Widening use of dexamethasone implant for the treatment of macular edema

Figures & data

Table 1 Published studies on the use of DEX implant for age-related macular degeneration

Reference	Study design	No of eyes	Previous treatment	Treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Calvo et al^Citation22	Retrospective	7 refractory	3 anti-VEGF	1 DEX + ranibizumab monthly	6 months	2 DEX (28.5%)	From 0.53±0.13 logMAR to 3 months: 0.45±0.3 (P=0.23) 6 months: 0.52±0.2 (P=0.23)	From 273.14±50.94 μm to 3 months: 241.5±36.6 μm; (P=0.04) 6 months: 260.71±58.51 μm (P=0.40)	3 ocular hypertension (42.8%) (27–32 mmHg)
Kuppermann et al ^Citation23	Prospective multicenter randomized	243	115 naïve:	58 DEX + ranibizumab vs 57 sham + ranibizumab PRN	6 months	3.15 DEX + ranibizumab PRN	Naïve Change from baseline: DEX: +0.3 to +2.7 L Sham: −0.5 to +2.6 L	Naïve Change from baseline: DEX: −12.61±96.4 μm Sham: −34.70±106.6 μm (P<0.05)	DEX 18.2% IOP ≥25 mmHg
			128 prev treatment	65 DEX + ranibizumab vs 63 sham + ranibizumab PRN		3.37 sham + ranibizumab	Prev treatment Change from baseline: DEX: +0.4 to +2.4 L Sham: −0.3 to 2.6 L	Prev treatment Change from baseline: DEX:−1.74±54.4 μm Sham:+6.84±84.9 μm (P=ns)	Sham 5.1% IOP ≥25 mmHg (P=0.002)
Rezar-Dreindl et al^Citation24	Prospective randomized	40	5.6±3.4 ranibizumab	20 ranibizumab	12 months	7.95 ranibizumab P=0.042	From 62 to 68 L (P=0.2)	From 485 μm to 6 months: 426 μm 12 months: 453 μm (P=0.38)	9% cataract surgery 0% IOP >30 mmHg 33% cataract surgery
			6.7±4.4 ranibizumab	20 ranibizumab + DEX		5.5 ranibizumab + 2 DEX (18 eyes)	68 to 71 L	From 439 μm to 6 months: 375 μm 12 months: 368 μm	15% IOP >30 mmHg
Chaudhary et al^Citation25	Prospective multicenter randomized	10	NR	5 ranibizumab	6 months	6.2±2.3	Change from baseline: 10.8±13.2 L 3.0±10.5 L (P=0.331)	Change from baseline: 31.7%±17.5% to 13.3%±27.0% (P=0.236)	1 IOP >30 mmHg
				5 ranibizumab + DEX		5.8±1.8 (P=0.766)

Abbreviations: BCVA, best corrected visual acuity; CMT, central macular thickness; DEX, dexamethasone implant; IOP, intraocular pressure; Naïve, previously untreated; NR, not reported; ns, not significant; prev treatment, previously treated; PRN, pro re nata; VEGF, vascular endothelial growth factor.

