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      Local delivery of corticosteroids in clinical ophthalmology: A review

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          Abstract

          Locally administered steroids have a long history in ophthalmology for the treatment of inflammatory conditions. Anterior segment conditions tend to be treated with topical steroids whilst posterior segment conditions generally require periocular, intravitreal or systemic administration for penetration. Over recent decades, the clinical applications of periocular steroid delivery have expanded to a wide range of conditions including macular oedema from retino‐vascular conditions. Formulations have been developed with the aim to provide practical, targeted, longer‐term and more efficacious therapy whilst minimizing side effects. Herein, we provide a comprehensive overview of the types of periocular steroid delivery, their clinical applications in ophthalmology and their side effects.

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          Randomized trial evaluating ranibizumab plus prompt or deferred laser or triamcinolone plus prompt laser for diabetic macular edema.

          Evaluate intravitreal 0.5 mg ranibizumab or 4 mg triamcinolone combined with focal/grid laser compared with focal/grid laser alone for treatment of diabetic macular edema (DME). Multicenter, randomized clinical trial. A total of 854 study eyes of 691 participants with visual acuity (approximate Snellen equivalent) of 20/32 to 20/320 and DME involving the fovea. Eyes were randomized to sham injection + prompt laser (n=293), 0.5 mg ranibizumab + prompt laser (n=187), 0.5 mg ranibizumab + deferred (> or =24 weeks) laser (n=188), or 4 mg triamcinolone + prompt laser (n=186). Retreatment followed an algorithm facilitated by a web-based, real-time data-entry system. Best-corrected visual acuity and safety at 1 year. The 1-year mean change (+/-standard deviation) in the visual acuity letter score from baseline was significantly greater in the ranibizumab + prompt laser group (+9+/-11, P<0.001) and ranibizumab + deferred laser group (+9+/-12, P<0.001) but not in the triamcinolone + prompt laser group (+4+/-13, P=0.31) compared with the sham + prompt laser group (+3+/-13). Reduction in mean central subfield thickness in the triamcinolone + prompt laser group was similar to both ranibizumab groups and greater than in the sham + prompt laser group. In the subset of pseudophakic eyes at baseline (n=273), visual acuity improvement in the triamcinolone + prompt laser group appeared comparable to that in the ranibizumab groups. No systemic events attributable to study treatment were apparent. Three eyes (0.8%) had injection-related endophthalmitis in the ranibizumab groups, whereas elevated intraocular pressure and cataract surgery were more frequent in the triamcinolone + prompt laser group. Two-year visual acuity outcomes were similar to 1-year outcomes. Intravitreal ranibizumab with prompt or deferred laser is more effective through at least 1 year compared with prompt laser alone for the treatment of DME involving the central macula. Ranibizumab as applied in this study, although uncommonly associated with endophthalmitis, should be considered for patients with DME and characteristics similar to those in this clinical trial. In pseudophakic eyes, intravitreal triamcinolone + prompt laser seems more effective than laser alone but frequently increases the risk of intraocular pressure elevation. Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            Adverse events and complications associated with intravitreal injection of anti-VEGF agents: a review of literature.

            Intravitreal injection of anti-vascular endothelial growth factor (VEGF) agents is increasingly used for the treatment of a wide variety of retinal diseases, including age-related macular degeneration, diabetic retinopathy and retinal vascular occlusions, and retinopathy of prematurity. Despite encouraging results in halting the disease and improving the vision, intravitreal injection of anti-VEGF agents may be associated with systemic adverse events and devastating ocular complications. In this review, we provide an overview of safety data for intravitreal injection of common anti-VEGF agents.
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              Causes and frequency of blindness in patients with intraocular inflammatory disease.

