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Background: This study aims to determine if the intravitreal dexamethasone implant (DEX implant, Ozurdex; Allergan, Inc., Irvine, California) is effective for treating intermediate, posterior, and panuveitis as a monotherapy or adjunctive treatment to systemic immunomodulatory therapies. Methods: A systematic review using MEDLINE, EMBASE, and PubMed database searches was conducted with the Oxford Centre for Evidence-based Medicine Levels of Evidence criteria to select publications. Available background information and patient data from each study was tabulated. Outcomes studied were central retinal thickness (CRT), best corrected visual acuity, intraocular inflammation (anterior chamber cells, vitreous haze), number of patients with prior and concomitant immunomodulatory treatments, intraocular pressure (IOP) elevation (≥ 25 mmHg), and other adverse effects associated with the implant. Results: One hundred ninety-five (61.51%) patients had previous immunomodulatory treatment while 232 (64.8%) were treated with concomitant immunomodulatory therapy with the DEX implant. CRT decreased by an average of 198.65 μm (42.74%). Visual acuity improved to an average of 0.451 (logMAR) or 20/57 (Snellen) which is a 43.11% improvement from baseline. One hundred seventy-three (59%) of eyes were quiescent at the end of the trials, of which 40 (13.7%) previously inflamed eyes became quiescent. Elevated IOP occurred in 91 (20.6%). The most common adverse events were cataract/posterior subcapsular opacities in 47 (11.03%) patients and conjunctival hemorrhage in 24 (5.44%) patients. Conclusions: The DEX implant is an effective medication for the treatment of posterior segment uveitis, uveitic macular edema, and results in improved visual acuity. Development of elevated IOP and cataract should be closely monitored as they are tangible risks associated with the DEX implant. This study was not able to determine whether the DEX implant was more effective as a monotherapy or as an adjunctive therapy to systemic immunomodulatory treatment. [ABSTRACT FROM AUTHOR]

A 50-year-old female presented with profound vision loss and was previously advised injection Ozurdex in the left eye. In the left eye, the anterior chamber was quiet, intraocular pressure (IOP) was 58 mmHg and cataractous changes were noted with Ozurdex implant inside the lens substance. The left eye had glaucomatous cupping (0.9:1 CDR), bipolar rim thinning, inferior notch and healed choroiditis. The patient underwent phacoemulsification, trabeculectomy and mitomycin-C in the left eye. Visual acuity improved and IOP was under control. Although Ozurdex is effective, there are reports of complications related to the drug and implantation procedure. This case highlights an uncommon complication of an uncontrolled, persistent steroid response leading to glaucomatous optic atrophy and profound vision loss due to an accidental intralenticular implantation of Ozurdex. Our case reinforces the need for caution about the decision regarding the judicious use of intravitreal steroids and employment of appropriate technique. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the efficacy, safety, and side effect profiles of a single-dose intravitreal dexamethasone implant (IDI, Ozurdex) in patients with diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. Methods: This study included 101 eyes of 78 diabetic patients with DME that remained persistent despite administering at least six doses of anti-VEGF therapy. The patients were evaluated at baseline and were followed up monthly until the sixth month after the IDI injection. The primary outcomes were central foveal thickness (CFT) and best-corrected visual acuity (BCVA). Results: The mean number of anti-VEGF injection administered to patients was 6.50±0.33. One month after the last injection, the response to treatment was evaluated. IDI injection was performed approximately 1.14±0.08 months after the last anti-VEGF injection. After the IDI injection, BCVA value increased (p<0.001) and CFT value decreased (p<0.001). The peak effect of the IDI was observed in the second month after the injection. CFT values increased and BCVA values decreased from the beginning of the fourth month after the IDI injection. The recurrence rate of CFT elevation in the sixth-month follow-up was 57.4%. Moreover, we observed that high pre-injection CFT values were correlated with a high post-injection recurrence rate of CFT elevation (p<0.001). Conclusion: These findings suggest that the IDI injection significantly improves BCVA and CFT values in patients with DME refractory to anti-VEGF therapy. However, recurrence of CFT elevation may occur in >50% patients in the sixth month after the first injection. [ABSTRACT FROM AUTHOR]

Ozurdex® 0.7 mg (dexamethasone 0.7 mg implant, Allergan, Dublin, Ireland), an intravitreal biodegradable implant, is indicated for cystoid macular edema due to various causes. One of its known and uncommon complications is implant migration to the anterior chamber, causing corneal edema that, in some cases, is irreversible. Reported risk factors for device migration are open or defective lens capsule and prior history of vitrectomy. We present a case of dexamethasone implant migration through a congenital iris coloboma in a pseudophakic patient with an intact lens capsule. The patient is a 56-year-old pseudophakic man with a history of congenital iris coloboma, myopia, retinal tears, and a branch retinal vein occlusion with subsequent cystoid macular edema resistant to anti-VEGF medications but responsive to corticosteroids. He presented with sudden painless decreased vision in his left eye, 8 weeks following dexamethasone implant (Ozurdex) injection to the same eye. Upon presentation, he was diagnosed with corneal edema caused by anterior chamber migration of the implant. He was referred for immediate surgical intervention to extract the implant, with a resolution of the corneal edema within 2 weeks postoperatively. To conclude, this is the first case that reports Ozurdex implant migration through an iris coloboma in the setting of an intact posterior capsule. In addition, we describe a novel surgical approach for implant removal from the anterior chamber that is simple and efficient. [ABSTRACT FROM AUTHOR]

