Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of intraoperative slow-release dexamethasone implant combined with idiopathic epiretinal membrane removal

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the efficacy of intraoperative slow-release dexamethasone implant (DEX) combined with removal of idiopathic epiretinal membrane (ERM).

Methods

In this observational retrospective study, data of 40 patients with phakic eyes affected by idiopathic ERM were analysed. All patients underwent cataract phacoemulsification, 25-gauge (G) pars plana vitrectomy (PPV), ERM removal with DEX implant (“DEX YES” group, #20) or without DEX implant (“DEX NO” group, #20). We collected data on best-corrected visual acuity (BCVA) < 20/40 Snellen charts, central macular thickness (CMT) ≤ 400 μm (measured by SD-OCT) and integrity of sub-foveal ellipsoid/myoid zone. BCVA, CMT and intraocular pressure (IOP) were evaluated at baseline as well as 15, 30 and 90 days after surgery.

Results

In the “DEX YES” group, statistically significant BCVA improvement was observed at 15, 30 and 90 days (p < 0.001), while in the “DEX NO” group, improvements were observed only at 30 and 90 days (p < 0.001). In both groups, CMT significantly decreased at each follow-up visit (p < 0.001), and no statistically significant increase of IOP was detected at each follow-up visit.

Conclusions

In this study, DEX accelerated the improvement of BCVA at 15 days after surgery. However, no evidence of further anatomical (CMT) and functional (BCVA) DEX effectiveness combined with removal of idiopathic ERM by 25-G PPV at 30 and 90 days follow-up was observed.

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

Fig. 1

Similar content being viewed by others

References

  1. Joshi M, Agrawal S, Christoforidis JB (2013) Inflammatory mechanisms of idiopathic epiretinal membrane formation. Mediat Inflamm 192582. https://doi.org/10.1155/2013/192582

  2. Cheung N, Tan SP, Lee SY, Cheung GCM, Tan G, Kumar N et al (2017) Prevalence and risk factors for epiretinal membrane: the Singapore Epidemiology of Eye Disease study. Br J Ophthalmol 101:371–376. https://doi.org/10.1136/bjophthalmol-2016-308563

    Article  PubMed  Google Scholar 

  3. Iwanoff A (1865) Beiträge zur normalen und pathologischen anatomie des auges. Graefes Arch Clin Exp Ophthalmol 11:135

    Article  Google Scholar 

  4. Koizumi H, Spaide RF, Fisher YL, Freund KB, Klancnik JM Jr, Yannuzzi LA (2008) Three-dimensional evaluation of vitreomacular traction and epiretinal membrane using spectral-domain optical coherence tomography. Am J Ophthalmol 145:509–517. https://doi.org/10.1016/j.ajo.2007.10.014

    Article  PubMed  Google Scholar 

  5. Gass JDM (1997) Macular dysfunction caused by epiretinal membrane contraction. In: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment, vol 2, 4th edn. Mosby, St Louis, pp 938–590

    Google Scholar 

  6. Stevenson W, Prospero Ponce C, Agarwal D, Gelman R, Christoforidis J (2016) Epiretinal membrane: optical coherence tomography-based diagnosis and classification. Clin Ophthalmol 10:527–534. https://doi.org/10.2147/OPTH.S97722

    Article  PubMed  PubMed Central  Google Scholar 

  7. Duker JS, Kaiser PK, Binder S et al (2013) The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 120:2611–2619. https://doi.org/10.1016/j.ophtha.2013.07.042

    Article  PubMed  Google Scholar 

  8. Kritzenberg M, Jungas B, Framme C, Helbig H, Gabel VP, Fuchshofer R et al (2011) Different collagen types define two types of idiopathic epiretinal membranes. Histopathology 58:953–965. https://doi.org/10.1111/j.1365-2559.2011.03820

