Skip to main content
SpringerLink
Log in

Clinical Applications of Dexamethasone for Aged Eyes

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

The risk of severe eye problems has been found to increase significantly with age, particularly between the fifth and sixth decades of life. Cataracts, dry eye, neovascular age-related macular degeneration, diabetic retinopathy and retinal vein occlusion (RVO) are very common and very different age-related ocular diseases that reduce the patient’s quality of life. The rationale for using corticosteroids to treat anterior and posterior ocular segment diseases is driven by inflammation. Dexamethasone, one of the most powerful corticosteroids available, is widely used for topical or intravitreal administration. Topical dexamethasone has proven efficacy for the management of postoperative inflammation in the anterior segment after cataract surgery and symptom relief in dry-eye disease. A new sustained-release 700 µg dexamethasone intravitreal implant (DEX) was recently approved for the treatment of macular edema following RVO, diabetic macular edema, or non-infectious uveitis, and its use is increasing, especially when other therapeutic agents have failed. The most common side effects are increased intraocular pressure and cataract formation. The potency of DEX, alone or in combination with other agents, makes DEX a promising option for treating several retinal diseases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dagnelie G. Age-related psychophysical changes and low vision. Invest Ophthalmol Vis Sci. 2013;54:ORSF88–93.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids: new mechanisms for old drugs. N Engl J Med. 2005;353:1711–23.

    Article  CAS  PubMed  Google Scholar 

  3. Hunter R, Lobo A. Dexamethasone intravitreal implant for the treatment of noninfectious uveitis. Clin Ophthalmol. 2011;5:1613–21.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Kupferman A, Leibowitz HM. Anti-inflammatory effectiveness of topically administered corticosteroids in the cornea without epithelium. Investig Ophthalmol. 1975;14:252–5.

    CAS  Google Scholar 

  5. Albrecht E, Richards JC, Pollock T, Cook C, Myers L. Adjunctive use of intravitreal dexamethasone in presumed bacterial endophthalmitis: a randomised trial. Br J Ophthalmol. 2011;95(10):1385–8.

    Article  CAS  PubMed  Google Scholar 

  6. Kwak HW, D’Amico DJ. Evaluation of the retinal toxicity and pharmacokinetics of dexamethasone after intravitreal injection. Arch Ophthalmol. 1992;110:259–66.

    Article  CAS  PubMed  Google Scholar 

  7. Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C, Dexamethasone DDS Phase II Study Group, et al. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol. 2007;125:309–17.

    Article  CAS  PubMed  Google Scholar 

  8. Chang-Lin JE, Attar M, Acheampong AA, Robinson MR, Whitcup SM, Kuppermann BD, et al. Pharmacokinetics and pharmacodynamics of a sustained-release dexamethasone intravitreal implant. Investig Ophthalmol Vis Sci. 2011;52:80–6.

    Article  CAS  Google Scholar 

  9. Jones R 3rd, Rhee DJ. Corticosteroid-induced ocular hypertension and glaucoma: a brief review and update of the literature. Curr Opin Ophthalmol. 2006;17:163–7.

    PubMed  Google Scholar 

  10. Chang-Lin JE, Burke JA, Peng Q, Lin T, Orilla WC, Ghosn CR, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes. Investig Ophthalmol Vis Sci. 2011;52:4605–9.

    Article  CAS  Google Scholar 

  11. Haller JA, Dugel P, Weinberg DV, Chou C, Whitcup SM. Evaluation of the safety and performance of an applicator for a novel intravitreal dexamethasone drug delivery system for the treatment of macular edema. Retina. 2009;29:46–51.

    Article  PubMed  Google Scholar 

  12. Haller JA, Kuppermann BD, Blumenkranz MS, Williams GA, Weinberg DV, Chou C, Dexamethasone DDS Phase II Study Group, et al. Randomized controlled trial of an intravitreous dexamethasone drug delivery system in patients with diabetic macular edema. Arch Ophthalmol. 2010;128:289–96.

    Article  CAS  PubMed  Google Scholar 

  13. Rao GN, Khanna R, Payal A. The global burden of cataract. Curr Opin Ophthalmol. 2011;22:4–9.

    Article  PubMed  Google Scholar 

  14. El-Harazi SM, Feldman RM. Control of intra-ocular inflammation associated with cataract surgery. Curr Opin Ophthalmol. 2001;12:4–8.

    Article  CAS  PubMed  Google Scholar 

  15. Bartlett JD, Woolley TW, Adams CM. Identification of high intraocular pressure responders to topical ophthalmic corticosteroids. J Ocul Pharmacol. 1993;9:35–45.

    Article  CAS  PubMed  Google Scholar 

  16. Chang DF, Tan JJ, Tripodis Y. Risk factors for steroid response among cataract patients. J Cataract Refract Surg. 2011;37:675–81.