Importance: Inflammatory‐mediated cystoid macular oedema (CMO) is the most common inflammatory‐mediated threat to vision in non‐infectious uveitis (NIU). Corticosteroid therapy is the cornerstone to the management of CMO in NIU. Sustained‐release dexamethasone (DEX) implant devices provide localized therapy. Background: The authors present a series documenting the efficacy of DEX implants for NIU in an Australian cohort. Design: A single centre, retrospective case series patients receiving DEX implants for NIU from 2012 to 2018 in a New South Wales tertiary eye hospital. Participants: Twenty eyes of 17 patients receiving DEX implants for confirmed cases of NIU of varying aetiologies. Methods: Cases from March 2012 and March 2018 were retrospectively selected with follow‐up assessment data recorded and analysed. All patients were seen at 1, 2 and 4 weeks post implant, then monthly. Minimum duration of follow‐up was 32 weeks. Main Outcome Measures: The primary outcome was change in central retinal thickness (CRT) of >20% at two consecutive visits. Secondary outcomes included change in best‐corrected visual acuity (BCVA), intraocular pressure and medication regimens. Results: Ninety‐five percent of patients achieved significant CRT reduction at 4, 8 and 16 weeks (P <.01). Sixty‐one percent demonstrated improved BCVA at week 8 (P <.05). Ninety percent of patients taking systemic corticosteroid therapy at commencement reduced their dose to below 7.5 mg/day. Adverse event frequency was low. Conclusions and Relevance: In keeping with larger studies, the authors suggest that DEX implants may effectively control uveitis refractory to other therapy, while improving BCVA and CRT. In addition, DEX usage has demonstrably reduced systemic steroid burden within the observed cohort. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the mid-long-term efficacy and safety of the dexamethasone intravitreal (DEX) implant (Ozurdex1) in naïve patients with diabetic macular edema (DME).Methods: Prospective and single-center study conducted on consecutive patients with a diagnosis of DME, who received a DEX implant and were followed up for at least 12 months. The main outcomes measurements were the mean change in best corrected visual acuity (BCVA) and in foveal thickness (FT) as compared to the baseline values.Results: Of the 84 screened patients 50 were included in the study. The BCVA significantly improved from 52.4 (20.4) letters at baseline to 62.6 (15.6), 61.2 (18.4), 61.6 (18.6), 60.6 (19.0), and 60.6 (18.8) at 2, 4, 6, 12 months and end of follow-up period, respectively (repeated measures ANOVA and the Greenhouse-Geisser correction; p = .0008). At the end of the follow-up period, a gain of BCVA of ≥5, ≥10, and ≥15 letters were observed in 26 (52.0%), 18 (36.0%), and 16 (32.0%) patients, respectively. The mean FT was significantly reduced from 446.0 (139.9) µm at baseline to 327.2 (103.6) at the end of follow-up (repeated measures ANOVA and the Greenhouse-Geisser correction; p = .0008). During the study follow-up, the patients receive a mean of 3.4 (2.9-3.9) implants. Of the 32 phakic eyes at baseline, 17 (53.1%) either developed new lens opacity or progression of an existing opacity.Conclusion: In eyes with DME not previously treated with intravitreal drugs, DEX implants provide meaningful functional and anatomical benefits, and these results are sustained mid-long-term. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the predictive capacity of the baseline hyperreflective dots (HRDs) on the functional and anatomical response in patients with diabetic macular edema (DME). Additionally, we assessed the impact of the intravitreal dexamethasone (DEX) implant on the functional and anatomic outcomes. Methods: Retrospective, multicenter study. The number of HRDs was graded in four different stages: [A] none HRDs; [B] few, 1–10 HRDs; [C] moderate, 11–20 HRDs; and [D] many, ≥ 21 HRDs. For statistical purposes, groups A and B were combined [scarce HRDs (S-HRDs)] and group D was renamed as [abundant HRDs (A-HRDs)]. The primary endpoints were the mean change in best corrected visual acuity (BCVA) and central macular thickness (CMT) according to baseline HRD stage. Results: One hundred eyes from one hundred patients were included in the study. Mean BCVA significantly improved from 52.9 (50.0 to 55.8) letters ETDRS at baseline to 57.2 (54.0 to 60.4) letters at month 6, p = 0.0039. There were no significant differences between the S-HRDs and A-HRD study groups in BCVA. As compared to baseline, CMT reduction was 106.3 (59.8 to 152.7) μm and 94.2 (34.7 to 153.7) μm in S-HRDs and A-HRD groups, respectively (p < 0.0001 each, respectively). Twenty-three (65.7%) and 18 (62.1%) eyes achieved a CMT reduction ≥ 10% in the S-HRD and A-HRD groups, respectively, p = 0.7640. DEX implant significantly reduced the presence of outer nuclear layer (ONL) disruptions (p = 0.0010). Conclusions: The number of HRDs did not influence either functional or anatomic outcomes. DEX implant significantly decreases the number of eyes with ONL disruptions, which might improve retinal integrity. [ABSTRACT FROM AUTHOR]

This systematic review aimed to evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatments for macular edema (ME) secondary to retinal vein occlusion (RVO), central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO). The electronic databases comprehensively searched for the studies that compared DEX with anti-VEGF treatments in patients suffering from RVO-related ME. The effectiveness was estimated using best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). All data were analyzed by Review Manager (RevMan) 5.3. According to the meta-analysis from five randomized control trials, both DEX implant and anti-VEGF agent treatments were effective, but no significant differences in BCVA and CRT were observed between these two treatments. Novartis' two studies indicated that anti-VEGF agents significantly reduced the CRT compared with DEX implant at 6 months [weighted mean difference: 158.53 μm, 95% confidence interval (CI): (71.09, 245.96), P= 0.0004]. Furthermore, anti-VEGF agents showed some advantages on cataract formation [risk ratio (RR): 3.43, 95% CI: (1.35, 8.71), P= 0.009] and other adverse events [RR: 1.19, 95% CI: (1.09, 1.31), P= 0.0002] without heterogeneity (P = 0.20, I2 = 35%). Anti-VEGF agents were also effective treatments for cataract formation or less adverse events for RVO-related ME. In contrast, DEX implant had higher risk for IOP elevation and lower cataract incidence than anti-VEGF agents. Hence, complementary and alternative treatments are expected. [ABSTRACT FROM AUTHOR]

Purpose: To describe the management of active choroidal neovascularization (CNV) during pregnancy with the use of a dexamethasone intravitreal implant (DXI) (Ozurdex). Methods: Case series of active CNV treated with DXI with at least 12-month follow-up retrospectively analyzed at 2 high-volume referral centers in France. Medical records and multimodal macular imaging were evaluated. Results: Three eyes of 3 patients (age 30.0 ± 3.6 years) were included. One case of idiopathic CNV and two cases of CNV secondary to multifocal choroiditis were analyzed. Mean follow-up was 20.6 ± 4.0 months (range, 16–23 months). The DXI was given at second trimester of established pregnancy in all cases. Mean central retinal thickness decreased from 359 ± 53 mm to 301 ± 17 mm 1 month after DXI and remained stable up to 12 months of follow-up. Visual improvement in all cases was observed (mean 10 letters; range, 5–30 letters) 1 month after DXI and remained stable/increased up to 12-month follow-up (mean 22 letters; range, 10–30 letters). All patients had an uneventful prenatal course and delivered a healthy full-term infant. Conclusion: In the authors’ experience, a single DXI revealed safe and effective in CNV treatment during pregnancy. [ABSTRACT FROM AUTHOR]

We report three cases of persistent vitreous hemorrhage after injection of a biodegradable 0.7 mg dexamethasone intravitreal implant (Ozurdex, Allergan), (DEX) to treat and manage diabetic macular edema (DME); we also summarize available case reports and review the literature regarding persistent vitreous hemorrhage. All three patients underwent pars plana vitrectomy due to nonclearing vitreous hemorrhage after conservative treatment for 2–3 months. During operation, we noted the presence of neovascular membrane along the vascular arcade with taut posterior hyaloid; however, no posterior vitreous detachment (PVD) was found in any of three patients. The implants were carefully preserved, so were the effects in reducing macular edema. Persistent vitreous hemorrhage after DEX injection was rare but manageable without interrupting the effect on DME. Eyes with neovascular membrane but without PVD may be at risk of developing vitreous hemorrhage after DEX injection. [ABSTRACT FROM AUTHOR]

