nach oben

Acta Diabetologica

Erschienen in:

01.03.2019 | Original Article

Efficacy of vitrectomy combined with an intraoperative dexamethasone implant in refractory diabetic macular edema

verfasst von: Young Hoon Jung, Younghoon Lee

Erschienen in: Acta Diabetologica | Ausgabe 6/2019

Einloggen, um Zugang zu erhalten

Abstract

Aims

To evaluate the safety and efficacy of vitrectomy combined with an intraoperative dexamethasone (Ozurdex^®) implant in refractory diabetic macular edema (DME).

Methods

Patients who were diagnosed at our institution as having DME refractory to more than 6 months of non-surgical treatment and underwent intravitreal dexamethasone implantation combined with vitrectomy. All patients were followed up for more than 12 months. Best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT), and intraocular pressure at the initial visit and 1, 3, 4, 6, and 12 months after treatment were recorded.

Results

Twenty-two eyes (22 patients) were included in this study. The mean preoperative BCVA was 0.68 and the mean CMT was 470.80 µm. The total number of the previous injections was 5.1 ± 1.6. The mean BCVA was significantly improved at all visits, and the mean CMT was also significantly reduced (p < 0.05). Sixteen eyes (73%) did not need additional implantations during follow-up.

Conclusions

Vitrectomy combined with an intraoperative dexamethasone (Ozurdex) implant was an effective and safe treatment option in patients with refractory DME.

Pelzek C, Lim KI (2002) Diabetic macular edema: review and update. Ophthalmol Clin N Am 15:555–563CrossRef

Early Treatment Diabetic Retinopathy Study Research Group (1985) Photocoagulation for diabetic macular edema Early Treatment Diabetic Retinopathy Study report number 1. Arch Ophthalmol 103:1796–1806CrossRef

Early Treatment Diabetic Retinopathy Study Research Group (1995) Focal photocoagulation treatment of diabetic macular edema Relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline: ETDRS report no. 19. Arch Ophthalmol 113:1144–1155CrossRef

Diabetic Retinopathy Clinical Research Network (DRCR.net) (2016) Aflibercept, bevacizumab, or ranibizumab for diabetic macular edema: two-year results from a comparative effectiveness randomized clinical trial. Ophthalmology 123:1351–1359CrossRef

Massin P, Audren F, Haouchine B et al (2004) Intravitreal triamcinolone acetonide for diabetic diffuse macular edema: preliminary results of a prospective controlled trial. Ophthalmology 111:218–224. https://doi.org/10.1016/j.ophtha.2003.05.037 CrossRef

Vasconcelos-Santos DV, Nehemy PG, Schachat AP, Nehemy MB (2008) Secondary ocular hypertension after intravitreal injection of 4 mg of triamcinolone acetonide: incidence and risk factors. Retina 28:573–580. https://doi.org/10.1097/IAE.0b013e31816079e8 CrossRefPubMed

Rosenblatt BJ, Shah GK, Sharma S, Bakal J (2005) Pars plana vitrectomy with internal limiting membranectomy for refractory diabetic macular edema without a taut posterior hyaloid. Graefes Arch Clin Exp Ophthalmol 243:20–25. https://doi.org/10.1007/s00417-004-0958-z CrossRefPubMed

Kumagai K, Furukawa M, Ogino N, Larson E, Iwaki M, Tachi N (2009) Long-term follow-up of vitrectomy for diffuse nontractional diabetic macular edema. Retina 29:464–472. https://doi.org/10.1097/IAE.0b013e31819c632f CrossRefPubMed

Dillinger P, Mester U (2004) Vitrectomy with removal of the internal limiting membrane in chronic diabetic macular oedema. Graefes Arch Clin Exp Ophthalmol 242:630–637. https://doi.org/10.1007/s00417-003-0849-8 CrossRefPubMed

10.

Flaxel CJ, Edwards AR, Aiello LP et al (2010) Factors associated with visual acuity outcomes after vitrectomy for diabetic macular edema: diabetic retinopathy clinical research network. Retina 30:1488–1495. https://doi.org/10.1097/IAE.0b013e3181e7974f CrossRefPubMed

11.

Lee SS, Ghosn C, Yu Z et al (2010) Vitreous VEGF clearance is increased after vitrectomy. Investig Ophthalmol Vis Sci 51:2135–2138. https://doi.org/10.1167/iovs.09-3582 CrossRef

12.

Pacella F, Ferraresi AF, Turchetti P et al (2016) Intravitreal injection of Ozurdex implant in patients with persistent diabetic macular edema, with six-month follow-up. Ophthalmol Eye Dis 8:11–16. https://doi.org/10.4137/OED.S38028 CrossRefPubMedPubMedCentral

13.

Gillies MC, Lim LL, Campain A et al (2014) A randomized clinical trial of intravitreal bevacizumab versus dexamethasone for diabetic macular edema: the BEVORDEX study. Ophthalmology 121:2473–2481. https://doi.org/10.1016/j.ophtha.2014.07.002 CrossRefPubMed

14.

Lazic R, Lukic M, Boras I et al (2014) Treatment of anti-vascular endothelial growth factor-resistant diabetic macular edema with dexamethasone intravitreal implant. Retina 34:719–724. https://doi.org/10.1097/IAE.0b013e3182a48958 CrossRefPubMed

15.