    Article  PubMed  Google Scholar 

  17. Leung YF, Tam PO, Lee WS, Lam DS, Yam HF, Fan BJ, et al. The dual role of dexamethasone on anti-inflammation and outflow resistance demonstrated in cultured human trabecular meshwork cells. Mol Vis. 2003;9:425–39.

    CAS  PubMed  Google Scholar 

  18. Pleyer U, Ursell P, Rama P. Intraocular pressure effects of common topical steroids for post-cataract inflammation: are they all the same? Ophthalmol Ther. 2013;2:55–72.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Akingbehin AO. Comparative study of the intraocular pressure effects of fluorometholone 0.1 % versus dexamethasone 0.1 %. Br J Ophthalmol. 1983;67:661–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Holland EJ, Bartlett JD, Paterno MR, Usner DW, Comstock TL. Effects of loteprednol/tobramycin versus dexamethasone/tobramycin on intraocular pressure in healthy volunteers. Cornea. 2008;27:50–5.

    Article  PubMed  Google Scholar 

  21. Saari KM, Nelimarkka L, Ahola V, Loftsson T, Stefansson E. Comparison of topical 0.7 % dexamethasone-cyclodextrin with 0.1 % dexamethasone sodium phosphate for postcataract inflammation. Graefes Arch Clin Exp Ophthalmol. 2006;244:620–6.

    Article  CAS  PubMed  Google Scholar 

  22. Leibowitz HM, Bartlett JD, Rich R, McQuirter H, Stewart R, Assil K. Intraocular pressure-raising potential of 1.0 % rimexolone in patients responding to corticosteroids. Arch Ophthalmol. 1996;114:933–7.

    Article  CAS  PubMed  Google Scholar 

  23. Henderson BA, Kim JY, Ament CS, Ferrufino-Ponce ZK, Grabowska A, Cremers SL. Clinical pseudophakic cystoid macular edema. Risk factors for development and duration after treatment. J Cataract Refract Surg. 2007;33:1550–8.

    Article  PubMed  Google Scholar 

  24. Loewenstein A, Zur D. Postsurgical cystoid macular edema. Dev Ophthalmol. 2010;47:148–59.

    Article  PubMed  Google Scholar 

  25. Yonekawa Y, Kim IK. Pseudophakic cystoid macular edema. Curr Opin Ophthalmol. 2012;23:26–32.

    Article  PubMed  Google Scholar 

  26. Khurana RN, Appa SN, McCannel CA, Elman MJ, Wittenberg SE, Parks DJ, et al. Dexamethasone implant anterior chamber migration: risk factors, complications, and management strategies. Ophthalmology. 2014;121:67–71.

    Article  PubMed  Google Scholar 

  27. Medeiros MD, Navarro R, Garcia-Arumí J, Mateo C, Corcóstegui B. Dexamethasone intravitreal implant for treatment of patients with recalcitrant macular edema resulting from Irvine-Gass syndrome. Investig Ophthalmol Vis Sci. 2013;54:3320–4.

    Article  Google Scholar 

  28. Abdolrahimzadeh S, Fenicia V, Maurizi Enrici M, Plateroti P, Cianfrone D, Recupero SM. Twelve-month results of a single or multiple dexamethasone intravitreal implant for macular edema following uncomplicated phacoemulsification. Biomed Res Int. 2015;2015:362564.

    PubMed  PubMed Central  Google Scholar 

  29. Sharma A, Hindman HB. Aging: a predisposition to dry eyes. J Ophthalmol. 2014;2014:781683.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lemp MA, Bron AJ, Baudouin C, Benítez Del Castillo JM, Geffen D, Tauber J, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol. 2011;151:792–8.

    Article  PubMed  Google Scholar 

  31. Messmer EM, Bulgen M, Kampik A. Hyperosmolarity of the tear film in dry eye syndrome. Dev Ophthalmol. 2010;45:129–38.

    Article  PubMed  Google Scholar 

  32. Coursey T, Henriksson J, Marcano D, Shin C, Isenhart L, Ahmed F, et al. Dexamethasone nanowafer as an effective therapy for dry eye disease. J Control Release. 2015;213:168–74.

    Article  CAS  PubMed  Google Scholar 

  33. Rosenfeld PJ, Brown DM, Heier JS, Boyer DS, Kaiser PK, Chung CY, MARINA Study Group, et al. Ranibizumab for neovascular age-related macular degeneration. N Engl J Med. 2006;355:1419–31.

    Article  CAS  PubMed  Google Scholar 

  34. Brown DM, Michels M, Kaiser PK, Heier JS, Sy JP, Lanchulev T, ANCHOR Study Group. Ranibizumab versus verteporfin photodynamic therapy for neovascular age-related macular degeneration: two-year results of the ANCHOR study. Ophthalmology. 2009;116:57–65.

