Efficacy of Dexamethasone Implant in Secondary Macular Edema due to Posterior Non-Infectious Entities Other than Behçet Disease.

Abstract

Purpose Investigation of the efficacy of intravitreal 0,7 mg dexamethasone implant in patients who were diagnosed with posterior non-infectious uveitis entities other than Behçet's disease and had cystoid macular edema despite the immunomodulation. Materials and Methods This study included cases of dexamethasone implantation followed up for at least 12 months. Visual acuity, intraocular pressure, central macular thickness values in optic coherence tomography were recorded before and after. Systemic immunomodulatory treatment agents before the injections were also recorded. Throughout the follow-up, injection related complications and the need for recurrent injection of the implant were noted. Results Anatomical success was achieved at a statistically significant level and the efficacy was maintained for the first 2 months. Despite reaching the peak of visual acuity within the first 2 months following injection, there was no statistically significant in-crease in BCVA outcomes. There was no complication other than IOP elevation requiring short-term topical anti-glaucomatous use. Conclu-sion The use of adjuvant intravitreal 0,7 mg dexamethasone implant in these patients who had cystoid macular edema despite the immuno-modulatory treatment is effective for the preservation of the macular anatomy without causing any systemic toxicity. However, significant increase in BCVA could not be achieved in this study.

Keywords

• Adjuvant,Dexamethasone implant,Cystoid macular edema,Non-infectious uveitis

Behçet Hastalığı Dışındaki Sebeplerle Oluşan Non-Enfeksiyöz Posterior Üveite Sekonder Makula Ödeminde Deksametazon İmplantın Etkinliği.

Abstract

Amaç İmmünmodülatör tedavi kullanımına rağmen kistoid makula ödemi gelişen Behçet hastalığı dışındaki sebeplerle non-infeksiyoz poste-rior üveiti olan hastalarda adjuvan intravitreal 0,7 mg deksametazon salınım sistemi uygulamasının etkinliğinin araştırılması Materyal-Metod Bu çalışmaya Behçet hastalığı dışında non-enfeksiyöz posterior üveit tanısı almış 13 hastanın 17 gözüne yapılan ve en az 12 ay takip edilen deksametazon implant olguları dahil edilmiştir. Olguların demografik özellikleri, enjeksiyon sırasında kullanılmakta olduğu sistemik im-münmodülatör tedavisi, takip süresi, enjeksiyon öncesi ve enjeksiyon sonrası en iyi düzeltilmiş görme keskinliği, göz içi basınçlar değerleri, optik koherens tomografideki santral makula kalınlığı kaydedilmiştir. İzlem süresince implanta bağlı gelişen glokom, katarakt ve endoftalmi gb. komplikasyonlar ve implant enjeksiyonunun tekrarlanma durumu incelenmiştir. Bulgular Elde edilen veriler olgularda istatistiksel olarak anlamlı seviyede anatomik başarı elde edildiğini ve etkinliğin ilk 2 ay korunduğu göstermektedir. Enjeksiyonu takip eden ilk 2 ay içerisinde görme artışının tepe noktasına ulaşılmasına rağmen istatistiksel olarak anlamlı görme artışı elde edilemediği izlenmektedir. İki olguda gelişen kısa süreli topikal anti-glokomatöz kullanımını gerektiren GİB yüksekliği dışında komplikasyon izlenmemiştir. Sonuç Behçet hastalığı dışındaki non-enfeksiyöz posterior üveit tanılı olgularda sistemik tedaviye rağmen KMÖ gelişen olgularda adjuvan intravitreal deksametazon tedavisi sistemik toksisite oluşturmadan makuler anatominin korunması açısından önem arz etmektedir. Bu çalışmada görmede istenilen seviyede artış elde edilmemiştir.