Table 2 Published studies on the use of DEX implant for Irvine–Gass syndrome

Reference	Study design	No of eyes	Previous treatment	Treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Williams et al^Citation33	Prospective multicenter randomized	41 uveitis + IGS (27)	Laser Medical therapy	DEX 0.7 mg or DEX 0.35 mg observation	6 months	NR	53.8% improvement ≥10 L after 3 months (P=0.029) 41.7% improvement ≥10 L after 3 months (P=0.117) 14.3% improvement ≥10 L after 3 months	NR	31% IOP >25 mmHg (0.7 mg)
Meyer and Schönfeld^Citation34	Case report	1	3 IVT 0.4 mg dexamethasone	1 DEX	4 months	NR	From 0.30 to 0.8 (for at least 3 months)	From 393 μm to 212 μm (for at least 3 months)	NR
Dutra Medeiros et al^Citation35	Retrospective	9	CAIs Topical NSAIDs Corticosteroids IVT anti-VEGF IVT TA	1 DEX	6 months	NR	From 0.62±0.15 logMAR to 1 month: 0.47±0.21 (P=0.008) 3 months: 0.37±0.24 (P=0.001) 6 months: 0.37±0.26 (P=0.002)	From 542.22±134.78 μm to 1 month: 350.88±98.71 μm (P=0.001) 3 months: 319.22±60.96 μm (P=0.002) 6 months: 398.33±127.89 μm (P=0.031)	NR
Brynskov et al^Citation36	Case report	1	TA Sub-Tenon’s 5 Ranibizumab IVT	DEX	12	Second DEX (187 days later)	First DEX: from 78 ETDRS letters to 76 Second DEX: from 76 ETDRS letters to 85	First DEX: from 541 to 219 μm (after 83 days) Second DEX: from 436 to 229 μm (after 56 days)	NR
Fenicia et al^Citation37	Case report	1 patient (2 eyes)	RE: topical NSAIDs Oral indomethacin 3 peribulbar methylprednisolone	RE: DEX + Ranibizumab IVT (84 days later)	NR	RE: 1DEX +1 ranibizumab IVT (84 days later) +1 DEX (2 months later IVT ranibizumab)	RE: from 20/70 to 50 days 20/20	−369 μm after 7 days	NR
			LE: topical NSAIDs	LE: DEX
			Oral indomethacin				LE: from 20/40 to 80 days 20/20
			Ranibizumab IVT			2 DEX (5 months after)
Dang et al^Citation38	Prospective, nonrandomized, comparative	18	Topical steroids Topical NSAIDs	DEX	6		1 month: VAI 44% P=0.625 vs TA 2 months: VAI 39% P=0.941 vs TA 3 months: VAI 39% P=0.553 vs TA 6 months: VAI 33% P=0.856 vs TA	1 month: −175 μm (mean change), P=0.783 vs TA 2 months: −145 μm (mean change), P=0.044 vs TA 3 months: −126 μm (mean change), P=0.049 vs TA	DEX 1 month: 6% IOP>21 mmHg 2 months: 6% IOP>21 mmHg 3 months: 6% IOP>21 mmHg 6 months: 0% IOP>21 mmHg (P=0.044)
						NR
								6 months: −125 μm (mean change), P=0.812 vs TA
		25		TA		15 1 IVT TA 9 2 IVT TA 1 3 IVT TA	1 month: VAI 52% 2 months: VAI 40% 3 months: VAI 48% 6 months: VAI 36%	1 month: −193 μm (mean change) 2 months: −95 μm (mean change) 3 months: −173 μm (mean change) 6 months: −140 μm (mean change)	TA 1 month: 12% IOP>21 mmHg 2 months: 12% IOP>21 mmHg 3 months: 20% IOP>21 mmHg 6 months: 20% IOP>21 mmHg
Furino et al^Citation39	Retrospective	11	NR	1 DEX	6.27±0.47	NR	From 20/40 to 20/22 (P<0.0001)	From 462±100 μm to 276±8 μm (P<0.0001)	IOP>20 mmHg
Al Zamil^Citation40	Retrospective	11	Oral CAIs Topical NSAIDs Corticosteroids IVT anti-VEGF IVTA	1 DEX	6	NR	From 0.58±0.17 logMAR to 1 month: 0.37±0.16 logMAR (P=0.008) 3 months: 0.20±0.13 logMAR (P=0.001) 6 months: 0.21±0.15 logMAR (P=0.002)	From 513.8±134.9 μm to 1 month: 371.6±91.9 (P=0.001) 3 months: 302.6±50.9 μm (P=0.002) 6 months: 308.0±54.5 μm (P=0.031)	NR
Khurana et al^Citation41	Prospective case series	6	Topical NSAIDs	1 DEX	NR		6 months: +14 L (P=0.03)	1 month: −100 μm (mean change) (P<0.01) 6 months: −72 μm (mean change) (P=0.004)
Ortega- Evangelico and Diago Sempere^Citation42	Retrospective	4	NR	1 DEX	6		From 0.3 to 1 month: 0.575 logMAR (mean) 3 months: 0.575 logMAR (mean)	From 414 μm to 1 month: 330.25 μm (mean change) 3 months: 346.75 μm (mean change)	NR
Mylonas et al^Citation43	Prospective randomized	29	NR	14 IVTA	6	19 second IVTA	From 63±13 L to 1 month: 73±11 L (P=0.001) 3 months: 73±11 L (P=0.001) 6 months: 71±13 L (P=0.001)	From 516±121 μm to 1 month: 355±59 μm (P=0.003) 3 months: 389±89 μm (P=0.001) 6 months: 365±74 μm (P=0.002)
				15 DEX			From 60±10 L to 1 month: 73±10 L (P<0.001) 3 months: 72±11 L (P<0.001) 6 months: 66±13 L (P=0.009) 1 month: P=0.86 vs DEX 3 months: P=0.80 vs DEX 6 months: P=0.80 vs DEX	From 548±110 μm to 1 month: 357±69 μm (P<0.001) 3 months: 391±102 μm (P<0.001) 6 months: 504±159 μm (P=0.05) 1 month: P=0.92 vs DEX 3 months: P=0.94 vs DEX 6 months: P=0.01 vs DEX
EPISODIC 2 study^Citation44	Retrospective	58 IGS of 100 overall	NR	1 DEX	24 months (25 eyes)	1.7 first year 1.657 second year	Baseline mean 58.5±15.6 L 18 months: 66.9 (±18.3) L 24 months: 62.3 L (±14.3) (P=0.0035)	Baseline 518.13±117.2 μm 18 months: 346.9±115.7 μm −176 μm (P<0.001) 24 months: 340.2±116 μm −182.7 μm (P<0.001)	6.2% IOP >25 mmHg
Sacchi et al^Citation45	Case report	1	Sub-Tenon’s betamethasone	1 DEX	6 months	NR	From 20/40 to 1 month: 20/30	NR	IOP >21 mmHg