    Article  PubMed  Google Scholar 

  35. Heier JS, Brown DM, Chong V, Korobelnik JF, Kaiser PK, Nguyen QD, VIEW 1 and VIEW 2 Study Groups. Intravitreal aflibercept (VEGF trap-eye) in wet age-related macular degeneration. Ophthalmology. 2012;119:2537–48.

    Article  PubMed  Google Scholar 

  36. Lazzeri S, Ripandelli G, Sartini MS, Parravano M, Varano M, Nardi M, et al. Aflibercept administration in neovascular age-related macular degeneration refractory to previous anti-vascular endothelial growth factor drugs: a critical review and new possible approaches to move forward. Angiogenesis. 2015;18:397–432.

    Article  CAS  PubMed  Google Scholar 

  37. Augustin AJ, Puls S, Offerman I. Triple therapy for choroidal neovascularisation due to age-related macular degeneration: verteporfin PDT, bevacizumab and dexamethasone. Retina. 2007;27:133–40.

    Article  PubMed  Google Scholar 

  38. Gopal L, Sharma T. Use of intravitreal injection of triamcinolone acetonide in the treatment of age-related macular degeneration. Indian J Ophthalmol. 2007;55:431–45.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Oliver A, Ciulla TA. Corticosteroids as antiangiogenic agents. Ophthalmol Clin North Am. 2006;19:345–51.

    PubMed  Google Scholar 

  40. Spaide RF, Sorenson J, Maranan L. Combined photodynamic therapy and intravitreal triamcinolone for nonsubfoveal choroidal neovascularization. Retina. 2005;25:685–90.

    Article  PubMed  Google Scholar 

  41. Kvanta A, Algvere PV, Berglin L, Seregard S. Subfoveal fibrovascular membranes in age-related macular degeneration express vascular endothelial growth factor. Investig Ophthalmol Vis Sci. 1996;37:1929–34.

    CAS  Google Scholar 

  42. Ding X, Patel M, Chan CC. Molecular pathology of age-related macular degeneration. Prog Retin Eye Res. 2009;28:1–18.

    Article  CAS  PubMed  Google Scholar 

  43. Calvo P, Ferreras A, Al Adel F, Wang Y, Brent MH. Dexamethasone intravitreal implant as adjunct therapy for patients with wet age-related macular degeneration with incomplete response to ranibizumab. Br J Ophthalmol. 2015;99:723–6.

    Article  PubMed  Google Scholar 

  44. Kuppermann BD, Goldstein M, Maturi RK, Pollack A, Singer M, Tufail A, Ozurdex® ERIE Study Group, et al. Dexamethasone intravitreal implant as adjunctive therapy to ranibizumab in neovascular age-related macular degeneration: a multicenter randomized controlled trial. Ophthalmologica. 2015;234:40–54.

    Article  CAS  PubMed  Google Scholar 

  45. International Diabetes Federation. The IDF Diabetes Atlas. 6th ed. Brussels: International Diabetes Federation; 2013.

    Google Scholar 

  46. Runkle EA, Antonetti DA. The blood retinal barrier: structure and functional significance. Methods Mol Biol. 2011;686:133–48.

    Article  CAS  PubMed  Google Scholar 

  47. Joussen AM, Smyth N, Niessen C. Pathophysiology of diabetic macular edema. Dev Ophthalmol. 2007;37:1–12.

    Article  Google Scholar 

  48. Romero-Aroca P. Targeting the pathophysiology of diabetic macular edema. Diabetes Care. 2010;33:2484–5.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Diabetic Retinopathy Clinical Research Network. A randomized trial comparing intravitreal triamcinolone acetonide and focal/grid photocoagulation for diabetic macular edema. Ophthalmology. 2008;115:1447–9.

    Article  PubMed Central  Google Scholar 

  50. Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, Ozurdex MEAD Study Group, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology. 2014;121:1904–14.

    Article  PubMed  Google Scholar 

  51. Escobar-Barranco JJ, Pina-Marin B, Fernandez-Bonet M. Dexamethasone implants in patients with naïve or refractory diffuse diabetic macular edema. Ophthalmologica. 2015;233:176–85.

    Article  CAS  PubMed  Google Scholar 

  52. Boyer DS, Faber D, Gupta S, Patel SS, Tabandeh H, Li XY, Ozurdex CHAMPLAIN Study Group, et al. Dexamethasone intravitreal implant for treatment of diabetic macular edema in vitrectomized patients. Retina. 2011;31:915–23.

    Article  CAS  PubMed  Google Scholar 

  53. Concillado M, Lund-Andersen H, Mathiesen ER, Larsen M. Dexamethasone intravitreal implant for diabetic macular edema during pregnancy. Am J Ophthalmol. 2016;165:7–15.