Diabetic macular edema (DME) is a chronic condition with a multifactorial pathogenesis. Vascular endothelial growth factor (VEGF) and several inflammatory mediators are upregulated in eyes with DME. VEGF inhibitors and corticosteroids have all been used successfully in the management of DME. Currently available corticosteroids include triamcinolone acetonide (TA), the dexamethasone (DEX) intravitreal implant, and the fluocinolone acetonide (FA) intravitreal implant. The response to treatment can vary substantially with each treatment modality. Some cases of DME are VEGF driven, and in others, inflammation plays a key role. Chronicity appears to favor corticosteroid treatment. There are no clear guidelines to guide switching from an anti-VEGF to a corticosteroid. Combination therapy of an anti-VEGF drug and a corticosteroid does not appear to provide additional benefit over monotherapy with either drug. The main advantage of corticosteroids over VEGF inhibitors is their longer duration of action. Vitrectomy does not affect the pharmacokinetics of the corticosteroid implants. Common adverse events of corticosteroids include cataract formation, cataract progression, and ocular hypertension. TA may cause a sterile endophthalmitis and pseudoendophthalmitis. Migration of the intravitreal DEX and FA implants into the anterior chamber can be problematic. Because of their less favorable safety profile, corticosteroids are generally used as a second-line treatment for DME. Advantages of using an intravitreal corticosteroid implant include the reduction of treatment burden and predictable pharmacokinetics even in vitrectomized eyes. Pseudophakic eyes, previously vitrectomized eyes and eyes with long-standing DME, particularly of patients who have difficulty in maintaining a monthly appointment, may benefit from primary treatment with a corticosteroid intravitreal implant. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long-term results of intravitreal dexamethasone implant (DEX) for noninfectious uveitis. Materials and Methods: The study included 62 eyes of 44 patients treated with DEX implant due to noninfectious uveitis and followed up for at least a year. Best-corrected visual acuity (BCVA), central foveal thickness, intraocular pressure (IOP), vitreous haze score, indications, immunomodulatory therapy and steroid usage before/after injection, number of injections, and adverse events were analyzed retrospectively. Results: Average follow-up was 20 months (range 12-64 months). The female/male ratio was 29/15. Mean age was 50 years (range 22-75 years). The most frequent uveitis etiologies were idiopathic (25 patients, 40.3%) and Behçet's uveitis. (17 patients, 27.4%) The most common indication for DEX injection was cystoid macular edema together with resistant vitreous haze (26 eyes, 41.9%). Twentytwo eyes (30%) received more than one DEX injection. Mean BCVA was improved from 0.55 logMAR at baseline to 0.38, 0.32, and 0.35 after 1, 3, and 6 months, respectively (p<0.001 for each). Mean CFT was decreased from 386 µm at baseline to 288, 311, and 302 µm after 1, 3, and 6 months, respectively (p<0.001 for each). Mean IOP did not change significantly during follow-up. Five eyes (8%) received topical anti-glaucoma medication (IOP ≥25 mmHg). Eighteen (46%) of 39 phakic eyes underwent cataract surgery during follow-up. Similar efficacy of the DEX implant was observed in eyes that received multiple injections. Systemic immunomodulatory therapy did not change significantly during follow-up. Conclusion: Intravitreal DEX injection does not alter systemic immunomodulatory therapy, but may facilitate the management of noninfectious uveitis by suppressing local intraocular inflammation. Multiple injections yielded comparable visual and anatomical outcomes to single injections. Follow-up for ocular hypertension and cataract formation are important, especially in eyes receiving multiple injections. Keywords: Dexamethasone implant, uveitis, Ozurdex, intravitreal injections. [ABSTRACT FROM AUTHOR]

Purpose: To assess the efficacy and safety of intravitreal dexamethasone implant injection in the management of sarcoidosis-related uveitis.Methods: A retrospective analysis was performed of the efficacy and safety of intravitreal dexamethasone implant injection for indications such as intractable vitritis, vasculitis, or cystoid macular edema.Results: This study comprised 20 patients with sarcoidosis-related uveitis. A single injection was performed in 13 eyes (65%) and 35% required more than 2 injections during the follow-up period [median 16.5 months (range 6-32)]. The best-corrected visual acuity showed significant improvement at 1 month (P = 0.004) and 3 months (P = 0.001), but there was no significance at 6 months after implant injection (P = 0.186). One month after treatment, the central macular thickness decreased to 278.95 ± 52.20 μm (P = 0.023). It further decreased to 274.70 ± 55.88 μm at 3 months (P = 0.027), but there was no significance at 6 months (280.65 ± 64.48 μm, P = 0.074).The anterior chamber cell grade (P = 0.003) and vitreous haze (P = 0.001) were significantly decreased for up to 6 months after a single implant injection. The most common ocular complication was worsening of cataracts during the first 6 months.Conclusion: Intravitreal dexamethasone implant injection is efficacious in reducing anterior chamber inflammation, vitreous haze, and cystoid macular edema in patients with sarcoidosis-related uveitis. Considering that sarcoidosis shows a chronic course of disease in a significant proportion of cases, intravitreal dexamethasone implant injection is a possible option to relieve intraocular inflammation. [ABSTRACT FROM AUTHOR]

The purpose of the study was to report a case of migration of a dexamethasone intravitreal implant (Ozurdex®) into anterior chamber and review the literature pertaining to the anterior chamber migration of implant. Clinical data were collected from a patient, in whom a dexamethasone intravitreal implant migrated to anterior chamber. A review of literature was conducted to analyze additional reports. A 59-year-old aphakic patient with recalcitrant cystoid macular edema due to chronic idiopathic uveitis was treated with intravitreal injection of dexamethasone implant. Migration of the implant into anterior chamber was noted after a month of injection. Since his cornea was clear and intraocular pressure was normal, he was managed conservatively. Sixteen such reports of migration of implant into anterior chamber was analyzed to look into the possible etiologies and outcome. Disruption of lens capsule, large basal iridectomy, and prior vitrectomy are the primary risk factors for migration of dexamethasone implant into the anterior chamber. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy of an intravitreal dexamethasone (IVD) implant (Ozurdex®) for the treatment of central retinal vein occlusion (CRVO) without macular edema (ME). Methods: A retrospective cohort study was designed, and 20 eyes of 20 patients diagnosed with non-ischemic CRVO without ME were included. A total of 10 CRVO eyes were observed without treatment, and another 10 CRVO eyes received a single IVD injection at baseline. Mean changes in pathomorphologic parameters of fundus and optical coherence tomography parameters were measured at baseline and at 1, 3, 6, and 12 months. Results: The decreases in venous tortuosity (p = 0.014 for superior; 0.036 for inferior arcades) and width (p = 0.024 for superior; 0.003 for inferior arcades) from baseline to 12 months after injection were significantly greater in the treated group than the observed group. The improvements in RNFL swelling (p = 0.010) and retinal hemorrhage (p = 0.006) were also significantly greater in the treated group. Visual symptom improvement was significantly faster in the treated group (p = 0.001). In two cases, IVD injection resulted in complete resolution of cilioretinal artery occlusion associated with the CRVO, leading to complete visual recovery in 1 week. None of the treated eyes showed signs of ME development, ischemia progression, or neovascularization. Conclusions: IVD implant was significantly effective in improving venous engorgement, retinal hemorrhage, RNFL swelling, and visual symptoms by presumed alleviation of disc swelling and venous outflow. This treatment may be a considerable treatment option in CRVO patients with no ME. [ABSTRACT FROM AUTHOR]

