• Uveitis
• cystoid macular edema
• macular hole
• pars plana vitrectomy
• rhegmatogenous retinal detachment

• Humans
• Uveitis/diagnosis
• Uveitis/surgery
• Vitreoretinal Surgery
• Vitrectomy
• Visual Acuity/physiology

• drugs
• epidemiology
• macula
• retina
• treatment other

• Humans
• Macular Edema/diagnosis
• Macular Edema/drug therapy
• Macular Edema/etiology
• Ranibizumab/therapeutic use
• Endothelial Growth Factors
• Vascular Endothelial Growth Factor A
• Diabetic Retinopathy/drug therapy
• Diabetic Retinopathy/complications
• Intravitreal Injections
• Angiogenesis Inhibitors/therapeutic use
• Diabetes Mellitus

• Consensus statement
• diabetic macular edema
• intravitreal anti-VEGFs
• steroids

To analyze the real-life clinical outcome of a single dexamethasone implant (DEX) injection in the treatment of persistent diabetic macular edema (DME) after anti-vascular endothelial growth factor (anti-VEGF) agents in a sample of the Jordanian population.

An observational case study design that involved a retrospective chart review analysis in a tertiary hospital in Amman, Jordan. Patients who showed persistent DME after receiving at least six doses of anti-VEGF agents for DME treatment were included.

The study population consisted of 72 participants (29 females, 43 males) having an average age of 66 years. All patients had best-corrected visual acuity (BCVA) less than 0.7 (6/9) and SD-OCT documented center-involved DME. The study results showed that the average baseline BCVA improved from 0.205±0.1 before DEX injection to 0.358±0.1 at 3 months post-injection (p<0.0001). The central mean thickness (CMT) showed significant improvement also (539.347±132.402 to 379.041±99.430, p<0.0001). There was a mean of 3 mmHg increase in intraocular pressure at 3 months post-injection (p<0.0001), however, only 4% of patients required medical treatment. Other inflammatory biomarkers in OCT, such as intraretinal hyper-reflective dots (HRD), showed significant improvement also (23.67±16 to 14.83±13, p<0.0001). No other significant safety concerns were noticed.

A single DEX injection showed significant clinical and anatomical improvement in DME cases that are persistent after anti-VEGF treatment in our sample, with an excellent safety profile. In case of supply shortage of intravitreal injections, which occurs frequently at our center, a single DEX injection may be utilized as an effective DME therapy. Further research is mandated to identify clinical response in a larger sample and more frequent injections.

• Jordan
• Ozurdex
• anti-VEGF
• dexamethasone
• diabetic macular edema

Purpose. To evaluate the real-world efficacy and safety of the dexamethasone implant (DEX implant) in patients with diabetic macular edema (DME). Methods. Retrospective, multicenter, and noncomparative study of DME patients who were treated with at least one DEX implant. A total of 186 eyes from 165 patients were included. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), complications, and number of retreatments were collected. Data at baseline and monthly for 6 months were analyzed. Results. The average baseline BCVA and CRT were 0.60 LogMAR and 491.6 μm, respectively. The mean BCVA improved until 3 months and then decreased up to 6 months of follow-up (0.53, 0.49, and 0.55 LogMAR at 1, 3, and 6 months; p = 0.001, <0.001, and 0.044, resp.). The change of mean CRT was similar to BCVA (345.0, 357.7, and 412.5 μm at 1, 3, and 6 months, p < 0.001, <0.001, and <0.001, resp.). 91 eyes (48.9%) received additional treatment with anti-VEGF or DEX implant. The average treatment-free interval was 4.4 months. In group analyses, the DEX implant was more effective in pseudophakic eyes, DME with subretinal fluid (SRF), or diffuse type. Conclusions. Intravitreal dexamethasone implants are an effective treatment for patients with DME, most notably in pseudophakic eyes, DME with SRF, or diffuse type. A half of these patients require additional treatment within 6 months.

• Angiogenesis Inhibitors/therapeutic use
• Diabetic Retinopathy/complications
• Diabetic Retinopathy/drug therapy
• Diabetic Retinopathy/therapy
• Humans
• Laser Therapy
• Macular Edema/drug therapy
• Macular Edema/etiology
• Macular Edema/therapy
• Vascular Endothelial Growth Factor A/antagonists & inhibitors

• Uveitic macula edema
• corticosteroids
• immunosuppressive therapy
• inflammation
• inflammatory edema
• uveitis