    Article  CAS  PubMed  Google Scholar 

  54. Ohira A, Hara K, Jóhannesson G, Tanito M, Ásgrímsdóttir GM, Lund SH, et al. Topical dexamethasone γ-cyclodextrin nanoparticle eye drops increase visual acuity and decrease macular thickness in diabetic macular oedema. Acta Ophthalmol. 2015;93:610–5.

    Article  CAS  PubMed  Google Scholar 

  55. Tanito M, Hara K, Takai Y, Matsuoka Y, Nishimura N, Jansook P, et al. Topical dexamethasone-cyclodextrin microparticle eye drops for diabetic macular edema. Investig Ophthalmol Vis Sci. 2011;52:7944–8.

    Article  CAS  Google Scholar 

  56. Loftsson T, Stefánsson E. Cyclodextrins in eye drop formulations: enhanced topical delivery of corticosteroids to the eye. Acta Ophthalmol Scand. 2002;80:144–50.

    Article  CAS  PubMed  Google Scholar 

  57. Campochiaro PA, Brown DM, Awh CC, Lee SY, Gray S, Saroj N, et al. Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology. 2011;118:2041–9.

    Article  PubMed  Google Scholar 

  58. Brown DM, Campochiaro PA, Bhisitkul RB, Ho AC, Gray S, Saroj N, et al. Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology. 2011;118:1594–602.

    Article  PubMed  Google Scholar 

  59. Brown DM, Heier JS, Clark WL, Boyer DS, Vitti R, Berliner AJ. Intravitreal aflibercept injection for macular edema secondary to central retinal vein occlusion: 1-year results from the phase 3 COPERNICUS study. Am J Ophthalmol. 2013;155:429–37.

    Article  CAS  PubMed  Google Scholar 

  60. Korobelnik JF, Holz FG, Roider J, Ogura Y, Simader C, Schmidt-Erfurth U, et al. GALILEO Study Group. Intravitreal aflibercept injection for macular edema resulting from central retinal vein occlusion: one-year results of the phase 3 GALILEO study. Ophthalmology. 2014;121:202–8.

    Article  PubMed  Google Scholar 

  61. Clark WL, Boyer DS, Heier JS, Brown DM, Haller JA, Vitti R, et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion: 52-week results of the VIBRANT study. Ophthalmology. 2016;123:330–6.

    Article  PubMed  Google Scholar 

  62. Haller JA, Bandello F, Belfort R Jr, Blumenkranz MS, Gillies M, Heier J, et al. Ozurdex GENEVA Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010;117:1134–46.

    Article  PubMed  Google Scholar 

  63. Cunningham MA, Edelman JL, Kaushal S. Intravitreal steroids for macular edema: the past, the present, and the future. Surv Ophthalmol. 2008;53:139–49.

    Article  PubMed  Google Scholar 

  64. Lowder C, Belfort R Jr, Lightman S, Foster CS, Robinson MR, Schiffman RM, et al. Ozurdex HURON Study Group. Dexamethasone intravitreal implant for noninfectious intermediate or posterior uveitis. Arch Ophthalmol. 2011;129:545–53.

    Article  PubMed  Google Scholar 

  65. Zarranz-Ventura J, Carreño E, Johnston RL, Mohammed Q, Ross AH, Barker C, et al. Multicenter study of intravitreal dexamethasone implant in noninfectious uveitis: indications, outcomes, and reinjection frequency. Am J Ophthalmol. 2014;158:1136–45.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. IIS-Aragon, Department of Ophthalmology, Miguel Servet University Hospital, Isabel la Católica 1-3, 50009, Zaragoza, Spain

    Beatriz Abadia, Pilar Calvo, Antonio Ferreras, Fran Bartol & Luis Pablo

  2. University of Zaragoza, Zaragoza, Spain

    Pilar Calvo, Antonio Ferreras & Luis Pablo

  3. Department of Endocrinology, Obispo Polanco Hospital, Teruel, Spain

    Guayente Verdes

Authors
  1. Beatriz Abadia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pilar Calvo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Antonio Ferreras
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fran Bartol
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Guayente Verdes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luis Pablo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pilar Calvo.

Ethics declarations

Conflicts of interest

Beatriz Abadia, Pilar Calvo, Antonio Ferreras, Fran Bartol, Guayente Verdes and Luis Pablo declare no conflicts of interest.

Funding

No funding was required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abadia, B., Calvo, P., Ferreras, A. et al. Clinical Applications of Dexamethasone for Aged Eyes. Drugs Aging 33, 639–646 (2016). https://doi.org/10.1007/s40266-016-0392-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-016-0392-z

Keywords

Search

Navigation