Retina Ven Tıkanıklıkları Tedavisinde İntravitreal Deksametazon İmplant Sonuçları
Özet
Retina ven tıkanıklıkları (RVT), dünyada görme kaybının önde gelen nedenlerinden biridir. RVT'ye bağlı makula ödemi (MÖ) tedavisinde intravitreal deksametazon implantı önemli bir tedavi seçeneğidir. Bu kitap bölümü, intravitreal 0,7 mg deksametazon implantının etkinlik ve güvenlilik sonuçlarını incelemektedir. Çalışmaya, RVT'ye bağlı MÖ tedavisi için deksametazon implantı uygulanan ve en az 6 ay takip edilen 71 hasta dahil edilmiştir. Sonuçlar, implantasyon sonrası ortalama görme keskinliğinde 10,9 harf kazanımı ve santral makula kalınlığında 432,7 mikron azalma ile başarılı bulunmuştur (p<0,0001). Tedavi süresince görme keskinliğinde 15 harf ve üzeri kazanım oranı %40,8, 10 harf ve üzeri kazanım oranı %63,4'tür. Deksametazon implantı, hızlı etki göstermekte ancak nüks riski nedeniyle 6 aydan önce tekrar uygulama gerektirebilmektedir. Yan etkiler arasında göz içi basınç artışı ve katarakt progresyonu gözlemlenmiş olup, bu yan etkiler kontrol altına alınabilmiştir. Bölüm, RVT'ye bağlı MÖ tedavisinde deksametazon implantının güvenli ve etkili bir tedavi seçeneği olduğunu vurgulamaktadır. Ayrıca, deksametazon implantı ile diğer tedavi yöntemlerinin karşılaştırıldığı daha geniş vaka serilerine dayanan uzun süreli prospektif çalışmalara ihtiyaç duyulmaktadır.
Retinal vein occlusions (RVO) are one of the leading causes of vision loss worldwide. Intravitreal dexamethasone implants are a key treatment option for macular edema (ME) secondary to RVO. This book chapter evaluates the efficacy and safety of intravitreal 0.7 mg dexamethasone implants. The study included 71 eyes of 71 patients treated with dexamethasone implants for RVO-related ME, with a follow-up of at least six months. Results showed a mean gain of 10.9 letters in best-corrected visual acuity (BCVA) and a mean decrease of 432.7 microns in central macular thickness (CMT) after treatment (p<0.0001). The cumulative rate of patients gaining 15 letters or more was 40.8%, while 63.4% gained at least 10 letters. Dexamethasone implants provided rapid improvement, but recurrence typically required retreatment within six months. Adverse effects included elevated intraocular pressure (IOP) and cataract progression, both of which were manageable. This chapter highlights the efficacy and safety of dexamethasone implants as a reliable treatment option for ME due to RVO. Additionally, there is a need for further prospective studies comparing dexamethasone implants with other treatment modalities, such as grid laser photocoagulation, IVTA, and intravitreal anti-VEGF, in larger case series over longer durations.
Referanslar
Ophthalmologists TRCo: Retinal Vein Occlusion (RVO) Interim Guidelines. February 2009 ed. London: The Royal College of Ophthalmologists, 2009, pp. 1-33.
Klein R, Moss SE, Meuer SM, Klein BE: The 15-year cumulative incidence of retinal vein occlusion: the Beaver Dam Eye Study. Arch Ophthalmol 2008;126:513–518.
Rogers S, McIntosh RL, Cheung N, et al: The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology 2010;117:313–319.
Lardenoye CW, Probst K, DeLint PJ, Rothova A: Photoreceptor function in eyes with macular edema. Invest Ophthalmol Vis Sci 2000, 41:4048-53.
Gomel N, D'Aloisio R, Wattad A, Mastropasqua R, Formenti F, Loewenstein A, Iglicki M, Zur D. Good Initial Visual Acuity in Patients with Macular Edema due to Retinal Vein Occlusion - Management and Outcomes. Retina. 2024 Aug 9. doi: 10.1097/IAE.0000000000004244. Epub ahead of print. PMID: 39121498.
Lendzioszek M, Bryl A, Poppe E, Zorena K, Mrugacz M. Retinal Vein Occlusion-Background Knowledge and Foreground Knowledge Prospects-A Review. J Clin Med. 2024 Jul 5;13(13):3950. doi: 10.3390/jcm13133950. PMID: 38999513; PMCID: PMC11242360.
SCORE Study Research Group. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study report 6. Arch Ophthalmol 2009;127:1115–28.
