Clinical observation of dexamethasone sustained release intraocular implantation combined with vitrectomy in pediatric ocular toxocariasis_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Jinghua , Li Songfeng , Deng Guangda , Li Liang , Ma Jing , Yuan Mingzhen ,  Lu Hai

Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China;

Corresponding author：

Lu Hai, Email: trdr_luhai2017@163.com

Keywords：

Child; Toxocariasis; Toxoplasmosis, ocular; Dexamethasone; Intravitreal injections

DOI：

10.3760/cma.j.cn511434-20220510-00284

Video：

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Objective To observe the efficacy of parsplana vitrectomy (PPV) combined with 0.7 mg dexamethasone sustained-release Ozurdex intravitreal implantation in the treatment of children with ocular toxocariasis (OT). Methods A retrospective clinical study. Fifty-three pediatric patients (53 eyes) diagnosed with OT and underwent PPV in Beijing Tongren Eye Center of Beijing Tongren hospital from March 2015 to December 2021 were included. There were 30 males and 23 females, with an average age of 7.07±3.45 (4-14) years; all were unilateral. Color Doppler imaging, fundus color photography, optical coherence tomography examinations were performed for patients who can cooperated with the examiners. Forty-three eyes were examined by best corrected visual acuity (BCVA); 47 eyes were examined by intraocular pressure; 29 eyes were examined by ultrasound biomicroscopy. According to the location of granuloma, OT was divided into posterior pole granulomatous type (posterior type), peripheral granulomatous type (peripheral type), and chronic endophthalmitis type. According to whether Ozurdex was implanted into the vitreous cavity after PPV, the children were divided into the oral glucocorticoid group after PPV (group A) and the PPV combined with vitreous cavity implantation of Ozurdex group (group B), 37 cases with 37 eyes and 16 cases with 16 eyes, respectively. There was no significant difference in age (t=0.432), sex composition ratio (χ²=0.117), BCVA (χ²=0.239), and clinical type (χ²=0.312) between the two groups (P＞0.05). The follow-up time after surgery was ≥5 months. The intraocular pressure at 1 week and 1, 3, and 6 months after surgery, the changes of BCVA and the occurrence of complications such as concurrent cataract and epimacular membrane were observed at the last follow-up, and the incidence of obesity in the children during the follow-up period was recorded. The measurement data between groups was compared by independent sample t test; the enumeration data was compared by χ² test. Results One month after the operation, the intraocular pressure of group A and group B were 15.17±6.21 and 25.28±10.38 mm Hg (1 mm Hg=0.133 kPa) respectively; the intraocular pressure of group B was significantly higher than that of group A, the difference was statistically significant (t=0.141, P=0.043). At the last follow-up, there was no significant difference in the percentage of visual acuity improvement between the two groups (χ²=0.315, P=0.053); there was no significant difference in the incidence of concurrent cataract and epimacular membrane (χ²=0.621, P＞0.05). Among the 37 cases in group A, 32 cases (86.5%, 32/37) developed obesity symptoms during the follow-up period. Conclusion PPV combined with intravitreal implantation of Ozurdex and oral glucocorticoid after PPV can effectively improve the visual acuity of the affected eye; the incidence of complications is similar, however, the incidence of obesity after oral glucocorticoid is higher.

Citation： Liu Jinghua, Li Songfeng, Deng Guangda, Li Liang, Ma Jing, Yuan Mingzhen, Lu Hai. Clinical observation of dexamethasone sustained release intraocular implantation combined with vitrectomy in pediatric ocular toxocariasis. Chinese Journal of Ocular Fundus Diseases, 2022, 38(7): 562-567. doi: 10.3760/cma.j.cn511434-20220510-00284 Copy