Drug delivery into the vitreous chamber remains a great challenge in the pharmaceutical industry due to the complex anatomy and physiology of the eye. Intravitreal injection is the mainstream route of drug administration to the posterior segment of the eye. The purpose of this review is to assess the current literature about the widening use of the intravitreal 0.7 mg dexamethasone (Dex) implant, and to provide a comprehensive collection of all the ocular disorders that benefit from Dex administration. Although anti-vascular endothelial growth-factors (VEGFs) have been largely indicated as a first-choice level, the Dex implant represents an important treatment option, especially in selected cases, such as vitrectomized eyes or patients in whom anti-VEGF failed or are contraindicated. In this article, the safety profile as well as the list of the possible complications related to intravitreal Dex injection are also discussed.

Alexandrite laser is one of the most common methods of hair removal. Its utilization is gradually increasing due to easy accessibility and high effectiveness. However, the disuse of protective goggles during the application of this laser is a serious problem. In this case report, we presented a 35-year-old male patient who had foveal injury by alexandrite laser. The inflammatory process secondary to the foveal injury and subsequent macular edema were treated with Ozurdex because of its potent antiedematous effect.

Over the recent years, retina specialists have enjoyed significant improvements in the surgical management of proliferative diabetic retinopathy including improved preoperative planning, vitreoretinal instrumentation and new surgical maneuvers. In this review, we present new tips and tricks such as preoperative pharmacotherapy approaches including pegaptanib injection and biodegradable dexamethasone implantation, bimanual vitrectomy techniques and the concept of mixing small gauges as well as valved cannulas and intraoperative optical coherence tomography. With advanced surgical planning and sophisticated operative maneuvers tailored to the individual patient, excellent outcomes can be achieved even in severe cases of diabetic tractional detachment.

Purpose: To determine the efficacy of an intravitreal dexamethasone implant (IDI) for diabetic macular edema (DME) in vitrectomized eyes. Methods: This interventional retrospective consecutive case series included vitrectomized eyes undergoing IDI placement for treatment of recalcitrant DME between June 2011 and June 2014. All patients had previously received anti-VEGF therapy (ranibizumab or bevacizumab). Primary endpoints were changes in visual acuity (VA) and central retinal thickness (CRT) from baseline values one month after device implantation. Secondary endpoints were VA and CRT changes at 3 months. Results: A total of 8 eyes of 8 patients met the inclusion criteria. One month after IDI placement, there was a significant (p = 0.01) improvement in VA from 0.79 ± 0.52 logMAR (20/123 Snellen equivalent) to 0.64 ± 0.55 logMAR (20/88), meanwhile CRT improved from 455.75 ± 123.19 to 295.00 ± 90.39 μm (p = 0.02). These findings persisted at 3 months. Conclusion: In vitrectomized eyes previously treated with anti-VEGF agents for recalcitrant DME, implantation of the IDI appears to be efficacious in improving VA and CRT at 1-month with the observed benefits persisting for at least for 3 months.

Purpose: The objective of this study was to evaluate patient safety and tolerance of consecutive bilateral intravitreal dexamethasone (Ozurdex) injections during a single visit for the treatment of cystoid macular edema secondary to retinal vein occlusion, diabetic macular edema, or noninfectious posterior uveitis. Methods: This was a retrospective single-center institutional review board–approved study from March 1, 2013, through August 1, 2016. All patients had a complete ophthalmologic examination and optical coherence tomography imaging. Bilateral intravitreal dexamethasone (Ozurdex) injection was performed according to standard sterile procedure. Twelve patients (24 eyes) were included in the study. Results: Atotal of48injections wereadministered to 24eyes of12patientsthat qualified for the study. Patients received intravitreal dexamethasone (Ozurdex) injections for treatment of diabetic macular edema (10 patients), retinal vein occlusion (1 patient), or noninfectious posterior uveitis (1 patient). There were no complications. Conclusion: Consecutive same-day bilateral intravitreal dexamethasone (Ozurdex) is safe and well tolerated. There were no significant complications, and patients preferred continuing bilateral implantation after their initial trial. Same-day treatment may optimize efficiency and decrease patient visits and ultimate treatment burden without compromising patient safety or clinical efficacy. [ABSTRACT FROM AUTHOR]

Intravitreal anti-vascular endothelial growth factor (VEGF) agents seem to be effective in choroidal neovascular membranes (CNV) in association with various entities of posterior uveitis. We herein report a 46-year-old woman who was treated with a simultaneous single intravitreal dexamethasone implant and ranibizumab administration for the treatment of unilateral extrafoveal CNV associated with an active serpiginous choroiditis. Simultaneously with the intravitreal therapy, oral mycophenolic acid (2 × 720 mg) was started, and oral cyclosporine (3 × 100 mg) was then added 2 months later. On the other hand, the fellow eye had been treated for subfoveal CNV but with an inactive disease 4 years previously and ended up with a final visual acuity of counting fingers despite treatment with a single session of photodynamic therapy and 3 subsequent intravitreal ranibizumab injections. Simultaneous administration of anti-VEGF agents and a dexamethasone implant can be a viable approach in eyes with CNV and active serpiginous choroiditis.

We report a 57-year-old patient with birdshot chorioretinopathy (BCR) who was treated with bilateral Ozurdex injections. The patient's vitritis resolved, and visual acuity improved following this treatment. This is only the second case report focused on the treatment of BCR with Ozurdex and the first to report its use for treating vitritis. A concise review of the literature on the use of intravitreal steroids for this disease is provided. This case serves to report the clinical usefulness of Ozurdex in treating posterior vitritis associated with BCR even in the absence of macular edema.