Abbreviations: BCVA, best corrected visual acuity; CAIs, carbonic anhydrase inhibitors; CMT, central macular thickness; DEX, dexamethasone implant; ETDRS, Early Treatment Diabetic Retinopathy Study; IGS, Irvine-Gass syndrome; IOP, intraocular pressure; IVT, intravitreal; IVTA, intravitreal triamcinolone acetonide; L, ETDRS letters; LE, left eye; NR, not reported; NSAIDs, nonsteroidal anti-inflammatory drugs; RE, right eye; TA, triamcinolone acetonide; VAI, visual acuity improvement >10 L; VEGF, vascular endothelial growth factor.

Table 3 DEX in vasoproliferative retinal tumors

Reference	Study design	No of eyes	Previous treatment	Treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Cebeci et al^Citation48	Case report	3	IVT BEV Laser photocoagulation	DEX	12 months	1 DEX + PDT (1 week after)	From 20/25 to 20/40	NR	1 subcapsular cataract

Abbreviations: BCVA, best corrected visual acuity; BEV, bevacizumab; CMT, central macular thickness; DEX, dexamethasone implant; IVT, intravitreal; NR, not reported; PDT, photodynamic therapy.

Table 4 Published studies on the use of DEX implant for retinal telangiectasia

Reference	Study design	No of eyes	Previous treatment	Treatment	Follow-up	Retreatment	BCVA	CMT Complications
Sandali et al^Citation55	Case report	1	3 BEV IVT	DEX	15 months	2 DEX	From 20/32 to 1 month: 20/20	From 398 μm NR to 1 month: 250 μm
Loutfi et al^Citation56	Case report	1	3 BEV IVT 1 IVTA	DEX	NR	3 DEX	From 0.3 to 0.59 logMAR: 6 weeks after 1st DEX; from 0.3 to 0.64 logMAR: 6 weeks after 2nd DEX; from 0.3 to 0.78 logMAR: 2 weeks after 3rd DEX	From 397 μm NR to 286 μm: 6 weeks after 1° DEX; 6 weeks after 2° DEX: 279 μm; 2 weeks after 3° DEX: 279 μm
Lei and Lam^Citation62	Retrospective	1	8 ranibizumab IVT + laser	DEX	17 months	4 DEX	From 1 to 52 weeks: 0.5 logMAR	From 607 μm NR to 52 weeks: 346 μm

Abbreviations: BCVA, best corrected visual acuity; BEV, bevacizumab; CMT, central macular thickness; DEX, dexamethasone implant; IVT, intravitreal; IVTA, intravitreal triamcinolone acetonide; NR, not reported.

