Dataset Information

Long-term management of non-ischemic central retinal vein occlusion with fluocinolone acetonide intravitreal implant 190 ?g (ILUVIEN®).

ABSTRACT: Introduction:Macular edema after central retinal vein occlusion is a common cause of vision loss. Upregulation of vascular endothelial growth factor and higher levels of inflammatory mediators have been involved in the pathogeny of the macular edema in central retinal vein occlusion. Case report:The authors report a case with non-ischemic central retinal vein occlusion that was successfully treated with a single sustained-release fluocinolone acetonide intravitreal implant. After a course of repeated injections of shorter-acting corticosteroid, the affected eye presented a visual acuity of 20/200 and a central subfield foveal thickness of 587 µm. After fluocinolone acetonide in intravitreal implant and during a follow-up period of 12 months, a continuous and sustained increase in visual acuity until 20/25 with significant anatomical improvements and an acceptable safety profile was observed. Conclusion:These results, demonstrate that fluocinolone acetonide intravitreal implant might be an effective treatment option in macular edema secondary to non-ischemic central retinal vein occlusion.

SUBMITTER: Coelho J

PROVIDER: S-EPMC6322089 | biostudies-other | 2019 Jan-Dec

REPOSITORIES: biostudies-other

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Long-term management of non-ischemic central retinal vein occlusion with fluocinolone acetonide intravitreal implant 190 μg (ILUVIEN®).

Coelho João J Pessoa Bernardete B Meireles Angelina A

Therapeutic advances in ophthalmology 20190105

<h4>Introduction</h4>Macular edema after central retinal vein occlusion is a common cause of vision loss. Upregulation of vascular endothelial growth factor and higher levels of inflammatory mediators have been involved in the pathogeny of the macular edema in central retinal vein occlusion.<h4>Case report</h4>The authors report a case with non-ischemic central retinal vein occlusion that was successfully treated with a single sustained-release fluocinolone acetonide intravitreal implant. After ...[more]

PMID: 30643869

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Project description:BackgroundThe comparative safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is unclear.ObjectivesThis meta-analysis aimed to compare the safety and efficacy of different doses of IVTA in this setting.MethodsA systematic literature search for randomized clinical trials (RCTs) was conducted on Cochrane Library, Ovid MEDLINE, and EMBASE from January 2005 to May 2022. Studies that reported on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA were included. A random-effects meta-analysis was performed. Cochrane's Risk of Bias Tool 2 was used to assess the risk of bias, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines were used to assess certainty of evidence.ResultsFive RCTs reporting on 1,041 eyes at baseline were included in this meta-analysis. In eyes with ME secondary to RVO, high-dose (4 mg) IVTA achieved a significantly better change in best-corrected visual acuity (WMD = -4.75 ETDRS letters, 95% CI = [-7.73, -1.78], p = 0.002) and reduction in retinal thickness (WMD = -93.02 μm, 95% CI = [-153.23, -32.82], p = 0.002) at months 4-6 compared to low-dose (1-2 mg) IVTA. However, high-dose IVTA had a higher risk of intraocular pressure-related adverse events (RR = 2.99, 95% CI = [1.05, 8.50], p = 0.04) and cataract surgery (RR = 5.67, 95% CI = [3.09, 10.41], p < 0.00001) than low-dose IVTA in eyes with ME secondary to RVO. These efficacy and safety differences in high-dose and low-dose IVTA were not observed in DME eyes.ConclusionsThe RCT evidence in this setting is limited. High-dose IVTA achieved greater improvements in visual acuity and reductions in retinal thickness than low-dose IVTA at months 4-6. However, high-dose IVTA had a less favorable safety profile than low-dose IVTA. The significance of these outcomes was based on patients with ME secondary to RVO, but not DME.

Project description:BackgroundRetinal vein occlusion (RVO) is the second most common vision-threatening retinal vascular disease. Intravitreal dexamethasone implant has been applied to treat macular edema secondary to RVO (RVO-ME). However, the alteration of morphologic features detected with optical coherence tomography angiography (OCTA) has not been fully studied in RVO-ME patients before and after the treatment.ObjectiveThis study is aimed at identifying potential therapeutic targets in RVO with integrative bioinformatic analysis and compares the OCTA characteristics alterations in patients with RVO-ME receiving injection of dexamethasone intravitreal implant.MethodsBioinformatic analysis was analyzed in GSE101398 dataset from the Gene Expression Omnibus database. Multiple functional enrichment analyses were performed, and protein-protein interaction network was constructed to visualize the key node genes. Eleven eyes with RVO-ME were examined with OCTA before and after intravitreal dexamethasone implant. The OCTA parameters, including macular thickness, vessel density, foveal avascular zone parameters, the number of hyperreflective foci (HRF), area of cystoid edema, and subretinal fluid (SRF), were compared. The correlation was analyzed between best-corrected visual acuity (BCVA) and OCTA parameters.ResultsA total of 79 differentially expressed genes were identified. Functional enrichment analyses revealed the enriched inflammatory events in RVO. In RVO-ME, Pearson correlation revealed that baseline BCVA was positively correlated with the area of SRF and central macular thickness, while no correlation was detected between baseline BCVA and HRF number or the area of cystoid edema. The visual acuity improved, and the central macular thickness was decreased after intravitreal dexamethasone implant injection. Besides, the number of HRF, the area of cystoid edema, and SRF were significantly alleviated after dexamethasone intravitreal injection.ConclusionRetinal inflammation plays a crucial role in RVO pathogenesis. The imaging biomarkers of RVO including Müller glial intracellular edema, and retinal pigment epithelium dysfunction, could be assessed in OCTA and attenuated by intravitreal dexamethasone implant effectively.

Dataset Information

Long-term management of non-ischemic central retinal vein occlusion with fluocinolone acetonide intravitreal implant 190 ?g (ILUVIEN®).

Publications

Long-term management of non-ischemic central retinal vein occlusion with fluocinolone acetonide intravitreal implant 190 μg (ILUVIEN®).

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