Systemic Effects of Repeated Intraocular Dexamethasone Intravitreal Implant in Diabetic Patients: A Retrospective Study.

The objective of this study is to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients. Retrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15 months of follow-up after Ozurdex treatment onset. Fifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6 mg/dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2 mg/dl, p = 0.04) but after 15 months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4 mg/dl, p = 0.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15. Ozurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction

Oct parameters as predictive factors for the visual outcome after ranibizumab therapy in neovascular age related macular degeneration

Objective: To evaluate macular morphological parameters measured by spectral domain optical coherence tomography (SD-OCT) as predictive factors of visual outcome in patients with exudative age-related macular degeneration (AMD) treated with ranibizumab. Methods: A retrospective study was conducted on 47 patients diagnosed with exudative AMD and treated with intravitreal ranibizumab for 12 months. Central retinal thickness (CRT), extension and thickness of modifications secondary to neovascular process, and status of the bands corresponding to the external limiting membrane (ELM) and to the ellipsoid region of the photoreceptors (ISe) were evaluated by means of SD-OCT. The relationship between these variables and visual acuity was analyzed by statistical methods. Results: At the time of the diagnosis, preservation of ELM and ISe bands, and CRT were correlated with initial visual acuity. Twelve months later, CRT and visual acuity were independent parameters. Bivariate relationship analysis showed a correlation between final visual acuity and the following parameters: initial CRT, initial ISe and ELM status, and ISe and ELM integrity after loading dose. Multiple regression analysis indicated that initial visual acuity and ISe band status after loading dose have a predictive value for final visual acuity. Conclusions: The status of ISe and ELM bands after 12 months of treatment with ranibizumab was associated with visual outcome. Initial visual acuity and status of the ISe band after loading dose are prognostic factors of final visual acuity