              Uveitis, an intraocular inflammatory disease, is a significant cause of visual impairment. It is not known how many patients with uveitis will retain visual acuity and how many develop visual impairment or even blindness. The aim of this study was to assess the frequency of blindness in patients with uveitis and, more specifically, to identify the clinical profile of patients at risk for visual loss. A cross sectional and retrospective study of 582 patients with uveitis who visited the ophthalmology departments of two university hospitals in the Netherlands was performed. Within the group of 582 patients, 203 (35%) exhibited blindness or visual impairment; bilateral legal blindness developed in 22 (4%) patients, 26 (4.5%) had one blind eye with visual impairment of the other, and nine (1.5%) had bilateral visual impairment. Unilateral blindness developed in 82 (14%) patients, whereas 64 (11%) exhibited unilateral visual impairment. The most important cause of both blindness and visual impairment was cystoid macular oedema (29% and 41%, respectively). Complications of uveitis were encountered in more than half of the patients and 23% underwent one or more surgical procedures. When the patients were subdivided according to anatomical site, those with panuveitis had the worst visual prognosis. The systemic diseases associated with a poor visual prognosis were juvenile chronic arthritis and sarcoidosis. Ocular toxoplasmosis was the most frequent cause of unilateral visual loss. Cystoid macular oedema is the most frequent complication of uveitis and its occurrence plays a decisive role in the visual outcome of this disease.
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                Author and article information

                Contributors
                adrian.fung@sydney.edu.au
                Journal
                Clin Exp Ophthalmol
                Clin. Experiment. Ophthalmol
                10.1111/(ISSN)1442-9071
                CEO
                Clinical & Experimental Ophthalmology
                John Wiley & Sons Australia, Ltd (Melbourne )
                1442-6404
                1442-9071
                22 January 2020
                April 2020
                : 48
                : 3 ( doiID: 10.1111/ceo.v48.3 )
                : 366-401
                Affiliations
                [ 1 ] Westmead Clinical School Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales Australia
                [ 2 ] Department of Ophthalmology, Faculty of Medicine and Health Sciences Macquarie University Sydney New South Wales Australia
                [ 3 ] Save Sight Institute Central Clinical School, Discipline of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, New South Wales Australia
                [ 4 ] Royal Victorian Eye and Ear Hospital Melbourne Victoria Australia
                [ 5 ] Centre for Eye Research Australia Melbourne Victoria Australia
                [ 6 ] University of Melbourne Melbourne Victoria Australia
                [ 7 ] Liverpool Clinical School, Faculty of Medicine University of New South Wales Sydney New South Wales Australia
                [ 8 ] Marsden Eye Specialists Sydney New South Wales Australia
                [ 9 ] Children's Hospital Westmead Westmead New South Wales Australia
                [ 10 ] University of Otago Dunedin New Zealand
                [ 11 ] Royal Melbourne Hospital Melbourne Victoria Australia
                [ 12 ] Melbourne Retina Associates Melbourne Victoria Australia
                [ 13 ] Eye Doctors Mona Vale Sydney New South Wales Australia
                Author notes
                [*] [* ] Correspondence

                Adrian T. Fung, MMed, FRANZCO, Department of Ophthalmology, Westmead Hospital, Corner of Hawkesbury and Darcy Roads, Westmead, New South Wales 2145, Australia.

                Email: adrian.fung@ 123456sydney.edu.au

                Author information
                https://orcid.org/0000-0002-1117-3893
                https://orcid.org/0000-0002-0853-2226
                Article
                CEO13702
                10.1111/ceo.13702
                7187156
                31860766
                f753c809-56ab-4524-9ae6-fa8bfc997a20
                © 2019 The Authors. Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 July 2019
                : 21 November 2019
                : 09 December 2019
                Page count
                Figures: 2, Tables: 3, Pages: 36, Words: 21298
                Categories
                Review
                Review
                Custom metadata
                2.0
                April 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.1 mode:remove_FC converted:28.04.2020

                corticosteroid,dexamethasone,fluocinolone acetonide,prednisolone acetate,triamcinolone acetonide

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