Keywords

• Adjuvan,Deksametazon implant,Kistoid makula ödemi,Non-infeksiyoz üveit

References

1. 1.Durrani, O.M., C.A. Meads, P.I. Murray. 2004. Uveitis: apotentially blinding disease. Ophthalmologica 218: 223–236.
2. 2.Dick AD, Tundia N, Sorg R et al. Risk of ocular complications in patients with noninfectious ıntermediate uveitis, posterioruveitis, or panuveitis. Ophthalmology. 2016;123:655-62.
3. 3.Zouboulis CC. Epidemiology of Adamantiades-Behçet’s disea-se. Ann Med Interne 1999;150:488-98.
4. 4.Kazokoglu H, Onal S, Tugal-Tutkun I et al. Demographic andclinical features of uveitis in tertiary centers in Turkey. Opht-halmic Epidemiol. 2008;15:285-93.
5. 5.Onal S, Kazokoglu H, Koc A et al. Long-term efficacy andsafety of low-dose and dose-escalating interferon alfa-2a the-rapy in refractory Behçet uveitis. Arch Ophthalmol.2011;129:288-94.
6. 6.Chang-Lin JE, Attar M, Acheampong AA et al. Pharmacokine-tics and pharmacodynamics of a sustained-release dexametha-sone intravitreal implant. Invest Ophthalmol Vis Sci.2011;52:80-6.
7. 7.Boyer DS, Yoon YH, Belfort R Jr et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant inpatients with diabetic macular edema. Ophthalmology.2014;121:1904-14.
8. 8.Palla S, Biswas J, Nagesha CK. Efficacy of Ozurdex implant intreatment of noninfectious intermediate uveitis. Indian J Opht-halmol 2015;63:767-70.

9. 9.Ossewaarde-van Norel A, Rothova A. Clinical review: Update on Treatment of Inflammatory Macular Edema, Ocular Immu-nology and Inflammation, 19:1, 75-83.
10. 10.Sella R, Oray M, Friling R, Umar L, Tugal-Tutkun I, Kramer M.Dexamethasone intravitreal implant (Ozurdex®) for pediatricuveitis. Graefes Arch Clin Exp Ophthalmol. 2015;253:1777-82.
11. 11.van Kooij B, Probst K, Fijnheer R, Roest M, de Loos W, Rot-hova A. Risk factors for cystoid macular oedema in patientswith uveitis. Eye. 2008;22:256–260.
12. 12.Thorne JE, Daniel E, Jabs DA, Kedhar SR, Peters GB, Dunn JP.Smoking as a risk factor for cystoid macular edema complica-ting intermediate uveitis. Am J Ophthalmol. 2008;145:841–846.
13. 13.Markomichelakis NN, Halkiadakis I, Pantelia E, et al. Courseof macular edema in uveitis under medical treatment. Ocul Im-munol Inflamm. 2007;15:71–79.
14. 14.Tuncer S, Yilmaz S, Urgancioglu M, Tugal-Tutkun I. Resultsof intravitreal triamcinolone acetonide (IVTA) injection for thetreatment of panuveitis attacks in patients with Behçet disease.J Ocul Pharmacol Ther 2007; 23: 395-401.
15. 15.Kuppermann Bd, Blumenkranz Ms, Haller Ja, et al. Randomi-zed controlled study of an intravitreous dexamethasone drugdelivery system in patients with persistent macular edema. ArchOphthalmol. 2007;125:309–317.
16. 16.Pelegrín L, de la Maza MS, Molins B, Ríos J, Adán A. Long-term evaluation of dexamethasone intravitreal implant in vitrec-tomized and non-vitrectomized eyes with macular edema se-condary to non-infectious uveitis. Eye. 2015;29:943-50.
17. 17.Cao JH, Mulvahill M, Zhang L, Joondeph BC, Dacey MS.Dexamethasone intravitreal implant in the treatment of persis-tent uveitic macular edema in the absence of active inflamma-tion. Ophthalmology. 2014; 121: 1871–1876.
18. 18.Tomkins-Netzer O, Taylor Sr, Bar A, et al. Treatment withrepeat dexamethasone implants results in long-term diseasecontrol in eyes with noninfectious uveitis. Ophthalmology.2014;121:1649–1654.
19. 19.Zarranz-Ventura J, Carreño E, Johnston RL et al. Multicenter study of intravitreal dexamethasone implant in noninfectiousuveitis: indications, outcomes, and reinjection frequency. Am JOphthalmol. 2014;158:1136–1145. e1135
20. 20.Deuter CM, Kötter I, Günaydin I, Stübiger N, Doycheva DG,Zierhut M. Efficacy and tolerability of interferon alpha treat-ment in patients with chronic cystoid macular oedema due tonon-infectious uveitis. Br J Ophthalmol. 2009;93:906–913.
21. 21.Markomichelakis NN, Theodossiadis PG, Pantelia E, Papaeft-himiou S, Theodossiadis GP, Sfikakis PP. Infliximab for chro-nic cystoid macular edema associated with uveitis. Am J Opht-halmol. 2004;138:648–650.
22. 22.Diaz-Llopis M, García-Delpech S, Salom D, et al. Adalimumab therapy for refractory uveitis: a pilot study. J Ocul PharmacolTher. 2008;24:351–361.
23. 23.Agrawal R, Lee C, Phatak S, Pavesio C. Immunopharmacothe-rapy of non-infectious uveitis: where do we stand? Expert OpinBiol Ther. 2014;14:1719-22.