Long-acting injectable formulations based on poly(lactide- co -glycolide) (PLGA) have been commercialized for over 30 years in at least 20 FDA-approved products. These formulations offer several advantages, including reduced dosing frequency, improved patient compliance, and maintenance of therapeutic levels of drug. Despite extensive studies, the inherent complexity of the PLGA copolymer still poses significant challenges associated with the development of generic formulations having drug release profiles equivalent to those of the reference listed drugs. In addition, small changes to PLGA physicochemical properties or the drug product manufacturing process can have a major impact on the drug release profile of these long-acting formulations. This work seeks to better understand how variability in the physicochemical properties of similar PLGAs affects drug release from PLGA solid implants using Ozurdex (dexamethasone intravitreal implant) as the model system. Four 50:50, acid-terminated PLGAs of similar molecular weights were used to prepare four dexamethasone intravitreal implants structurally equivalent to Ozurdex. The PLGAs were extensively characterized by using a variety of analytical techniques prior to implant manufacture using a continuous, hot-melt extrusion process. In vitro release testing of the four structurally equivalent implants was performed in both normal saline and phosphate-buffered saline (PBS), yielding drastically different results between the two methods. In normal saline, no differences in the release profiles were observed. In PBS, the drug release profiles were sensitive to small changes in the residual monomer content, carboxylic acid end group content, and blockiness of the polymers. This finding further underscores the need for a physiologically relevant in vitro release testing method as part of a robust quality control strategy for PLGA-based solid implant formulations.

Purpose: To evaluate the efficacy and safety of dexamethasone (DEX) implant compared with inferior fornix-based sub-Tenon triamcinolone injection (PSTA) for treatment of uveitis.Methods: A total of 48 eyes received DEX and 49 eyes received PSTA as the first treatment.Results: A total of 31 eyes were implanted with DEX relapsed (64.5%) after the first injection, while 32 eyes were injected with PSTA as the first treatment relapsed (65.3%). Kaplan-Meier estimated survival to overall relapse after the first injection was a mean 20 months± 3.6 months for DEX (median,7) and 14 months± 1.9 months (median,9) for the PSTA (P = 0.505). Of 49 eyes receiving the PSTA implant as the first treatment, inflammation persisted in 14.3% after the first injection but persisted in none after the DEX injection (P = 0.005).Conclusions: DEX implantation achieved a higher rate of disease control in the initial 12 weeks postinjection with a relative equivalence in the duration of effect and relapse rates when compared with PSTA. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of dexamethasone intravitreal implants (DEX implant) in patients with treatment-resistant macular edema (ME) owing to branch and central retinal vein occlusion (BRVO/CRVO), and the influence of prior vitrectomy on this treatment. Methods: Multicenter retrospective chart review was performed on 40 CRVO and 32 BRVO eyes with persistent ME despite intravitreal anti-vascular endothelial growth factor agents and/or intravitreal triamcinolone, and/or laser therapy. Each patient received ≥1 dexamethasone 700 μg implant between March 2011 and December 2015. Thirteen patients underwent prior vitrectomy. Data were collected on best-corrected visual acuity (BCVA), central macular thickness (CMT), time to relapse, and adverse events. Results: At the end of follow-up, BRVO eyes had a lesser CMT reduction from baseline compared to CRVO eyes (-122.50 ± 152.47 μm and -202.26 ± 194.09 μm, respectively). Neither BRVO nor CRVO eyes had a sustained BCVA benefit (P = 0.7041 and P = 0.7027, respectively). Vitrectomized and nonvitrectomized eyes overall had a sustained significant CMT reduction throughout the study with -192.46 ± 172.62 μm and -164.02 ± 180.36 μm, respectively, at final follow-up. Similar time to relapse of 24.4 ± 6.5 and 23.3 ± 13.5 weeks, respectively, was observed. By the end of follow-up, BCVA had only improved in vitrectomized eyes. However, multivariable regression analyses showed no significant association between vitrectomy status and CMT or BCVA change after the first and last injection. Cataract formation and ocular hypertension occurred in 25% and 17%, respectively. Conclusions: Multiple DEX implant are effective in reducing CMT in patients resistant to previous treatments and appear to be similarly effective in vitrectomized and nonvitrectomized eyes. [ABSTRACT FROM AUTHOR]

Purpose: To study the safety and efficacy of intravitreal injection of dexamethasone implant in the management of posterior segment involvement in tubercular uveitis (TBU).Methods: In this study, retrospective analysis of safety and efficacy of intravitreal injection of dexamethasone implant for various indications such as cystoid macular edema (CME), vitritis, or paradoxical worsening in TB-related intermediate uveitis, retinal vasculitis, and multifocal serpiginoid choroiditis (MSC) was performed.Results: The study included 17 patients (19 eyes; 7 males). IOP increased from 14.88 ± 2.68 mm Hg to 16.4 ± 5.82 mm Hg (p = 0.18) at 3 months. BCVA improved from 0.37 ± 0.35 to 0.27 ± 0.21 at 3 months (p = 0.03). CME resolved at 3 months and two patients with paradoxical worsening showed resolution within 1 month.Conclusion: Intravitreal dexamethasone implant is safe and efficacious as an adjunct to ATT in reducing the central macular thickness, vitritis, and progression of choroiditis lesions in paradoxical worsening of MSC. [ABSTRACT FROM AUTHOR]

Purpose: To investigate efficacy of dexamethasone intravitreal (DEX) implant in treating refractory macular edema caused by retinal vein occlusion. Methods: Retrospective chart review. Results: Twenty-two eyes with refractory macular edema caused by retinal vein occlusion were treated with a mean of 2.2 DEX over 12 months. Patient had previously received a mean of 7 treatments (laser, bevacizumab, and/or triamcinolone) for macular edema present for at least 4 months duration (mean 20.8 ± 17.6 months, range 4-72 months) before starting DEX. Mean baseline visual acuity was 20/91, and mean central subfield thickness was 506 µm. DEX improved mean best-corrected visual acuity to 20/75 and 20/66 at 7 weeks and 6 months follow-up, although it worsened to 20/132 at 12 months. Mean central subfield thickness improved to 292, 352, and 356 µm at 7 weeks, 6 months, and 12 months follow-up, respectively. There was a statistically significant association between number of DEX treatments and central subfield thickness (P = 3.28 x 10-9). There was a statistically significant association between number of days followed and best-corrected visual acuity (P = 0.006). Six of 12 (50%) phakic patients developed visually significant cataract requiring surgery. Five of 22 (23%) patients developed ocular hypertension (intraocular pressure . 30) and consequently did not undergo further treatment with DEX. Conclusion: DEX resulted in sustained anatomical reduction of retinal vein occlusion--associated refractory macular edema, although this did not translate into long-term bestcorrected visual acuity improvement in either phakic or pseudophakic patients, possibly related to chronic structural alterations in the retina despite reduction of edema. [ABSTRACT FROM AUTHOR]

