Document Detail


Comparison of intravitreal bevacizumab upload followed by a dexamethasone implant versus dexamethasone implant monotherapy for retinal vein occlusion with macular edema.
MedLine Citation:
PMID:  22739239     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To compare the efficacy and safety of three intravitreal bevacizumab upload injections followed by a dexamethasone implant versus dexamethasone implant monotherapy in eyes with macular edema due to retinal vein occlusion.
METHODS: Sixty-four eyes of 64 patients were included in this prospective, consecutive, nonrandomized case series: group 1 consisted of 38 patients (22 with central retinal vein occlusion, CRVO, 16 with branch retinal vein occlusion, BRVO) treated using a dexamethasone implant (Ozurdex) alone; group 2 consisted of 26 patients (14 CRVO, 12 BRVO) treated with three consecutive intravitreal bevacizumab injections at monthly intervals followed by a dexamethasone implant. In case of recurrence, both cohorts received further dexamethasone implants. Preoperatively and monthly best corrected visual acuity (BCVA, ETDRS), central retinal thickness (Spectralis-OCT), intraocular pressure, and wide-angle fundus photodocumentation (Optomap) were performed. The primary clinical endpoint was BCVA at 6 months after initiation of therapy. Secondary endpoints were central retinal thickness and safety of the therapy applied.
RESULTS: In group 1, an increase in BCVA of 2.5 (±1.6) letters in the CRVO and of 13.0 (±3.2) letters in BRVO patients was seen after 6 months, in group 2 of 5.9 (±0.4) letters (CRVO) and 3.8 (±2.4) letters (BRVO), which was not statistically significant. When comparing the two treatment groups with respect to the type of vein occlusion, there was a significant advantage for BRVO patients for the dexamethasone implant monotherapy (BRVO patients in group 1, p = 0.005). Central retinal thickness showed a significant reduction after 6 months only in patients of group 1, both for CRVO (p = 0.01) and BRVO (p = 0.003). First recurrence after the first dexamethasone implant injection occurred after 3.8 months (mean) in CRVO and 3.5 months in BRVO patients (group 1), versus 3.2 and 3.7 months, respectively, in group 2. In group 1, 63.6% with CRVO and 50% with BRVO showed an increased intraocular pressure after treatment; in group 2, 57.1% with CRVO and 50.0% with BRVO, respectively.
CONCLUSION: In CRVO, there was no difference between the two treatment strategies investigated. However, in BRVO, dexamethasone implant monotherapy was associated with better functional outcome.
Authors:
Wolfgang J Mayer; Matthias Remy; Armin Wolf; Daniel Kook; Anselm Kampik; Michael Ulbig; Lukas Reznicek; Christos Haritoglou
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-06-23
Journal Detail:
Title:  Ophthalmologica. Journal international d'ophtalmologie. International journal of ophthalmology. Zeitschrift für Augenheilkunde     Volume:  228     ISSN:  1423-0267     ISO Abbreviation:  Ophthalmologica     Publication Date:  2012  
Date Detail:
Created Date:  2012-07-31     Completed Date:  2012-10-05     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0054655     Medline TA:  Ophthalmologica     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  110-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 S. Karger AG, Basel.
Affiliation:
Department of Ophthalmology, Ludwig Maximilians University Munich, Mathildenstrasse 8, Munich, Germany. wolfgang.j.mayer @ med.uni-muenchen.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Angiogenesis Inhibitors / administration & dosage*,  adverse effects
Antibodies, Monoclonal, Humanized / administration & dosage*,  adverse effects
Dexamethasone / administration & dosage*,  adverse effects
Drug Implants
Drug Therapy, Combination
Female
Glucocorticoids / administration & dosage*,  adverse effects
Humans
Intravitreal Injections
Macular Edema / diagnosis,  drug therapy*,  physiopathology
Male
Prospective Studies
Retinal Vein Occlusion / diagnosis,  drug therapy*,  physiopathology
Tomography, Optical Coherence
Treatment Outcome
Vascular Endothelial Growth Factor A / antagonists & inhibitors
Visual Acuity / physiology
Chemical
Reg. No./Substance:
0/Angiogenesis Inhibitors; 0/Antibodies, Monoclonal, Humanized; 0/Drug Implants; 0/Glucocorticoids; 0/VEGFA protein, human; 0/Vascular Endothelial Growth Factor A; 2S9ZZM9Q9V/bevacizumab; 50-02-2/Dexamethasone

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