Heier JS, Campochiaro PA, Yau L, Li Z, Saroj N, Rubio RG, et al.: Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology 2012, 119:802-9
Boyer D, Heier J, Brown DM, Clark WL, Vitti R, Berliner AJ, et al.: Vascular endothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmology 2012, 119:1024-32.
Haller JA, Bandello F, Belfort R, Jr., Blumenkranz MS, Gillies M, Heier J, et al.:Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results.Ophthalmology 2011;118:2453-60.
Joshi L, Yaganti S, Gemenetzi M, Lightman S, Lindfield D, Liolios V,et al.: Dexamethasone implants in retinal vein occlusion: 12-month clinical effectiveness using repeat injections as-needed. Br J Ophthalmol 2013, 97:1040-4.
Daugirdas SP, Maatouk CM, Lai HJ, Ogidigben MJ, Singh RP. Central Retinal Thickness Variability as a Predictive Factor for Visual Acuity After Dexamethasone Implant in Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina. 2024 Aug 1:1-8. doi: 10.3928/23258160-20240621-04. Epub ahead of print. PMID: 39172228.
Sperduto RD, Hiller R, Chew E, Seigel D, Blair N, Burton TC, et al. Risk factors for hemiretinal vein occlusion: comparison with risk factors for central and branch retinal vein occlusion: the eye disease case-control study. Ophthalmology. 1998 May;105(5):765-71.
O'Mahoney PR, Wong DT, Ray JG. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008 May;126(5):692-9.
Cheung N, Klein R, Wang JJ, Cotch MF, Islam AF, Klein BE, et al. Traditional and novel cardiovascular risk factors for retinal vein occlusion: the multiethnic study of atherosclerosis. Invest Ophthalmol Vis Sci. 2008 Oct;49(10):4297-302.
Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophtalmol 1984; 98:271-282.
Hayreh SS, Rubenstein L, Podhajsky P. Argon laser scatter photocoagulation in treatment of branch retinal vein occlusion. A prospective clinical trial. Ophthalmologica. 1993;206:1-14.
Hayreh SS. Management of central retinal vein occlusion. Ophthalmologica. 2003 May-Jun;217(3):167-88.
A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. The Central Vein Occlusion Study Group N report. Ophthalmology. 1995 Oct;102(10):1434-44.
Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmocokinetics of triamcinolone acetonide after single intravitreal injection. Ophthalmology 2003;110: 681-686.
Jain N, Stinnett SS, Jaffe GJ. Prospective study of a fluocinolone acetonide implant for chronic macular edema from central retinal vein occlusion: thirty-six-month results. Ophthalmology. 2012 ;119:132-7.
Noma H, Minamoto A, Funatsu H, Tsukamoto H, Nakano K, Yamashita H, et al. Intravitreal levels of vascular endothelial growth factor and interleukin-6 are correlated with macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2006 Mar;244(3):309-15
Campochiaro PA, Bhisitkul RB, Shapiro H, Rubio RG: Vascular endothelial growth factor promotes progressive retinal nonperfusion in patients with retinal vein occlusion. Ophthalmology 2013, 120:795-802.
Rosenfeld PJ, Fung AE, Puliafito CA: Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 2005, 36:336-9.
Costa RA, Jorge R, Calucci D, et al. Intravitreal bevacizumab (Avastin) for central and hemicentral retinal vein occlusions: IBeVO Study. Retina 2007; 27: 141-9.
Matsumoto Y, Freund KB, Peiretti E, Cooney MJ, Ferrara DC, Yannuzzi LA. Rebound macular edema following bevacizumab (Avastin) therapy for retinal venous occlusive disease. Retina. 2007;27:426-31.
Prager F, Michels S, Kriechbaum K, Georgopoulos M, Funk M, Geitzenauer W, et al. Intravitreal bevacizumab (Avastin) for macular oedema secondary to retinal vein occlusion: 12-month results of a prospective clinical trial. Br J Ophthalmol. 2009 ;93:452-6.
Brown DM, Campochiaro PA, Singh RP, Li Z, Gray S, Saroj N,et al., Investigators C: Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010, 117:1124-3385
Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC,et al: Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010, 117:1102-12 e1.
Capone A Jr, Singer MA, Dodwell DG, Dreyer RF, Oh KT, Roth DB, Walt JG, Scott LC, Hollander DA. Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion (Shasta study). Retina. 2014;34:342-51.