A known diabetic patient presented with diabetic macular edema (DME) and nonproliferative diabetic retinopathy in both eyes with a vision of 6/18, N12in the right eye and 4/60, N36in the left eye (LE). The patient had undergone injection of dexamethasone implant in the LE which got misdirected into the crystalline lens. The patient was taken up for phacoemulsification with intraocular lens implantation along with vitrectomy and posterior vitreous detachment induction, and redirection of the dexamethasone implant into the vitreous cavity. The DME resolved over the next 3 months. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of age on dexamethasone intravitreal implant (Ozurdex®) response in macular edema secondary to branch retinal vein occlusion (BRVO).Methods: Seventy-three eyes of 73 patients with macular edema secondary to BRVO were recruited in the study. The patients in the study were divided into the following four groups according to their ages: group 1 (<60 years), group 2 (60-69 years), group 3 (70-79 years), and group 4 (≥80 years). Single-dose Ozurdex injection was applied to all patients. The effectiveness of Ozurdex treatment on macular edema is evaluated via optical coherence tomography (OCT) according to the age groups.Results: Two months after Ozurdex injection, mean reduction of central retinal thickness in groups 1, 2, 3, and 4 were -466.4 ± 149.6, -379.7 ± 238.7, -280.1 ± 233.0, and -180.5 ± 81.4 µm, respectively. This reduction of central retinal thickness decreased with aging (p = 0.001). Also, ages of patients were negatively correlated with the mean reduction of central retinal thickness for the whole study group (r = -0.439, p < 0.001).Conclusion: Our study revealed that the effectiveness of Ozurdex treatment decreases with aging. [ABSTRACT FROM AUTHOR]

Purpose: To report the therapeutic efficacy and results of an accidentally injected intralenticular sustained-release dexamethasone implant (Ozurdex) in a patient with macular edema secondary to central retinal vein occlusion at 14 months after injection. Observations: We present a 70-year-old female patient with central retinal vein occlusion who underwent an Ozurdex injection. Patient discontinued from the treatment period during the 14-month and there was no ophthalmologic examination of the patient. Detailed ophthalmological examination was performed. Ozurdex localization was determined by Pentacam rotating Scheimpflug System. The implant was accidentally injected into the crystalline lens. It did not cause a totally lens opacification but did result only in a posterior subcapsular cataract. The macular edema did not resolve, and the patient underwent phacoemulsification surgery. Conclusions and importance: Ozurdex that totally located inside the crystallize lens may not have the therapeutic effects.

The idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome is a disease characterized by multiple retinal macroaneurysms, neuroretinitis and peripheral capillary nonperfusion. Visual loss may result from either ischemia-related complications or macular involvement. Treatment is not always rewarding. We report a case with stage 2 IRVAN syndrome who was successfully treated with a single bilateral intravitreal dexamethasone implant in addition to panretinal photocoagulation and systemic azathioprine treatment.

Simultaneous branch retinal artery and vein occlusion is a rare condition that may cause severe visual loss, and its treatment is often unrewarding. Herein, we report a case with simultaneous central retinal vein and branch retinal artery occlusion; it was successfully treated with a single dexamethasone intravitreal implant. The affected eye attained a visual acuity level of 20/25 from the visual acuity of hand motions at presentation with a residual, but relatively diminished, altitudinal scotoma during a follow-up period of 6 months.

Purpose: To report the impact of transient, self-resolving, untreated "macular edema" detected on spectral domain optical coherence tomography in Asian Indian premature infants with retinopathy of prematurity (ROP) on visual acuity (VA) and refraction at 1-year of corrected age. Materials and Methods: Visual acuity and refraction of 11 infants with bilateral macular edema (Group A) was compared with gestational age-matched 16 infants with ROP without edema (Group B) and 17 preterms infants without ROP and without edema (Group C) at 3, 6, 9 and 12 months of corrected age using Teller Acuity Cards and cycloplegic retinoscopy. Sub-group analysis of the previously described pattern A and B macular edema was performed. Results: Visual acuity was lower in infants with macular edema compared with the other two control groups throughout the study period, but statistically significant only at 3 months. Visual improvement in these infants was highest between the 3 rd and 6 th month and plateaued by the end of the 1 st year with acuity comparable to the other two groups. The edema cohort was more hyperopic compared to the other two groups between 3 and 12 months of age. Pattern A edema had worse VA compared to pattern B, although not statistically significant. Conclusion: Macular edema, although transient, caused reduced VA as early as 3 months of corrected age in Asian Indian premature infants weighing

Aim: To assess the variations in cone mosaic in myopia and its correlation with axial length (AL). Subjects and Methods: Twenty-five healthy myopic volunteers underwent assessment of photoreceptors using adaptive optics retinal camera at 2° and 3° from the foveal center in four quadrants superior, inferior, temporal and nasal. Data was analyzed using SPSS version 17 (IBM). Multivariable regression analysis was conducted to study the relation between cone density and AL, quadrant around the fovea and eccentricity from the fovea. Results: The mean cone density was significantly lower as the eccentricity increased from 2° from the fovea to 3° (18,560 ± 5455-16,404 ± 4494/mm 2 respectively). There was also a statistically significant difference between four quadrants around the fovea. The correlation of cone density and spacing with AL showed that there was a significant inverse relation of AL with the cone density. Conclusion: In myopic patients with good visual acuity cone density around the fovea depends on the quadrant, distance from the fovea as well as the AL. The strength of the relation of AL with cone density depends on the quadrant and distance.

Purpose: To evaluate the predictability of the refractive correction achieved with a positional accommodating intraocular lenses (IOL) and to develop a potential optimization of it by minimizing the error associated with the keratometric estimation of the corneal power and by developing a predictive formula for the effective lens position (ELP). Materials and Methods: Clinical data from 25 eyes of 14 patients (age range, 52-77 years) and undergoing cataract surgery with implantation of the accommodating IOL Crystalens HD (Bausch and Lomb) were retrospectively reviewed. In all cases, the calculation of an adjusted IOL power (P IOLadj ) based on Gaussian optics considering the residual refractive error was done using a variable keratometric index value (n kadj ) for corneal power estimation with and without using an estimation algorithm for ELP obtained by multiple regression analysis (ELP adj ). P IOLadj was compared to the real IOL power implanted (P IOLReal , calculated with the SRK-T formula) and also to the values estimated by the Haigis, HofferQ, and Holladay I formulas. Results: No statistically significant differences were found between P IOLReal and P IOLadj when ELP adj was used (P = 0.10), with a range of agreement between calculations of 1.23 D. In contrast, P IOLReal was significantly higher when compared to P IOLadj without using ELP adj and also compared to the values estimated by the other formulas. Conclusions: Predictable refractive outcomes can be obtained with the accommodating IOL Crystalens HD using a variable keratometric index for corneal power estimation and by estimating ELP with an algorithm dependent on anatomical factors and age.

