Intravitreal steroids in the management of macular oedema

Plasma concentrations were obtained from 21 patients with macular edema due to branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO), and 21 patients with diabetic macular edema (DME) prior to dosing and at 4 to 5 additional post-dose timepoints on Days 1, 7, 21, 30, 45, 60, and 90 following the administration of the first intravitreal implant containing mg dexamethasone. In RVO and DME patients, the majority of plasma dexamethasone concentrations were below the lower limit of quantitation (LLOQ = 50 pg/mL). Plasma dexamethasone concentrations from 12% of samples were above the LLOQ, ranging from 52 pg/mL to 102 pg/mL. Plasma dexamethasone concentration did not appear to be related to age, body weight, or sex of patients.

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Vision loss from edematous macular conditions remains a significant problem. The mainstay of treatment for these conditions, thermal laser photocoagulation, carries the risk of tissue damage. Furthermore, many conditions are not amenable to laser therapy.

This has led to the advent of intravitreal steroid injection in an attempt to better manage macular edematous conditions and preserve vision. Recent research has demonstrated benefits from this new therapeutic approach and, in time, there should be clear indications as to the proper usage of intravitreal steroid injections for the management of edematous macular diseases.

Dr. Vollmer is an Instructor of Optometry at Nova Southeastern University in Ft. Lauderdale. Dr. Sowka is a Professor of Optometry at Nova Southeastern University. Special acknowledgements also go to Julio Perez, ., and Rena Cappelli, .

Investigations for Diabetic Retinopathy
If diabetic retinopathy is noted, color photographs of the retina may be taken and FLUORESCEIN ANGIOGRAPHY performed. This involves dilating the pupils and injection of a fluorescent dye into a vein in the arm. Photographs of the retina are taken rapidly as the dye passes through the retinal blood vessels. This test helps in determining if laser photocoagulation treatment is necessary. If treatment is to be done, it helps in identifying what structures and areas need treatment with laser.
OPTICAL COHERENCE TOMOGRAPHY (OCT), which is newer non-invasive diagnostic modality provides a cross-sectional view of the retina and helps in quantifying the amount and type of swelling and guides the treatment.

Intravitreal steroids in the management of macular oedema

intravitreal steroids in the management of macular oedema

Investigations for Diabetic Retinopathy
If diabetic retinopathy is noted, color photographs of the retina may be taken and FLUORESCEIN ANGIOGRAPHY performed. This involves dilating the pupils and injection of a fluorescent dye into a vein in the arm. Photographs of the retina are taken rapidly as the dye passes through the retinal blood vessels. This test helps in determining if laser photocoagulation treatment is necessary. If treatment is to be done, it helps in identifying what structures and areas need treatment with laser.
OPTICAL COHERENCE TOMOGRAPHY (OCT), which is newer non-invasive diagnostic modality provides a cross-sectional view of the retina and helps in quantifying the amount and type of swelling and guides the treatment.

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