Bakri SJ, Omar AF, Iezzi R, Kapoor KG. EVALUATION OF MULTIPLE DEXAMETHASONE INTRAVITREAL IMPLANTS IN PATIENTS WITH MACULAR EDEMA ASSOCIATED WITH RETINAL VEIN OCCLUSION. Retina. 2016 Mar;36(3):552-7. doi: 10.1097/IAE.0000000000000750. PMID: 26418442.
Querques L, Querques G, Lattanzio R et al. Repeated intravitreal dexamethasone implant (Ozurdex®) for retinal vein occlusion. Ophthalmologica. 2013;229(1):21-5.
Brunner M, Haueter I, Valmaggia C: Dexamethason implant in the treatment of macular edema in retinal vein occlusion and intraocular inflammatory disease. Klin Monbl Augenheilkd 2013, 230:396-400.
Koss MJ, Pfister M, Rothweiler F, Michaelis M, Cinatl J, Schubert R, et al. Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion. Acta Ophthalmol 2012, 90:98-103.
Mayer WJ, Remy M, Wolf A, Kook D, Kampik A, Ulbig M, Reznicek L, Haritoglou C: Comparison of intravitreal bevacizumab upload followed by a dexamethasone implant versus dexamethasone implant monotherapy for retinal vein occlusion with macular edema. Ophthalmologica 2012, 228:110-6.
Kim JE, Mantravadi AV, Hur EY, Covert DJ: Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents. Am J Ophthalmol 2008, 146:930-4 e1.
Nehme A, Lobenhofer EK, Stamer WD, Edelman JL: Glucocorticoids with different chemical structures but similar glucocorticoid receptor potency regulate subsets of common and unique genes in human trabecular meshwork cells. BMC Med Genomics 2009, 2:58.
Marchino T, Vela JI, Bassaganyas F, Sanchez S, Buil JA: Acute-Onset Endophthalmitis Caused by Alloiococcus otitidis following a Dexamethasone Intravitreal Implant. Case Rep Ophthalmol 2013, 4:37-41.
Arıkan Yorgun M, Mutlu M, Toklu Y, Cakmak HB, Cağıl N. Suspected bacterial endophthalmitis following sustained-release dexamethasone intravitreal implant: a case report. Korean J Ophthalmol. 2014 Jun;28(3):275-7.
Cai X, Zhao J, Dang Y. Safety and Efficiency of Anti-VEGF with Dexamethasone Intravitreal Implant for Non-Ischemic Retinal Vein Occlusion: A Prospective, Case-controlled, Cohort Study. Rev Recent Clin Trials. 2024 May 29. doi: 10.2174/0115748871315894240514044305. Epub ahead of print. PMID: 39082150.
Călugăru D, Călugăru M. Safety and long-term efficacy of repeated dexamethasone intravitreal implant for the treatment of cystoid macular edema secondary to retinal vein occlusion with and without a switch to anti-VEGF agents: a 3-year experience. Graefes Arch Clin Exp Ophthalmol. 2018 Nov;256(11):2269-2270. doi: 10.1007/s00417-018-4094-6. Epub 2018 Aug 2. PMID: 30069751.
Sadda S, Danis RP, Pappuru RR, Keane PA, Jiao J, Li XY, Whitcup SM: Vascular changes in eyes treated with dexamethasone intravitreal implant for macular edema after retinal vein occlusion. Ophthalmology 2013, 120:1423-31.
Referanslar
Ophthalmologists TRCo: Retinal Vein Occlusion (RVO) Interim Guidelines. February 2009 ed. London: The Royal College of Ophthalmologists, 2009, pp. 1-33.
Klein R, Moss SE, Meuer SM, Klein BE: The 15-year cumulative incidence of retinal vein occlusion: the Beaver Dam Eye Study. Arch Ophthalmol 2008;126:513–518.
Rogers S, McIntosh RL, Cheung N, et al: The prevalence of retinal vein occlusion: pooled data from population studies from the United States, Europe, Asia, and Australia. Ophthalmology 2010;117:313–319.
Lardenoye CW, Probst K, DeLint PJ, Rothova A: Photoreceptor function in eyes with macular edema. Invest Ophthalmol Vis Sci 2000, 41:4048-53.
Gomel N, D'Aloisio R, Wattad A, Mastropasqua R, Formenti F, Loewenstein A, Iglicki M, Zur D. Good Initial Visual Acuity in Patients with Macular Edema due to Retinal Vein Occlusion - Management and Outcomes. Retina. 2024 Aug 9. doi: 10.1097/IAE.0000000000004244. Epub ahead of print. PMID: 39121498.