Purpose The aim of the study was to test a combination of dexamethasone intravitreal implant with macular grid laser versus combined intravitreal bevacizumab (IVB) and macular grid laser for macular edema (ME) in patients with branch retinal vein occlusion (BRVO). Design This study was designed as a prospective, randomized, interventional case series. Patients and methods Sixty eyes with ME secondary to BRVO with central retinal thickness (CRT) more than 400 μm were randomized into three groups: in group 1, 20 eyes underwent an Ozurdex intravitreal implant 0.7 mg at baseline, followed after 1 month with modified grid laser; in group 2, 20 eyes received IVB 1.25 mg/0.05 ml followed after 1 month with modified grid laser; and in group 3, 20 eyes were subjected to only modified grid laser and served as the control group. Patients were followed up monthly for 12 months and retreated with Ozurdex implant in group 1 or IVB in group 2 and group 3 whenever there was recurrence of ME on optical coherence tomography and fundus fluorescein angiography or a decrease in best-corrected visual acuity (BCVA). Recurrence was defined as a decrease in BCVA by 0.3 logMAR or as an increase in CMT by more than 50 μm compared with that in the previous examination. Results Baseline data showed no statistically significant difference between the three groups. In group 1 BCVA and CRT improved significantly at 12 months, to 0.18 ± 0.29 logMAR and 224 ± 51 μm, respectively. In group 2, BCVA improved significantly to 0.38 ± 0.17 logMAR and mean CRT reduced significantly to 258 ± 67 μm. In the control group BCVA at 12 months was 0.40 ± 0.24 and CMT was 362 ± 69 μm. At 12 months two eyes (10%) in group 1, 12 eyes (60%) in group 2, and 14 eyes (70%) in group 3 were retreated. Conclusion The synergistic effect of combined IVB and modified grid laser is comparable to combined DEX implant and modified macular grid laser in the treatment of BRVO with ME with fewer complications but more frequent injections.

Purpose: To correlate the structural and functional changes following intravitreal injection of dexamethasone 0.7 mg (Ozurdex ® ) implant in patients with recalcitrant uveitic cystoid macular edema (CME). Materials and Methods: In a prospective, interventional, nonrandomized study, 30 eyes (27 patients) with uveitic CME received Ozurdex ® implant and were followed-up for 24 weeks at periodic intervals to monitor structural alterations seen on spectral domain optical coherence tomography (SD-OCT). The outcome measures included change in central macular thickness (CMT) and best-corrected visual acuity (BCVA) as well as structural alterations seen on OCT such as change in the height of cystoid spaces (CSs) and sub-foveal serous retinal detachment (SSRD). The integrity of external limiting membrane and inner-outer segment junction was assessed at baseline and follow-up visits. Results: Mean age of the patients was 46.09 ± 15.66 years. The mean CMT decreased by 96 μm at 1-day, 231.64 μm at 1-week, 254.21 μm at 4 weeks and 249.14 μm at 12 weeks (P < 0.001) compared with baseline. BCVA improved from a baseline mean of 0.62 LogMAR units to 0.49 on day 1 to 0.31 at 24 weeks (P < 0.001). A decrease in the mean height of CS, that is, 133.28 μm from a baseline of 317.71 μm was noted on the 1 st day (P < 0.001). 4 eyes demonstrated the presence of CS at 4 weeks, 1 eye at 6 weeks and 3 eyes at 12 weeks. At baseline, 16 eyes (53.33%) demonstrated the presence of SSRD. Among these, 11 eyes showed resolution of SSRD on day 1. SSRD resolved in all patients at 4 weeks and was maintained up to 24 weeks. Conclusions: Ozurdex ® implant improves the visual outcome of patients with recalcitrant uveitic CME. Reversibility of retinal changes may be possible following treatment with dexamethasone implant. Thus final visual outcome may be independent of pretreatment CMT, the height of CS or SSRD.

Purpose: To measure the choroidal thickness (CT) after dynamic exercise by using enhanced depth imaging optical coherence tomography (EDI-OCT). Materials and Methods: A total of 19 healthy participants performed 10 min of low-impact, moderate-intensity exercise (i.e., riding a bicycle ergometer) and were examined with EDI-OCT. Each participant was scanned before exercise and afterward at 5 min and 15 min. CT measurement was taken at the fovea and 1000 μ away from the fovea in the nasal, temporal, superior, and inferior regions. Retinal thickness, intraocular pressure, ocular perfusion pressure (OPP), heart rate, and mean blood pressure (mBP) were also measured. Results: A significant increase occurred in OPP and mBP at 5 min and 15 min following exercise (P ˂ 0.05). The mean subfoveal CT at baseline was 344.00 ± 64.71 μm compared to 370.63 ± 66.87 μm at 5 min and 345.31 ± 63.58 μm at 15 min after exercise. CT measurements at all locations significantly increased at 5 min following exercise compared to the baseline (P ˂ 0.001), while measurements at 15 min following exercise did not significant differ compared to the baseline (P ˃ 0.05). There was no significant difference in retinal thickness at any location before and at 5 min and 15 min following exercise (P ˃ 0.05). Conclusion: Findings revealed that dynamic exercise causes a significant increase in CT for at least 5 min following exercise.

ExPress glaucoma filtration device (GFD) has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs) not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medications) was achieved in eight cases (66.7%) and qualified success (IOP ≤ 18 mmHg, with additional glaucoma medications) in two cases (16.7%) at 1-year after surgery. Early intervention was needed in 4 patients; two underwent anterior chamber reformation while the other two required needling. Two patients required resurgery. There was no significant change in the best corrected visual acuity postoperatively (P = 0.37). ExPress GFD does not seem to offer a benefit over standard trabeculectomy in patients with advanced glaucomatous disease in terms of IOP control or complication rate. However, due to the small sample size with a heterogeneous mixture of primary and secondary glaucoma′s, we await further studies with a larger sample size and long-term follow-up, to see how the device performs.

Aim: The aim of the present study was to study the effect of ocular magnification on macular measurements made using spectral domain optical coherence tomography (OCT). Materials and Methods: One hundred and fifty-one subjects were included from the normative study of foveal morphology carried out at our hospital. Subjects underwent comprehensive eye examination and macular scanning using Cirrus high-definition OCT and axial length (AXL) measurement. Macular cube 512 × 128 scan protocol was used for scanning the macula. Automated measurements of the fovea namely foveal diameter, foveal slope (lateral measurements) and foveal depth (axial measurement) were taken. A correction factor for ocular magnification was done using the formula t = p × q × s, where "t0" is the corrected measurement, "p" is the magnification of OCT, "q0" is the ocular magnification, and "s" is the measurement on OCT without correction. The difference between corrected and uncorrected measurements was evaluated for statistical significance. Results: Mean AXL was 22.95 ± 0.78 mm. Refractive error ranged from −3D to +4D. Mean difference between measured and corrected foveal diameter, slope and depth was 166.05 ± 95.37 ΅m (P < 0.001), 0.81° ± 0.53° (P < 0.001) and 0.05 ± 0.49 ΅m (P = 0.178) respectively. AXL lesser than the OCT calibrated value of 24.46 mm showed an increased foveal diameter (r = 0.961, P < 0.001) and a reduced foveal slope (r = −0.863, P < 0.001) than the corrected value. Conclusion: Lateral measurements made on OCT varied with AXL s other than the OCT calibrated value of 24.46 mm. Therefore, to estimate the actual dimensions of a retinal lesion using OCT, especially lateral dimensions, we recommend correction for the ocular magnification factor.

