Dexamethasone Implant as an Adjunct Therapy in Refractory Diabetic Macular Edema: Real-World Experience in a Turkish Population.

INTRODUCTION: To evaluate,in a real-world setting, the effects of intravitreal dexamethasone (DEX) implants in patients with refractory diabetic macular edema after 3 initial anti-vascular endothelial growth factor (anti-VEGF) injections. METHODS: Each enrolled patient received a DEX implant after suboptimal response to 3 monthly anti-VEGF injections and was followed for 12 months. A second DEX implant was allowed at least 6 months later. Anti-VEGF injections were administered on a pro re nata (PRN) regimen after DEX implant. Predictive factors for visual and morphological outcomes and additional therapies during follow-up were evaluated. RESULTS: Among 81 included eyes, mean central macular thickness (CMT) decreased from 583+-178 µm to 259+-119 µm, and 28 eyes (35%) gained more than 5 ETDRS letters after 1 month. Visual acuity significantly improved most commonly in patients with intact ellipsoid zones. The decrease in CMT was positively correlated with baseline CMT and cyst size. Despite the PRN protocol, significant losses in improvements were seen after 6 months compared to 1 month in the percentage of eyes with CMTs smaller than 300 µm (47% vs 75%) and losing at least5 ETDRSletters (16% vs 5%; P <0.001). The values at 6 and 12 months were not statistically different. DISCUSSION AND CONCLUSION: A DEX implant is an option in eyes with suboptimal responses to 3 monthly anti-VEGF injections. In a real-world setting, anti-VEGF injections on a PRN regimen is not sufficient to preserve the benefits of a DEX implant for a period of 6 months

The Importance of Lower Gastrointestinal Tract Endoscopy Regarding the Preoperative Evaluation of Malignant Adnexal Masses

AbstractObjective: Our aim in this study was to investigate the value of lower gastrointestinal system (GIS) endoscopy regarding the detection of colon invasion and its importance in recognizing primary and secondary ovarian cancers in cases clinically prediagnosed as advanced stage ovarian cancers.Materials and Methods: Records of patients, who were operated due to adnexal mass suspicious for malignancy at our clinic between September 2012 and May 2017, were examined. One hundred thirteen cases of advanced stage (Stage III – IV) malignant adnexal masses were detected.Results: Cases that underwent laparotomy because of a prediagnosis of malignant adnexal mass (mostly ovarian), and had stage III and IV disease, were compared regarding clinical characteristics and foreseeing bowel resection (51 patients had undergone lower GIS endoscopy, 62 had not). Six of the 51 patients, who underwent endoscopy, were diagnosed with colon involvement during endoscopy while 4 other patients were diagnosed intraoperatively. Among the 62 patients, without preoperative endoscopy, 10 patients underwent intraoperative bowel resection. The mean age of the patients with bowel resection was 57.35±13.53y; the mean age of the remaining patients was 55.8±12.54y. Rectosigmoid region was the most common area of resection (17/20). The positive predictive value of colonoscopy for predicting bowel resection was 100%, while the negative predictive value was 91%.Conclusion: Bowel resection is a pivotal component of the surgical approach to advanced stage malignant adnexal masses. The detection of tumor spread in lower GIS endoscopy is very important while planning the surgery, dealing with postoperative stoma problems and emotional issues and during the differential diagnosis of metastatic tumors.</div