Lendzioszek M, Bryl A, Poppe E, Zorena K, Mrugacz M. Retinal Vein Occlusion-Background Knowledge and Foreground Knowledge Prospects-A Review. J Clin Med. 2024 Jul 5;13(13):3950. doi: 10.3390/jcm13133950. PMID: 38999513; PMCID: PMC11242360.
SCORE Study Research Group. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study report 6. Arch Ophthalmol 2009;127:1115–28.
Heier JS, Campochiaro PA, Yau L, Li Z, Saroj N, Rubio RG, et al.: Ranibizumab for macular edema due to retinal vein occlusions: long-term follow-up in the HORIZON trial. Ophthalmology 2012, 119:802-9
Boyer D, Heier J, Brown DM, Clark WL, Vitti R, Berliner AJ, et al.: Vascular endothelial growth factor Trap-Eye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmology 2012, 119:1024-32.
Haller JA, Bandello F, Belfort R, Jr., Blumenkranz MS, Gillies M, Heier J, et al.:Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results.Ophthalmology 2011;118:2453-60.
Joshi L, Yaganti S, Gemenetzi M, Lightman S, Lindfield D, Liolios V,et al.: Dexamethasone implants in retinal vein occlusion: 12-month clinical effectiveness using repeat injections as-needed. Br J Ophthalmol 2013, 97:1040-4.
Daugirdas SP, Maatouk CM, Lai HJ, Ogidigben MJ, Singh RP. Central Retinal Thickness Variability as a Predictive Factor for Visual Acuity After Dexamethasone Implant in Retinal Vein Occlusion. Ophthalmic Surg Lasers Imaging Retina. 2024 Aug 1:1-8. doi: 10.3928/23258160-20240621-04. Epub ahead of print. PMID: 39172228.
Sperduto RD, Hiller R, Chew E, Seigel D, Blair N, Burton TC, et al. Risk factors for hemiretinal vein occlusion: comparison with risk factors for central and branch retinal vein occlusion: the eye disease case-control study. Ophthalmology. 1998 May;105(5):765-71.
O'Mahoney PR, Wong DT, Ray JG. Retinal vein occlusion and traditional risk factors for atherosclerosis. Arch Ophthalmol. 2008 May;126(5):692-9.
Cheung N, Klein R, Wang JJ, Cotch MF, Islam AF, Klein BE, et al. Traditional and novel cardiovascular risk factors for retinal vein occlusion: the multiethnic study of atherosclerosis. Invest Ophthalmol Vis Sci. 2008 Oct;49(10):4297-302.
Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophtalmol 1984; 98:271-282.
Hayreh SS, Rubenstein L, Podhajsky P. Argon laser scatter photocoagulation in treatment of branch retinal vein occlusion. A prospective clinical trial. Ophthalmologica. 1993;206:1-14.
Hayreh SS. Management of central retinal vein occlusion. Ophthalmologica. 2003 May-Jun;217(3):167-88.
A randomized clinical trial of early panretinal photocoagulation for ischemic central vein occlusion. The Central Vein Occlusion Study Group N report. Ophthalmology. 1995 Oct;102(10):1434-44.
Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmocokinetics of triamcinolone acetonide after single intravitreal injection. Ophthalmology 2003;110: 681-686.
Jain N, Stinnett SS, Jaffe GJ. Prospective study of a fluocinolone acetonide implant for chronic macular edema from central retinal vein occlusion: thirty-six-month results. Ophthalmology. 2012 ;119:132-7.
Noma H, Minamoto A, Funatsu H, Tsukamoto H, Nakano K, Yamashita H, et al. Intravitreal levels of vascular endothelial growth factor and interleukin-6 are correlated with macular edema in branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol. 2006 Mar;244(3):309-15
Campochiaro PA, Bhisitkul RB, Shapiro H, Rubio RG: Vascular endothelial growth factor promotes progressive retinal nonperfusion in patients with retinal vein occlusion. Ophthalmology 2013, 120:795-802.
Rosenfeld PJ, Fung AE, Puliafito CA: Optical coherence tomography findings after an intravitreal injection of bevacizumab (avastin) for macular edema from central retinal vein occlusion. Ophthalmic Surg Lasers Imaging 2005, 36:336-9.
Costa RA, Jorge R, Calucci D, et al. Intravitreal bevacizumab (Avastin) for central and hemicentral retinal vein occlusions: IBeVO Study. Retina 2007; 27: 141-9.
Matsumoto Y, Freund KB, Peiretti E, Cooney MJ, Ferrara DC, Yannuzzi LA. Rebound macular edema following bevacizumab (Avastin) therapy for retinal venous occlusive disease. Retina. 2007;27:426-31.
