OSLI Retina

February 2017

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160 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Efficacy of the Intravitreal Sustained-Release Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-Vascular Endothelial Growth Factor Therapy: Meta-Analysis and Clinical Implications Zainab Khan, BHSc, MD; Robin K. Kuriakose, BS; Maryam Khan, BHSc, MSc (Epi); Eric K Chin, MD; David R. P. Almeida, MD, MBA, PhD BACKGROUND AND OBJECTIVE: To assess the effect on best-corrected visual acuity (BCVA) and efficacy of the intravitreal sustained-release 0.7 mg dexa- methasone implant (Ozurdex; Allergan, Irvine, CA) in patients with recalcitrant diabetic macular edema (DME). PATIENTS AND METHODS: Meta-analysis utilizing the MOOSE framework and a random effects mod- el. Studies included adults undergoing treatment with Ozurdex for DME. The methodologic quality of each study was assessed using the MINORS and the Cochrane Collaboration Risk of Bias for ran- domized studies. RESULTS: A total of 3,859 patients among 15 stud- ies were included in the final analysis. The mean difference in BCVA was a gain of four lines or 20 Early Treatment of Diabetic Retinopathy Study let- ters with Ozurdex at a mean follow-up period of 6 months. CONCLUSIONS: Treatment with Ozurdex is associ- ated with significant mean improvement in visual acuity. Clinicians should have a multimodality ap- proach to treating DME and be aware of this treat- ment option in those who have a suboptimal re- sponse to anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:160-166.] INTRODUCTION In the 1980s, the Early Treatment of Diabetic Reti- nopathy Study (ETDRS) established laser photoco- agulation as the gold-standard treatment of diabetic macular edema (DME). 1 Although laser photocoagula- tion significantly reduces the risk of moderate vision loss, large vision gains have been infrequent. More recently, vascular endothelial growth factor (VEGF) inhibition has been established as providing better visual outcomes compared to laser photocoagulation in DME and is regarded as first-line therapy for cen- ter-involving DME. 2-8 Depending upon the evidence examined, reported improvements in vision using anti-VEGF therapy have been up to approximately 11 letters to 15 letters; however, up to 40% of patients fail to achieve these gains after 6 months of intensive therapy. 12,13 Corticosteroids serve to dampen the downstream proinflammatory products in DME and downregulate a variety of damaging pathways, including the pro- duction of VEGF. 11 Although studies have shown that intraocular corticosteroids resolve DME, 3,13 the extent of this visual improvement in these cases has been variable, particularly when considering cataract pro- gression and its short half-life in the vitreous cavi- ty. 2,3 As such, a biodegradable 0.7 mg dexamethasone intravitreal implant (Ozurdex; Allergan, Irvine, CA) was created to enable a steady release of steroid in the treatment of DME. 28 Ozurdex, in conjunction with or in place of anti- VEGF therapy, has been shown to improve visual out- comes in diabetic macular edema; 13 however, there From the Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada (ZK, MK); Virginia Commonwealth University School of Medicine, Richmond, VA (RKK); Retina Consultants of Southern California, Redlands, CA; VitreoRetinal Surgery PA, Minneapolis. Originally submitted August 23, 2016. Revision received November 6, 2016. Accepted for publication December 12, 2016. Dr. Chin is a cofounder of Citrus Therapeutics. Dr. Almeida is a speaker and consultant for, and has received honoraria from, Allergan; is a cofounder of Citrus Therapeutics; and is a speaker and consultant for, and has received honoraria from, Genentech. The remaining authors report no relevant financial disclosures. Address correspondence to Zainab Khan, MD, Department of Ophthalmology, Queen's University, 99 University Ave., Kingston, ON K7L 3N6, Canada; email: zkhan@qmed.ca. doi: 10.3928/23258160-20170130-10 ■ I N S T R U M E N T S / D E V I C E S / T E C H N O L O G Y ■

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