Objective To investigate the effect of intravitreal injection with dexamethasone on leukocyte accumulation, vascular permeability, and the expression of intercellular adhension molecule (ICAM-1) in rats with diabetes. Methods Seventy-two BN rats were divided into 4 groups: control group, diabetes group, diabetes+ physiologic saline group, and diabetes+ dexamethasone group, with 18 rats in each group. Streptozotocin was injected into the rats to set up the diabetic model. Accumulated leukocytes were counted in vivo by acridine orange leukocyte fluorography, and retinal vascular permeability was measured by Evans blue assay. The expression of mRNA and protein level of ICAM-1 were evaluated by real-time quantitative polymerase chain reaction analysis and enzymelinked immunosorbent assay. Results In the diabetes+ dexamethasone group, accumulated leukocytes were reduced, retinal vascular permeability decreased, and the expression of ICAM-1 decreased. The expression of ICAM-1 mRNA and protein levels in control group, diabetes group, diabetes+ physiologic saline group, and diabetes+ dexamethasone group were 0.43plusmn;0.07，0.76plusmn;0.21，0.74plusmn;0.18，and 0.55plusmn;0.13; (37.90plusmn;4.56), (76.74plusmn;6.68), (74.32plusmn;7.11), and (39.61plusmn;4.47) pg/mg respectively. Conclusions Dexamethasone can reduce accumulated leukocytes and retinal vascular permeability, which may be caused by inhibiting the expression of ICAM-1. (Chin J Ocul Fundus Dis,2007,23:273-276)
Objective To evaluate the efficacy and safety of dexamethasone intravitreal implant (Ozurdex) in the treatment of macular edema (ME) secondary to retinal vein occlusion (RVO). Methods Thirty-nine patients (39 eyes) with ME secondary to RVO were enrolles in this study. Of the patients, 27 were male and 12 were female. The mean age was (41.9±16.3) years. The mean course of disease was (5.0±5.3) months. The best corrected visual acuity (BCVA), intraocular pressure and optical coherence tomography (OCT) were performed. BCVA was measured by Early Treatment Diabetic Retinopathy Study charts. Central macular thickness (CMT) was measured by OCT. The mean BCVA was (13.4±15.3) letters. The mean intraocular pressure (IOP) was (14.1±2.8) mmHg (1 mmHg=0.133 kPa). The mean CMT was (876.1±437.9) μm. Of the 39 eyes, 33 were central RVO, 6 were branch RVO. Patients were categorized into ischemic (18 eyes)/non-ischemic (21 eyes) groups and previous treatment (22 eyes)/treatment naïve (17 eyes) groups. All eyes underwent intravitreal 0.7 mg Ozurdex injections. BCVA, IOP and CMT were assessed at 1, 2, 3, 6, 9, 12 months after injection. Three months after injection, intravitreal injections of Ozurdex, triamcinolone acetonide or ranibizumab could be considered for patients with ME recurrence or poor treatment effects. Change of BCVA, IOP and CMT were evaluated with paired t test. The presence of ocular and systemic adverse events were assessed. Results BCVA, IOP significantly increased and CMT significantly decreased at 1 month after injection compared to baseline in all groups (t=3.70, 3.69, 4.32, 3.08, 4.25, 6.09, 6.25, 4.02, 5.49, 8.18, 6.54, 5.73; P＜0.05). Two months after injection, change of BCVA, IOP and CMT was most significant (t=4.93, 6.80, 6.71, 5.53, 4.97, 5.89, 5.13, 7.68, 7.31, 8.67, 8.31, 5.82; P＜0.05). Twelve months after injection, there was no statistical difference regarding BCVA of ischemic RVO group and previous treatment group, compared to baseline (t=1.86, 0.67; P＞0.05); BCVA of non-ischemic RVO group and treatment naïve group significantly increased compared to baseline (t=2.27, 2.30; P＜0.05); there was no statistical difference regarding IOP in all groups (t=0.30, 0.13, 0.64, 1.53; P＞0.05);however, CMT significantly decreased in all groups (t=4.60, 3.26, 3.00, 4.87; P＜0.05). Twenty-seven eyes (69.2%) experiences ME recurrence (4.5±1.5) months after injection. Most common side-effect was secondary glaucoma. 41.0% eyes had IOP more than 25 mmHg, most of which were lowered to normal range with use of topical IOP lowering drugs. Four eyes (10.3%) presented with significant cataract progression and needed surgical treatment, all were central RVO eyes. No serious ocular or systemic adverse events such as vitreous hemorrhage, retinal detachment or endophthalmitis were noted. Conclusions Intravitreal injection of Ozurdex for patients with ME secondary to RVO is effective in increasing BCVA and lowering CMT in the first few months. Significant treatment effect could be seen at 1 month after injection and was most significant at 2 months after injection. The long-term vision of eyes in non-ischemic RVO group and treatment naïve group are better. 69.2% eyes experience ME recurrence at 4 months after injection. Short term adverse events were mostly secondary glaucoma and long term adverse events are mostly cataract progression.
ObjectiveTo observe the short-term intraocular pressure changes of the affected eye after the implantation of dexamethasone vitreous implant (Ozurdex), and indirectly understand the tightness of the scleral perforation of the 22G implant device.MethodsThis is a prospective cohort design clinical observational study. From January 2018 to January 2020, 90 eyes (90 patients) who underwent vitreous Ozurdex implantation in the Department of Ophthalmology of Beijing Hospital were included in the study. There were 52 males (52 eyes), and 38 females (38 eyes); they were 14-79 years old. Forty-three eyes (43 patients) had retinal vein occlusion with macular edema, 29 eyes (29 patients) had uveitis with or without macular edema, 18 eyes (18 patients) had diabetic macular edema. All eyes underwent standard scleral tunnel vitreous cavity implantation Ozurdex treatment. The intraocular pressure was measured with a non-contact pneumatic tonometer 10 min before implantation (baseline) and 10, 30 min and 2, 24 h after implantation. The difference were compared between the intraocular pressure at different time points after implantation and the baseline. Wilcoxon signed rank test was used to compare intraocular pressure between baseline and different time points after implantation.ResultsThe average baseline intraocular pressure of the affected eye was 14.85 [interquartile range (IQR): 11.60, 17.63] mmHg (1 mmHg=0.133 kPa). The average intraocular pressure at 10, 30 and 2, 24 hours after implantation were 11.90 (IQR: 8.95, 16.30), 13.75 (IQR: 9.95, 16.80), 13.60 (IQR: 10.95, 17.20), and 14.65 (IQR: 12.20, 17.50) mmHg. Compared with the baseline intraocular pressure, the intraocular pressure decreased at 10 and 30 minutes after implantation, the difference was statistically significant (P＜0.001, P=0.002); the intraocular pressure difference was not statistically significant at 2, 24 h after implantation (P=0.140, 0.280).ConclusionsThere is a statistically significant difference in intraocular pressure reduction compared with the baseline in 10 and 30 minutes after vitreous implantation of Ozurdex, and there is no statistically significant difference between 2, 24 hours. This suggests that the 22G scleral puncture port of the preinstalled implant device cannot be completely closed immediately, and short-term intraocular pressure monitoring after implantation should be appropriately strengthened.