1.	Stewart JM, Cubillan LD, Cunningham ET Jr. Prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis[J]. Retina, 2005, 25(8): 1005-1013. DOI: 10.1097/00006982-200512000-00009.
2.	Woodhall D, Starr MC, Montgomery SP, et al. Ocular toxocariasis: epidemiologic, anatomic, and therapeutic variations based on a survey of ophthalmic subspecialists[J]. Ophthalmology, 2012, 119(6): 1211-1217. DOI: 10.1016/j.ophtha.2011.12.013.
3.	Giuliari GP, Ramirez G, Cortez RT. Surgical treatment of ocular toxocariasis: anatomic and functional results in 45 patients[J]. Eur J Ophthalmol, 2011, 21(4): 490-494. DOI: 10.5301/EJO.2010.6118.
4.	Zhang T, Guo D, Xu G, et al. Ocular toxocariasis: long-term follow-up and prognosis of patients following vitrectomy[J]. Ocul Immunol Inflamm, 2020, 28(3): 517-523. DOI: 10.1080/09273948.2019.1597897.
5.	Ferrara G, Petrillo MG, Giani T, et al. Clinical use and molecular action of corticosteroids in the pediatric age[J]. Int J Mol Sci, 2019, 20(2): 444. DOI: 10.3390/ijms20020444.
6.	Kapoor KG, Wagner MG, Wagner AL. The sustained-release dexamethasone implant: expanding indications in vitreoretinal disease[J]. Semin Ophthalmol, 2015, 30(5-6): 475-481. DOI: 10.3109/08820538.2014.889179.
7.	Medeiros MD, Alkabes M, Navarro R, et al. Dexamethasone intravitreal implant in vitrectomized versus nonvitrectomized eyes for treatment of patients with persistent diabetic macular edema[J]. J Ocul Pharmacol Ther, 2014, 30(9): 709-716. DOI: 10.1089/jop.2014.0010.
8.	Singer MA, Jansen ME, Tyler L, et al. Long-term results of combination therapy using anti-VEGF agents and dexamethasone intravitreal implant for retinal vein occlusion: an investigational case series[J]. Clin Ophthalmol, 2016, 11: 31-38. DOI: 10.2147/OPTH.S119373.
9.	Pichi F, Nucci P, Baynes K, et al. Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis[J]. Int Ophthalmol, 2017, 37(1): 221-228. DOI: 10.1007/s10792-016-0265-9.
10.	Cai Y, Yang Y, Zhong X. A case report of intravitreal dexamethasone implant with exudative retinal detachment for ocular toxocariasis treatment[J]. Korean J Parasitol, 2022, 60(2): 133-137. DOI: 10.3347/kjp.2022.60.2.133.
11.	Whitcup SM, Robinson MR. Development of a dexamethasone intravitreal implant for the treatment of noninfectious posterior segment uveitis[J]. Ann N Y Acad Sci, 2015, 1358: 1-12. DOI: 10.1111/nyas.12824.
12.	Bratton ML, He YG, Weakley DR. Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis[J]. J AAPOS, 2014, 18(2): 110-113. DOI: 10.1016/j.jaapos.2013.11.014.
13.	He Y, Ren XJ, Hu BJ, et al. A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema[J]. BMC Ophthalmol, 2018, 18(1): 121. DOI: 10.1186/s12886-018-0779-1.
14.	Kishore K, Bhat PV, Venkatesh P, et al. Dexamethasone intravitreal implant for the treatment of macular edema and uveitis: a comprehensive narrative review[J]. Clin Ophthalmol, 2022, 16: 1019-1045. DOI: 10.2147/OPTH.S209395.
15.	Chang-Lin JE, Burke JA, Peng Q, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4605-4609. DOI: 10.1167/iovs.10-6387.
16.	Fassbender Adeniran JM, Jusufbegovic D, Schaal S. Common and rare ocular side-effects of the dexamethasone implant[J]. Ocul Immunol Inflamm, 2017, 25(6): 834-840. DOI: 10.1080/09273948.2016.1184284.
17.	Tomkins-Netzer O, Talat L, Seguin-Greenstein S, et al. Outcome of treating pediatric uveitis with dexamethasone implants[J]. Am J Ophthalmol, 2016, 161: 110-115. DOI: 10.1016/j.ajo.2015.09.036.
18.	Reid GA, Sahota DS, Sarhan M. Observed complications from dexamethasone intravitreal implant for the treatment of macular edema in retinal vein occlusion over 3 treatment rounds[J]. Retina, 2015, 35(8): 1647-1655. DOI: 10.1097/IAE.0000000000000524.