Table 5 DEX implant in Coats’ disease

Reference	Study design	No of eyes	Previous treatment	Primary treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Saatci et al^Citation60	Case report	2	5 ranibizumab IVT + laser photocoagulation in 1 eye	DEX in one patient DEX + laser photocoagulation in the other patient	12 months 6 months	NR	Unchanged From 2/10 to 3/10	NR	IOP rise >25 mmHg in both eyes
Martínez-Castillo et al^Citation61	Case report	1	None	DEX + laser photocoagulation	12 months	NR	From 20/200 to 20/25	NR	None
Lei and Lam^Citation62	Retrospective chart review	1	3 BEV IVT + laser photocoagulation	DEX	16 months	3 DEX	From 1.3 to 52 weeks: 1.8 logMAR	From 821 μm to 52 weeks: 589 μm	None

Abbreviations: BCVA, best corrected visual acuity; BEV, bevacizumab; CMT, central macular thickness; DEX, dexamethasone implant; IOP, intraocular pressure; IVT, intravitreal; NR, not reported.

Table 6 Published studies on the use of DEX implant for radiation maculopathy

Reference	Study design	No of eyes	Previous treatment	Primary treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Baillif et al^Citation63	Retrospective	5	None	DEX	6.4 months	3 eyes: 1 DEX 2 eyes: 2 DEX	From 41 L to 2 months: 47 L	From 487.1 μm to 2 months: 331.2 μm	1 eye IOP >25 mmHg
Caminal et al^Citation64	Retrospective	12	2 laser 2 VEGF IVT 5 laser + anti-VEGF IVT	DEX	8.2±7.8 months	1 eye: 2 DEX	From 1±0.58 to 0.8±1.58 logMAR (P=0.091)	From 416±263 to 254±170 μm (P=0.016)	1 eye cataract 1 eye IOP rise
Russo et al^Citation65	Retrospective comparative	16	NR	8 DEX	Range 7–52 months	2.4±0.9 DEX (24 months) (P=0.018 vs ranibizumab)	DEX: from 0.45±0.18 to last follow-up: 0.27±0.15 logMAR (P=0.011)	From 437±71 μm to last follow-up: 254±44 μm (P=0.012)	NR
				8 ranibizumab IVT
						6±1.8 ranibizumab (24 months)	Ranibizumab: from 0.49±0.14 to last follow-up: 0.34±0.13 logMAR (P=0.012)	From 459±81 μm to last follow-up: 243±58 μm (P=0.012) (P=0.721 vs ranibizumab)
Bui et al^Citation66	Retrospective	2	16 BEV IVT +4 IVTA 7 BEV +1 IVTA	DEX	NR	2 DEX	From 20/60 Snellen to 3 months: unchanged From 20/400 Snellen to 3 months: unchanged	From 456 to 238 μm after first DEX, 277 μm after second DEX From 618 to 336 μm	1 cataract surgery 2 IOP rise
Seibel et al^Citation67	Retrospective comparative	5 DEX	None	DEX	At least 12 months	1–2 DEX BEV (range 1–10) IVTA (range 1–3)	DEX: 0.8 logMAR, unchanged BEV: 0.8 logMAR, 1 month, after last IVT 0.7 logMAR IVTA: 0.8 logMAR, unchanged	DEX: from 440 μm to 4 weeks 265 μm (P=0.049 BEV: from 479 μm to 4 weeks 362 μm (P=0.01) IVTA: from 454 μm to 4 weeks 314 μm (P=0.034)	NR
		38 BEV		BEV
		35 IVTA		IVTA
Tarmann et al^Citation68	Retrospective	4	BEV IVT in 3 eyes BEV IVT + panretinal laser photocoagulation and IVTA in 1 eye	DEX	NR	NR	From 20/100 Snellen to 2–4 weeks 20/50 to 10 weeks 20/80 Snellen to 14–17 weeks: 20/100 Snellen	From 616 μm to 2–4 weeks: 399 μm 10 weeks: 393 μm 14–17 weeks: 568 μm	1 eye IOP >25 mmHg

Abbreviations: BCVA, best corrected visual acuity; BEV, bevacizumab; CMT, central macular thickness; DEX, dexamethasone implant; IOP, intraocular pressure; IVT, intravitreal; IVTA, intravitreal triamcinolone acetonide; NR, not reported; VEGF, vascular endothelial growth factor.