    Article  Google Scholar 

  9. Kampik A (2012) Pathology of epiretinal membrane, idiopathic macular hole, and vitreomacular traction syndrome. Retina 32(Suppl 2):S194–S198;discussion S198–9. https://doi.org/10.1097/IAE.0b013e31825bc20a

    Article  CAS  PubMed  Google Scholar 

  10. Sebag J, Gupta P, Rosen RR et al (2007) Macular holes and macular pucker: the role of vitreoschisis as imaged by optical coherence tomography/scanning laser ophthalmoscopy. Trans Am Ophthalmol Soc 105:121–129

    PubMed  PubMed Central  Google Scholar 

  11. Romano MR, Comune C, Ferrara M, Cennamo G, De Cillà S, Toto L et al (2015) Retinal changes induced by epiretinal tangential forces. J Ophthalmol 2015:372564. https://doi.org/10.1155/2015/372564

    Article  PubMed  PubMed Central  Google Scholar 

  12. Miyazaki M, Nakamura H, Kubo M, Kiyohara Y, Iida M, Ishibashi T et al (2003) Prevalence and risk factors for epiretinal membranes in a Japanese population: the Hisayama study. Graefes Arch Clin Exp Ophthalmol 241:642–646. https://doi.org/10.1007/s00417-003-0723-8

    Article  PubMed  Google Scholar 

  13. Katira RC, Zamani M, Berinstein DM, Garfinkel RA (2008) Incidence and characteristics of macular pucker formation after primary retinal detachment repair by pars plana vitrectomy alone. Retina 28:744–748. https://doi.org/10.1097/IAE

    Article  PubMed  Google Scholar 

  14. Bu S, Kuijer R, Li X, Hooymans J, Los L (2014) Idiopathic epiretinal membrane. Retina 34:2317–2335. https://doi.org/10.1097/IAE.0000000000000349

    Article  CAS  PubMed  Google Scholar 

  15. Suh MH, Seo JM, Park KH, Yu HG (2009) Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal. Am J Ophthalmol 147:473–480. https://doi.org/10.1016/j.ajo.2008.09.020

    Article  PubMed  Google Scholar 

  16. Miguel AI, Legris A (2017) Prognostic factors of epiretinal membranes: a systematic review. J Fr Ophtalmol 40:61–79. https://doi.org/10.1016/j.jfo.2016.12.001

    Article  CAS  PubMed  Google Scholar 

  17. Carpentier C, Zanolli M, Wu L et al (2013) Residual internal limiting membrane after epiretinal membrane peeling: results of the pan-American collaborative retina study group. Retina 33:2026–2031. https://doi.org/10.1097/IAE.0b013e31828e69c2

    Article  PubMed  Google Scholar 

  18. Ripandelli G, Scarinci F, Piaggi P et al (2015) Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response. Retina 35:498–507. https://doi.org/10.1097/IAE.0000000000000330

    Article  PubMed  Google Scholar 

  19. Boyer D, Yoon Y, Belfort R, Bandello F, Ozurdex MEAD Study Group et al (2014) Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 121:1904–1914. https://doi.org/10.1016/j.ophtha.2014.04.024

    Article  PubMed  Google Scholar 

  20. Massa H, Georgoudis P, Panos G (2019) Dexamethasone intravitreal implant (OZURDEX®) for macular edema secondary to noninfectious uveitis: a review of the literature. Ther Deliv 10:343–351. https://doi.org/10.4155/tde-2019-0024

    Article  CAS  PubMed  Google Scholar 

  21. Chang Y, Liu P, Kao T, Wu H et al (2018) Dexamethasone intravitreal implant (Ozurdex) for long-term macular edema after epiretinal membrane peeling surgery. Ophthalmol 2018:5832186. https://doi.org/10.1155/2018/5832186

    Article  CAS  Google Scholar 

  22. Furino C, Boscia F, Recchimurzo N, Sborgia C, Alessio G (2014) Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker. Retina 34:1612–1616. https://doi.org/10.1097/IAE.0000000000000105

