ScienceOpen disciplines: Pharmacology & Pharmaceutical medicine
                Keywords: epiretinal membrane, intravitreal dexamethasone, macular pucker, intraretinal cysts

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