• P30 EY014801 NEI NIH HHS

Macular edema is one of the most common vision-threatening complications of uveitis noted in one third of patients with uveitis. The release of a number of inflammatory mediators induces retinal vascular hyperpermeability leading to uveitic macular edema (UME) which most commonly is of cystoid shape. Fluorescein angiography and non-invasive spectral-domain optical coherence tomography are standard procedures for diagnosis and follow-up of UME with some innovations such as scanning laser ophthalmoscope retro-mode imaging. Effective management of UME requires thorough understanding of the individual case. Proper control of intraocular inflammation is mandatory before targeting macular edema itself. Mainstay of treatment is immunosuppressive therapy with various drug delivery routes including topical, local subconjunctival, peribulbar and sub-Tenon’s, intravitreal and systemic. Clinical trials with biologics are under way to study the efficacy of these agents in suppressing intraocular inflammation and resolution of UME. Visual prognosis in UME depends on numerous factors. Younger age and better visual acuity at baseline are associated with more favorable visual outcome in most studies

• Intraocular inflammation
• Uveitic macular edema
• Fluorescein angiography
• Optical coherence tomography
• Corticosteroid therapy
• Drug delivery
• Clinical trials

• Computer-aided diagnosis
• Fundus imaging
• Image processing
• Pattern classification
• Retina
• Retinopathy

Uveitic macular edema is the major cause of reduced vision in eyes with uveitis.

To assess the effectiveness of interventions in the treatment of uveitic macular edema.

Cochrane Central Register of Controlled Trials, Medline, and Embase. There were no language or data restrictions in the search for trials. The databases were last searched on December 1, 2011. Reference lists of included trials were searched. Archives of Ophthalmology, Ophthalmology, Retina, the British Journal of Ophthalmology, and the New England Journal of Medicine were searched for clinical trials and reviews.

Participants of any age and sex with any type of uveitic macular edema were included. Early, chronic, refractory, or secondary uveitic macular edema were included. We included trials that compared any interventions of any dose and duration, including comparison with another treatment, sham treatment, or no treatment.

Best-corrected visual acuity and central macular thickness were the primary outcome measures. Secondary outcome data including adverse effects were collected.

More results from randomized controlled trials with long follow-up periods are needed for interventions for uveitic macular edema to assist in determining the overall long-term benefit of different treatments. The only intervention with sufficiently robust randomized controlled trials for a meta-analysis was acetazolamide, which was shown to be ineffective in improving vision in eyes with uveitic macular edema, and is clinically now rarely used. Interventions showing promise in this disease include dexamethasone implants, immunomodulatory drugs and anti-vascular endothelial growth-factor agents. When macular edema has become refractory after multiple interventions, pars plana vitrectomy could be considered. The disease pathophysiology is uncertain and the course of disease unpredictable. As there are no clear guidelines from the literature, interventions should be tailored to the individual patient.

• uveitic macular edema
• uveitis

• Angiogenesis Inhibitors/therapeutic use
• Antibodies, Monoclonal, Humanized/therapeutic use
• Bayes Theorem
• Bevacizumab
• Diabetic Retinopathy/complications
• Humans
• Macular Edema/drug therapy
• Macular Edema/etiology
• Markov Chains
• Monte Carlo Method
• Ranibizumab
• Treatment Outcome
• Visual Acuity

• HSRU1 Chief Scientist Office

To evaluate the safety of pegaptanib sodium 0.3 mg intravitreal injection in the treatment of neovascular age-related macular degeneration in subjects with or without diabetes mellitus.

A pooled, retrospective, analysis was conducted of data from 9 sponsor-administered, randomized, open-label trials. Subjects who received pegaptanib by randomization or change in dose assignment, crossover design, or protocol amendment, were included. Reports of endophthalmitis, increased intraocular pressure, retinal injury, intraocular hemorrhage, traumatic cataract, hypersensitivity reactions, stroke, myocardial infarction, and other arterial thromboembolic events defined by the Antiplatelet Trialists’ Collaboration were identified by Medical Dictionary for Regulatory Activities preferred terms. Adverse events were summarized from the first injection to 42 days after the last injection. The incidence of adverse events was stratified by the presence/absence of diabetes.

Of 1,586 subjects enrolled, 165 (10.4%) had a history of diabetes mellitus and 1,421 (89.6%) did not. The 2 populations were similar at baseline. Based on the comparison of prespecified ocular, hypersensitivity, and Antiplatelet Trialists’ Collaboration event terms, the safety review did not identify any notable differences between the 2 populations.

This retrospective analysis found no increased safety risk resulting from treatment with pegaptanib 0.3 mg in individuals with neovascular age-related macular degeneration and concomitant diabetes mellitus.

• Anti-VEGF
• Diabetic retinopathy
• Laser
• Management
• Pathophysiology
• Steroids