Dutra Medeiros M, Postorino M, Navarro R, Garcia-Arumí J, Mateo C, Corcóstegui B (2014) Dexamethasone intravitreal implant for treatment of patients with persistent diabetic macular edema. Ophthalmologica 231:141–146. https://doi.org/10.1159/000356413 CrossRefPubMed

16.

Catharina B, Dinah Z, Samantha FB et al (2018) Shall we stay, or shall we switch? Continued anti-VEGF therapy versus early switch to dexamethasone implant in refractory diabetic macular edema. Acta Diabetol 55:789–796CrossRef

17.

Diabetic Retinopathy Clinical Research Network, Beck RW, Edwards AR, Aiello LP, Bressler NM, Ferris F, Glassman AR, Hartnett E, Ip MS, Kim JE, Kollman C (2009) Three-year follow-up of a randomized trial comparing focal/grid photocoagulation and intravitreal triamcinolone for diabetic macular edema. Arch Ophthalmol 127:245–251. https://doi.org/10.1001/archophthalmol.2008.610 CrossRefPubMedCentral

18.

Aiello LP, Avery RL, Arrigg PG et al (1994) Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 331:1480–1487. https://doi.org/10.1056/NEJM199412013312203 CrossRefPubMed

19.

Diabetic Retinopathy Clinical Research Network, Scott IU, Edwards AR et al (2007) A phase II randomized clinical trial of intravitreal bevacizumab for diabetic macular edema. Ophthalmology 114:1860–1867. https://doi.org/10.1016/j.ophtha.2007.05.062 CrossRefPubMedCentral

20.

Bakri SJ, Snyder MR, Reid JM et al (2007) Pharmacokinetics of intravitreal bevacizumab (Avastin). Ophthalmology 114:855–859. https://doi.org/10.1016/j.ophtha.2007.01.017 CrossRefPubMed

21.

Shimura M, Nakazawa T, Yasuda K et al (2008) Comparative therapy evaluation of intravitreal bevacizumab and triamcinolone acetonide on persistent diffuse diabetic macular edema. Am J Ophthalmol 145:854–861. https://doi.org/10.1016/j.ajo.2007.12.031 CrossRefPubMed

22.

Thakur A, Kadam R, Kompella UB (2001) Trabecular meshwork and lens partitioning of corticosteroids: implications for elevated intraocular pressure and cataracts. Arch Ophthalmol 129:914–920. https://doi.org/10.1001/archophthalmol.2011.39 CrossRef

23.

Chang-Lin JE, Burke JA, Peng Q et al (2011) Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes. Investig Ophthalmol Vis Sci 52:4605–4609. https://doi.org/10.1167/iovs.10-6387 CrossRef

24.

Yu IC, Song S, Seo MS (2002) Peeling of internal limiting membrane for diabetic macular edema with severe hard exudates. J Korean Ophthalmol Soc 43:630–637 (242)

25.

Patel JI, Hykin PG, Schadt M et al (2006) Pars plana vitrectomy with and without peeling of the inner limiting membrane for diabetic macular edema. Retina 26:5–13CrossRef

26.

Lee DH, Kim YJ, Yoon YH (2016) Minimally invasive microincision vitrectomy surgery with an intraoperative dexamethasone implant for refractory diabetic macular edema. Ophthalmologica 235:150–156. https://doi.org/10.1159/000443751 CrossRefPubMed

27.

Lea Q, Mariacristina P, Riccardo S et al (2017) Ischemic index changes in diabetic retinopathy after intravitreal dexamethasone implant using ultra-widefield fluorescein angiography: a pilot study. Acta Diabetol 54:769–773CrossRef

28.

Matias I, Dinah Z, Catharina B, Mali O, Anat L (2018) Progression of diabetic retinopathy severity after treatment with dexamethasone implant: a 24-month cohort study the ‘DR–Pro–DEX Study’. Acta Diabetol 55:541–547CrossRef

Titel: Efficacy of vitrectomy combined with an intraoperative dexamethasone implant in refractory diabetic macular edema
verfasst von: Young Hoon Jung
Younghoon Lee
Publikationsdatum: 01.03.2019
Verlag: Springer Milan
Erschienen in: Acta Diabetologica / Ausgabe 6/2019
Print ISSN: 0940-5429
Elektronische ISSN: 1432-5233
DOI: https://doi.org/10.1007/s00592-019-01305-w

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Aims

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 6/2019

A marker of type VI collagen formation (PRO-C6) is associated with higher arterial stiffness in type 1 diabetes

A common polymorphism in MIR155 gene promoter region is associated with a lower risk to develop type 2 diabetes

Ten years of experience with DPP-4 inhibitors for the treatment of type 2 diabetes mellitus

Agonistic autoantibodies against B2-adrenergic receptors correlating with macrovascular disease in longstanding diabetes type 2

Spousal diabetes status as a risk factor for incident type 2 diabetes: a prospective cohort study and meta-analysis

Cross-talk between fetal membranes and visceral adipose tissue involves HMGB1–RAGE and VIP–VPAC2 pathways in human gestational diabetes mellitus