Prager F, Michels S, Kriechbaum K, Georgopoulos M, Funk M, Geitzenauer W, et al. Intravitreal bevacizumab (Avastin) for macular oedema secondary to retinal vein occlusion: 12-month results of a prospective clinical trial. Br J Ophthalmol. 2009 ;93:452-6.
Brown DM, Campochiaro PA, Singh RP, Li Z, Gray S, Saroj N,et al., Investigators C: Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010, 117:1124-3385
Campochiaro PA, Heier JS, Feiner L, Gray S, Saroj N, Rundle AC,et al: Ranibizumab for macular edema following branch retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology 2010, 117:1102-12 e1.
Capone A Jr, Singer MA, Dodwell DG, Dreyer RF, Oh KT, Roth DB, Walt JG, Scott LC, Hollander DA. Efficacy and safety of two or more dexamethasone intravitreal implant injections for treatment of macular edema related to retinal vein occlusion (Shasta study). Retina. 2014;34:342-51.
Bakri SJ, Omar AF, Iezzi R, Kapoor KG. EVALUATION OF MULTIPLE DEXAMETHASONE INTRAVITREAL IMPLANTS IN PATIENTS WITH MACULAR EDEMA ASSOCIATED WITH RETINAL VEIN OCCLUSION. Retina. 2016 Mar;36(3):552-7. doi: 10.1097/IAE.0000000000000750. PMID: 26418442.
Querques L, Querques G, Lattanzio R et al. Repeated intravitreal dexamethasone implant (Ozurdex®) for retinal vein occlusion. Ophthalmologica. 2013;229(1):21-5.
Brunner M, Haueter I, Valmaggia C: Dexamethason implant in the treatment of macular edema in retinal vein occlusion and intraocular inflammatory disease. Klin Monbl Augenheilkd 2013, 230:396-400.
Koss MJ, Pfister M, Rothweiler F, Michaelis M, Cinatl J, Schubert R, et al. Comparison of cytokine levels from undiluted vitreous of untreated patients with retinal vein occlusion. Acta Ophthalmol 2012, 90:98-103.
Mayer WJ, Remy M, Wolf A, Kook D, Kampik A, Ulbig M, Reznicek L, Haritoglou C: Comparison of intravitreal bevacizumab upload followed by a dexamethasone implant versus dexamethasone implant monotherapy for retinal vein occlusion with macular edema. Ophthalmologica 2012, 228:110-6.
Kim JE, Mantravadi AV, Hur EY, Covert DJ: Short-term intraocular pressure changes immediately after intravitreal injections of anti-vascular endothelial growth factor agents. Am J Ophthalmol 2008, 146:930-4 e1.
Nehme A, Lobenhofer EK, Stamer WD, Edelman JL: Glucocorticoids with different chemical structures but similar glucocorticoid receptor potency regulate subsets of common and unique genes in human trabecular meshwork cells. BMC Med Genomics 2009, 2:58.
Marchino T, Vela JI, Bassaganyas F, Sanchez S, Buil JA: Acute-Onset Endophthalmitis Caused by Alloiococcus otitidis following a Dexamethasone Intravitreal Implant. Case Rep Ophthalmol 2013, 4:37-41.
Arıkan Yorgun M, Mutlu M, Toklu Y, Cakmak HB, Cağıl N. Suspected bacterial endophthalmitis following sustained-release dexamethasone intravitreal implant: a case report. Korean J Ophthalmol. 2014 Jun;28(3):275-7.
Cai X, Zhao J, Dang Y. Safety and Efficiency of Anti-VEGF with Dexamethasone Intravitreal Implant for Non-Ischemic Retinal Vein Occlusion: A Prospective, Case-controlled, Cohort Study. Rev Recent Clin Trials. 2024 May 29. doi: 10.2174/0115748871315894240514044305. Epub ahead of print. PMID: 39082150.
Călugăru D, Călugăru M. Safety and long-term efficacy of repeated dexamethasone intravitreal implant for the treatment of cystoid macular edema secondary to retinal vein occlusion with and without a switch to anti-VEGF agents: a 3-year experience. Graefes Arch Clin Exp Ophthalmol. 2018 Nov;256(11):2269-2270. doi: 10.1007/s00417-018-4094-6. Epub 2018 Aug 2. PMID: 30069751.
Sadda S, Danis RP, Pappuru RR, Keane PA, Jiao J, Li XY, Whitcup SM: Vascular changes in eyes treated with dexamethasone intravitreal implant for macular edema after retinal vein occlusion. Ophthalmology 2013, 120:1423-31.