Table 7 DEX implant in retinitis pigmentosa

Reference	Study design	No of eyes	Previous treatment	Treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Srour et al^Citation77	Retrospective	4	CAIs in all cases subtenon TA 1 case NSAIDs in 2 cases	DEX	6 months	2 DEX in 2 eyes after 3 months	From 20/160 to 6 months: 20/125 after 1 DEX	From 443±185 μm to 6 months: 305±124 μm after 1 DEX	None
Ahn et al^Citation78	Case report	2 eyes of one patient	CAIs Anti-VEGF IVT	DEX	12 months	2 DEX in 1 eye 6 months after DEX	From 20/100 to 12 months: 20/60 RE From 20/150 to 12 months: 20/100 LE	From 631 μm to 12 months: 531 μm RE From 681 μm to 12 months: 499 μm LE	IOP rise IOP>21 mmHg
Saatci et al^Citation79	Case report	2 eyes of one patient	Topical CAIs	1 DEX	7 months	NR	From 2/10 to 1 week: 4/10 both eyes 3 months: 2/10 both eyes	NR	None
Patil and Lotery^Citation80	Case report	1	Topical CAIs Depo-Medrone Parabulbar Anti-VEGF IVT IVTA Cryotherapy	1 DEX	10 months	NR	From 1.01 logMAR to 6 weeks: 0.89 logMAR	From 559 μm to 6 weeks: 271 μm	None

Abbreviations: BCVA, best corrected visual acuity; CAIs, carbonic anhydrase inhibitors; CMT, central macular thickness; DEX, dexamethasone implant; IOP, intraocular pressure; IVT, intravitreal; IVTA, intravitreal triamcinolone; LE, left eye; NR, not reported; NSAIDs, nonsteroidal anti-inflammatory drugs; RE, right eye; TA, triamcinolone acetonide; VEGF, vascular endothelial growth factor.

Table 8 Published studies on the use of DEX implant for other conditions

Reference	Study design	No of eyes	Previous treatment	Primary treatment	Follow-up	Retreatment	BCVA	CMT	Complications
Furino et al^Citation81	Retrospective	8 PPV + ILM peeling + cataract surgery	Diclofenac sodium and betamethasone drops	DEX	6.75±0.71 month	NR	From 20/50 to 20/23 P<0.00001	From 438±45 μm to 296±49 μm P<0.00001	No eye IOP >18 mmHg
Taney et al^Citation82	Retrospective	5 PPV with ERM peeling	Topical prednisolone 1% Topical NSAIDs Subtenon TA IVTA in 1 eye Anti-VEGF IVT in 3 eyes Anti-VEGF IVT 1 eye	DEX	NR	1 DEX in 3 eyes 9 DEX in 1 eye 7 DEX in 1 eye	3 Snellen lines improvement in 3 eyes at 4–6 weeks after DEX 1 Snellen line improvement in 1 eye at 4–6 weeks after DEX No BCVA improvement in 1 eye at 4–6 weeks after DEX	Mean CMT decrease of 106 μm (range 56–155 μm) in 4 eyes at 4–6 weeks after DEX No CMT improvement in 1 eye at 4–6 weeks after DEX	1 eye IOP >25 mmHg Cataract in 1 out of the 2 phakic eyes
Merkoudis and Granstam^Citation83	Case report	1 PPV + ILM peeling and C2F6 tamponade + cataract surgery	IVTA Topical NSAIDs Oral CAI Anti-VEGF IVT	1 DEX	10 months	NR	From 20/200 to 2 months: 20/40	Reduction of CMT 2 months after DEX	None
Georgalas et al^Citation84	Case report	1 PPV + ILM peeling cataract surgery	Topical steroids Subtenon steroids Intravitreal steroids	1 DEX	6 months	NR	From counting fingers to 1 week: 6/36	From 640 μm to 1 week: 383 μm	None
Bonfiglio et al^Citation85	Case report	1 scleral buckling + cryopexy	Oral prednisolone Oral CAI Topical prednisolone Topical NSAIDs TA Subtenon	1 DEX	6 months	NR	From 0.70 to 6 months: 0.20 logMAR	From 510 μm to 6 months: 290 μm	None

Abbreviations: BCVA, best corrected visual acuity; CAI, carbonic anhydrase inhibitor; CMT, central macular thickness; DEX, dexamethasone implant; ERM, epiretinal membrane; ILM, inner limiting membrane; IOP, intraocular pressure; IVT, intravitreal; IVTA, intravitreal triamcinolone; NR, not reported; NSAIDs, nonsteroidal anti-inflammatory drugs; PPV, pars plana vitrectomy; TA, triamcinolone acetonide; VEGF, vascular endothelial growth factor.

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