1. Stewart JM, Cubillan LD, Cunningham ET Jr. Prevalence, clinical features, and causes of vision loss among patients with ocular toxocariasis[J]. Retina, 2005, 25(8): 1005-1013. DOI: 10.1097/00006982-200512000-00009.
2. Woodhall D, Starr MC, Montgomery SP, et al. Ocular toxocariasis: epidemiologic, anatomic, and therapeutic variations based on a survey of ophthalmic subspecialists[J]. Ophthalmology, 2012, 119(6): 1211-1217. DOI: 10.1016/j.ophtha.2011.12.013.
3. Giuliari GP, Ramirez G, Cortez RT. Surgical treatment of ocular toxocariasis: anatomic and functional results in 45 patients[J]. Eur J Ophthalmol, 2011, 21(4): 490-494. DOI: 10.5301/EJO.2010.6118.
4. Zhang T, Guo D, Xu G, et al. Ocular toxocariasis: long-term follow-up and prognosis of patients following vitrectomy[J]. Ocul Immunol Inflamm, 2020, 28(3): 517-523. DOI: 10.1080/09273948.2019.1597897.
5. Ferrara G, Petrillo MG, Giani T, et al. Clinical use and molecular action of corticosteroids in the pediatric age[J]. Int J Mol Sci, 2019, 20(2): 444. DOI: 10.3390/ijms20020444.
6. Kapoor KG, Wagner MG, Wagner AL. The sustained-release dexamethasone implant: expanding indications in vitreoretinal disease[J]. Semin Ophthalmol, 2015, 30(5-6): 475-481. DOI: 10.3109/08820538.2014.889179.
7. Medeiros MD, Alkabes M, Navarro R, et al. Dexamethasone intravitreal implant in vitrectomized versus nonvitrectomized eyes for treatment of patients with persistent diabetic macular edema[J]. J Ocul Pharmacol Ther, 2014, 30(9): 709-716. DOI: 10.1089/jop.2014.0010.
8. Singer MA, Jansen ME, Tyler L, et al. Long-term results of combination therapy using anti-VEGF agents and dexamethasone intravitreal implant for retinal vein occlusion: an investigational case series[J]. Clin Ophthalmol, 2016, 11: 31-38. DOI: 10.2147/OPTH.S119373.
9. Pichi F, Nucci P, Baynes K, et al. Sustained-release dexamethasone intravitreal implant in juvenile idiopathic arthritis-related uveitis[J]. Int Ophthalmol, 2017, 37(1): 221-228. DOI: 10.1007/s10792-016-0265-9.
10. Cai Y, Yang Y, Zhong X. A case report of intravitreal dexamethasone implant with exudative retinal detachment for ocular toxocariasis treatment[J]. Korean J Parasitol, 2022, 60(2): 133-137. DOI: 10.3347/kjp.2022.60.2.133.
11. Whitcup SM, Robinson MR. Development of a dexamethasone intravitreal implant for the treatment of noninfectious posterior segment uveitis[J]. Ann N Y Acad Sci, 2015, 1358: 1-12. DOI: 10.1111/nyas.12824.
12. Bratton ML, He YG, Weakley DR. Dexamethasone intravitreal implant (Ozurdex) for the treatment of pediatric uveitis[J]. J AAPOS, 2014, 18(2): 110-113. DOI: 10.1016/j.jaapos.2013.11.014.
13. He Y, Ren XJ, Hu BJ, et al. A meta-analysis of the effect of a dexamethasone intravitreal implant versus intravitreal anti-vascular endothelial growth factor treatment for diabetic macular edema[J]. BMC Ophthalmol, 2018, 18(1): 121. DOI: 10.1186/s12886-018-0779-1.
14. Kishore K, Bhat PV, Venkatesh P, et al. Dexamethasone intravitreal implant for the treatment of macular edema and uveitis: a comprehensive narrative review[J]. Clin Ophthalmol, 2022, 16: 1019-1045. DOI: 10.2147/OPTH.S209395.
15. Chang-Lin JE, Burke JA, Peng Q, et al. Pharmacokinetics of a sustained-release dexamethasone intravitreal implant in vitrectomized and nonvitrectomized eyes[J]. Invest Ophthalmol Vis Sci, 2011, 52(7): 4605-4609. DOI: 10.1167/iovs.10-6387.
16. Fassbender Adeniran JM, Jusufbegovic D, Schaal S. Common and rare ocular side-effects of the dexamethasone implant[J]. Ocul Immunol Inflamm, 2017, 25(6): 834-840. DOI: 10.1080/09273948.2016.1184284.
17. Tomkins-Netzer O, Talat L, Seguin-Greenstein S, et al. Outcome of treating pediatric uveitis with dexamethasone implants[J]. Am J Ophthalmol, 2016, 161: 110-115. DOI: 10.1016/j.ajo.2015.09.036.
18. Reid GA, Sahota DS, Sarhan M. Observed complications from dexamethasone intravitreal implant for the treatment of macular edema in retinal vein occlusion over 3 treatment rounds[J]. Retina, 2015, 35(8): 1647-1655. DOI: 10.1097/IAE.0000000000000524.

Chinese Journal of Ocular Fundus Diseases

Clinical observation of dexamethasone sustained release intraocular implantation combined with vitrectomy in pediatric ocular toxocariasis

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