    Article  CAS  PubMed  Google Scholar 

  23. Rizzo S, Pacini B, De Angelis L, Barca F et al (2020) Intrascleral hydration for 23-gauge pars plana vitrectomy sclerotomy closure. Retina. https://doi.org/10.1097/IAE.0000000000002703

  24. Chang-Lin E, Burke JA, Peng Q et al (2011) Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes. Invest Ophthalmol Vis Sci 52:4605–4609. https://doi.org/10.1167/iovs.10-6387

    Article  CAS  PubMed  Google Scholar 

  25. Hattenbach L, Springer-Wanner C, Hoerauf H, Callizo J et al (2017) Intravitreal sustained-release steroid implants for the treatment of macular edema following surgical removal of epiretinal membranes. Ophthalmologica 237:232–237. https://doi.org/10.1159/000464259

    Article  CAS  PubMed  Google Scholar 

  26. Chatziralli I, Dimitriou E, Theodossiadis G, Chatzirallis A, Kazantzis D, Theodossiadis P (2019) Treatment of macular edema after pars plana vitrectomy for idiopathic epiretinal membrane using intravitreal dexamethasone implant: long-term outcomes. Ophthalmologica 242:16–21. https://doi.org/10.1159/000496705

    Article  CAS  PubMed  Google Scholar 

  27. Taney LS, Baumal CR, Duker JS (2015) Sustained-release dexamethasone intravitreal implant for persistent macular edema after vitrectomy for epiretinal membrane. Ophthalmic Surg Lasers Imaging Retina 46:224–228. https://doi.org/10.3928/23258160-20150213-01

    Article  PubMed  Google Scholar 

  28. Guidi G, Casini G, Ripandelli G, Piaggi P et al (2018) Intraretinal edema after 25-gauge vitrectomy and macular pucker removal: is intraoperative sustained-release dexamethasone a real treatment option? Retina 38:993–999. https://doi.org/10.1097/IAE.0000000000001627

    Article  PubMed  Google Scholar 

  29. Iovino C, Giannaccare G, Pellegrini M, Bernabei F (2019) Efficacy and safety of combined vitrectomy with intravitreal dexamethasone implant for advanced stage epiretinal membrane. Drug Des Devel Ther 13:4107–4114. https://doi.org/10.2147/DDDT.S229031

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Giansanti F, Bitossi A, Giacomelli G, Virgili G et al (2013) Evaluation of macular thickness after uncomplicated cataract surgery using optical coherence tomography. Eur J Ophthalmol 23:751–756. https://doi.org/10.5301/ejo.5000280

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Ophthalmology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy

    Alfonso Savastano, Gloria Gambini, Umberto De Vico, Patrizio Bernardinelli, Maria Cristina Savastano & Stanislao Rizzo

  2. Catholic University of “Sacro Cuore”, Rome, Italy

    Alfonso Savastano, Patrizio Bernardinelli, Maria Cristina Savastano & Stanislao Rizzo

  3. Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy

    Alice Bitossi, Fabrizio Giansanti, Lorenzo Vannozzi, Tomaso Caporossi, Francesco Barca & Gianni Virgili

  4. Consiglio Nazionale della Ricerca (CNR), Istituto di Neuroscienze, Pisa, Italy

    Stanislao Rizzo

Authors
  1. Alfonso Savastano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alice Bitossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabrizio Giansanti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lorenzo Vannozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomaso Caporossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francesco Barca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gianni Virgili
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gloria Gambini
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Umberto De Vico
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Patrizio Bernardinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Maria Cristina Savastano
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Stanislao Rizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alfonso Savastano.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Savastano, A., Bitossi, A., Giansanti, F. et al. Evaluation of intraoperative slow-release dexamethasone implant combined with idiopathic epiretinal membrane removal. Graefes Arch Clin Exp Ophthalmol 259, 379–385 (2021). https://doi.org/10.1007/s00417-020-04911-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-020-04911-5

Keywords

Search

Navigation