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Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic agent in patients with macular edema: A retrospective cohort study.

Abstract To evaluate the safety and efficiency in macular edema patients who concurrently received a single injection of a dexamethasone intravitreal implant (DEX, 0.7 mg) and ranibizumab (2.3 mg).A retrospective cohort study was conducted, and medical records from 2012 to 2016 were reviewed. Patients who received concurrent DEX and ranibizumab injections with a follow-up period of at least 3 months were enrolled in the study group. An age and gender-matched group received ranibizumab injections and was designated the control group. The best-corrected visual acuity (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were included in the analysis. Steroid-induced ocular hypertension (SIOH) is defined as either an elevation of more than 10 mmHg from baseline or a single IOP measurement of more than 30 mmHg.A total of 26 patients were enrolled in the current study with 13 patients in each group. Both the BCVA (P = .04) and CMT (P < .01) achieved significant improvement after the follow-up period in the study group. The IOP increased after the injection but no significant elevation was observed throughout the follow-up period in the study group (P = .15). For SIOH, 1 patient in the study group had an elevated IOP of 10 mmHg (7.7%) at 2 postoperative months, and no single IOP measurement of more than 30 mmHg was obtained. Five patients (38.5%) in the study group received medical treatment that successfully retarded their IOP elevation, and no individuals required surgical management. In the control group, there were no significant fluctuations concerning BCVA, CMT, and IOP, and no ocular hypertension was observed. According to the inter-group analysis, the CMT and BCVA recovered more significantly in the study group than in the control group.Concurrent injection of DEX and ranibizumab is a preliminary method that shows effectiveness in treating ME. Furthermore, safety is also guaranteed, with moderate levels of severity and transient IOP elevation being observed. A future large-scale study is necessary to evaluate the long-term effects and safety of this combined treatment.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29382007
OWN - NLM
STAT- MEDLINE
DCOM- 20180209
LR  - 20180209
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 47
DP  - 2017 Nov
TI  - Concurrent injection of dexamethasone intravitreal implant and anti-angiogenic
      agent in patients with macular edema: A retrospective cohort study.
PG  - e8868
LID - 10.1097/MD.0000000000008868 [doi]
AB  - To evaluate the safety and efficiency in macular edema patients who concurrently 
      received a single injection of a dexamethasone intravitreal implant (DEX, 0.7 mg)
      and ranibizumab (2.3 mg).A retrospective cohort study was conducted, and medical 
      records from 2012 to 2016 were reviewed. Patients who received concurrent DEX and
      ranibizumab injections with a follow-up period of at least 3 months were enrolled
      in the study group. An age and gender-matched group received ranibizumab
      injections and was designated the control group. The best-corrected visual acuity
      (BCVA), central macular thickness (CMT) and intraocular pressure (IOP) were
      included in the analysis. Steroid-induced ocular hypertension (SIOH) is defined
      as either an elevation of more than 10 mmHg from baseline or a single IOP
      measurement of more than 30 mmHg.A total of 26 patients were enrolled in the
      current study with 13 patients in each group. Both the BCVA (P = .04) and CMT (P 
      &lt; .01) achieved significant improvement after the follow-up period in the study
      group. The IOP increased after the injection but no significant elevation was
      observed throughout the follow-up period in the study group (P = .15). For SIOH, 
      1 patient in the study group had an elevated IOP of 10 mmHg (7.7%) at 2
      postoperative months, and no single IOP measurement of more than 30 mmHg was
      obtained. Five patients (38.5%) in the study group received medical treatment
      that successfully retarded their IOP elevation, and no individuals required
      surgical management. In the control group, there were no significant fluctuations
      concerning BCVA, CMT, and IOP, and no ocular hypertension was observed. According
      to the inter-group analysis, the CMT and BCVA recovered more significantly in the
      study group than in the control group.Concurrent injection of DEX and ranibizumab
      is a preliminary method that shows effectiveness in treating ME. Furthermore,
      safety is also guaranteed, with moderate levels of severity and transient IOP
      elevation being observed. A future large-scale study is necessary to evaluate the
      long-term effects and safety of this combined treatment.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Lin, Hung-Yu
AU  - Lin HY
AD  - Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua.
AD  - Institute of Medicine.
AD  - Department of Optometry, Chung Shan Medical University, Taichung.
AD  - Department of Optometry, Yuanpei University of Medical Technology, Hsinchu.
FAU - Lee, Chia-Yi
AU  - Lee CY
AD  - Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua.
FAU - Huang, Jing-Yang
AU  - Huang JY
AD  - Department of Medical Research, Chung Shan Medical University Hospital, Taichung.
FAU - Yang, Shun-Fa
AU  - Yang SF
AD  - Institute of Medicine.
AD  - Department of Medical Research, Chung Shan Medical University Hospital, Taichung.
FAU - Chao, Shih-Chun
AU  - Chao SC
AD  - Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua.
AD  - Department of Electrical and Computer Engineering, National Chiao Tung
      University, Hsinchu.
AD  - Department of Optometry, Central Taiwan University of Science and Technology,
      Taichung, Taiwan.
LA  - eng
PT  - Evaluation Studies
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Angiogenesis Inhibitors)
RN  - 0 (Drug Implants)
RN  - 7S5I7G3JQL (Dexamethasone)
RN  - ZL1R02VT79 (Ranibizumab)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Angiogenesis Inhibitors/*administration &amp; dosage
MH  - Dexamethasone/*administration &amp; dosage
MH  - Drug Implants
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Intraocular Pressure/drug effects
MH  - Intravitreal Injections
MH  - Macula Lutea/drug effects/pathology
MH  - Macular Edema/*drug therapy/pathology
MH  - Male
MH  - Middle Aged
MH  - Ocular Hypertension/chemically induced
MH  - Ranibizumab/*administration &amp; dosage
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Visual Acuity/drug effects
PMC - PMC5709006
EDAT- 2018/02/01 06:00
MHDA- 2018/02/10 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/10 06:00 [medline]
AID - 10.1097/MD.0000000000008868 [doi]
AID - 00005792-201711270-00098 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Nov;96(47):e8868. doi: 10.1097/MD.0000000000008868.