Diabetic retinopathy (DR) is a complication of long-term diabetes mellitus (DM). Over the last 2 decades lot of work has been on early diagnosis of DR and screening programs have been designed to help the masses. Large numbers of clinical studies have been done for patients of diabetes and DR wherein the role of blood sugar control, metabolic control, role of oral medicines for DR, role of imaging, fluorescein angiography, and retinal photocoagulation has been studied. Newer treatment modalities are being devised and studied for better patient care. We discuss these issues in our review highlight and newer advances over the last few years.

Publishing manuscripts is the only way by which scientists communicate with each other. In recent times, there is an increasing desire to publish manuscripts from the developing world for a variety of reasons. Though, performing a research study is challenging in itself, writing it for publication is the final frontier that can be daunting, especially for the novice. Work that remains unpublished in one form or the other is essentially incomplete or undone. Hence, it is critically important for one to publish one′s findings in a reputed journal. The purpose of this paper is to alleviate the mystique involved in manuscript writing and provide a blueprint where the subheadings given under each of the sections of introduction, methods, results and discussion can be expanded as per the particular study and the manuscript can be constructed in a stepwise manner. We hope that by following this approach, potential researchers and practicing ophthalmologists will develop the skill and aptitude for medical writing, and that the developing world shall do justice to its tremendous intellectual capital by making meaningful contributions to global scientific literature.

Purpose: Evaluation of outcomes in retinal vein occlusions (RVOs) for: (1) multiple repeat dexamethasone (DEX) injections and (2) conversion from DEX to ranibizumab. Methods: We conducted a retrospective study evaluating outcomes of multiple DEX injections and those requiring conversion to ranibizumab at Moorfields Eye Hospital, Bedford, UK. All patients had undergone a complete ophthalmic work-up. Results: Patients (n = 129) had a mean follow-up of 19.9 months. The mean improvement in central retinal thickness was 312 µm after final DEX (p = <0.0001). Mean peak best corrected visual acuity (BCVA) after final DEX was an improvement of 16 ETDRS letters (p < 0.0001). Forty-nine patients were converted and received a mean of 9.37 ranibizumab injections with a mean improvement in BCVA of 15 ETDRS letters (p < 0.0001) compared with final DEX. Conclusions: This study supports the use of ranibizumab in eyes previously treated with DEX and provides long-term efficacy and safety data for multiple DEX injection. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study is to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients. Methods: Retrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15 months of follow-up after Ozurdex treatment onset. Results: Fifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6 mg/dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2mg/dl, p = 0.04) but after 15months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4mg/dl, p = 0.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15. Conclusion: Ozurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of intravitreal dexamethasone (DEX) implants in patients affected by diabetic macular edema (DME) with high best-corrected visual acuity (BCVA) and contraindications to therapy with anti-vascular endothelial growth factor over a 12-month follow-up. Methods: In this interventional nonrandomized clinical study, 14 consecutive patients (14 eyes) affected by DME with a BCVA of 0.3 LogMAR or better were prospectively enrolled. All patients were treated with a sustained-release 700-µg DEX implant at baseline, revaluated every 6 weeks, and retreated on a pro re nata basis. Primary outcomes included changes in BCVA and central macular thickness (CMT). Secondary outcomes included number of implants, average period between injections, and incidence of side effects. Results: At the 12-month examination, a significant improvement in mean BCVA was noted compared to baseline (from 0.25 ± 0.05 to 0.10 ± 0.07 LogMAR; p < 0.001); CMT decreased from 484 ± 127 to 311 ± 51 µm (p < 0.001). No differences in BCVA and CMT improvements were found between treatmentnaïve patients and previously treated patients (p = 0.768 and 0.119, respectively). The mean number of implants was 1.71 ± 0.61 (range, 1-3). The mean period between the first and the second implant was 6.1 ± 1.6 months. Conclusions: The DEX implant on a pro re nata basis can be considered a beneficial approach for DME patients with high BCVA over a 12-month follow-up; functional and anatomical outcome of the patients significantly improved with few injections and a good safety profile. [ABSTRACT FROM AUTHOR]

Purpose: To compare effect of intravitreal dexamethasone implant in eyes with cystoid macular edema secondary to branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO). Methods: A total of 40 patients treated with Ozurdex injection; 20 patients with CRVO and 20 patients with BRVO were retrospectively reviewed. Complete ophthalmologic examination including measurement of best-corrected visual acuity (BCVA), IOP measurement with goldmann applanation tonometry and fundus examination was performed. After diagnosis central macular thickness (CMT) measurement with Heidelberg Spectralis OCT and fundus fluorescein angiography was also performed. One month after Ozurdex injection BCVA, IOP and OCT measurements were performed. Results: In the BRVO group the mean BCVA was 0,8 ± 0.2 logMAR and 1,0 ± 0.2 logMAR in the CRVO group at baseline (p=0,133). The mean CMT was 705±252 μm and 713±268 μm respectively (p=0,961). One month after the Ozurdex injection, the mean BCVA was 0,4 ± 0.2 logMAR in the BRVO group and 0,6 ± 0.3 logMAR in the CRVO group. BCVA was significantly improved in both groups (p<0.001 and p<0.001 respectively). The mean CMT was 268±132 μm in the BRVO group and 328±154 μm in the CRVO group after Ozurdex injection. The mean CMT significantly decreased in both groups (p<0.001 and p<0.001 respectively). Conclusion: The properties of macular edema secondary to BRVO and CRVO and response to the treatment were similar. Ozurdex injection is effective for the treatment of both diseases. [ABSTRACT FROM AUTHOR]

Purpose To evaluate a pro re nata administration of Ozurdex® implant versus a single administration for treating diabetic macular oedema ( DME). Methods This exploratory study is designed as a comparative, multicentre, randomized study with a follow-up of 6 months. Patients with DME were assigned to treatment at baseline either with a single Ozurdex® implant during the entire six-month follow-up (fixed group) or Ozurdex® implant followed by retreatment on an individualized basis ( PRN group). Patients were scheduled for monthly evaluation based on assessment of best-corrected visual acuity ( BCVA) and optical coherence tomography. Results Twenty eyes were enrolled to the PRN group, and 22 were included in the fixed group. Following an equally steady, initial gain up to month 1, and maintenance up to month 3, vision started to decline in the fixed regimen group. At 6 months, a difference of 0.11 log MAR in BCVA was observed in favour of the PRN group. Compared to baseline, a significant reduction in retinal thickness was achieved up to month 2, when the fixed regimen group had begun to revert to pretreatment level. At 4 and 5 months, the difference in thickness between the two groups was statistically significant (p < 0.05). Mean number of treatments was 1.6 in the PRN group. Both fixed and PRN administration of Ozurdex showed a good safety profile . Conclusion A personalized treatment with monthly monitoring and retreatment as needed is effective in maintaining functional and anatomical benefits of Ozurdex®. [ABSTRACT FROM AUTHOR]