Ermete Giancipoli

Dexamethasone implant with fixed or individualized regimen in the treatment of diabetic macular oedema: six‐month outcomes of the UDBASA study

To evaluate a pro re nata administration of Ozurdex® implant versus a single administration for treating diabetic macular oedema (DME).

Combined Phacoemulsification and Intravitreal Dexamethasone Implant (Ozurdex®) in Diabetic Patients with Coexisting Cataract and Diabetic Macular Edema

Purpose To investigate the effectiveness and safety of combined phacoemulsification and dexamethasone intravitreal implant in patients with cataract and diabetic macular edema. Methods In this two-center, retrospective, single-group study, the charts of 16 consecutive patients who underwent combined phacoemulsification and intravitreal dexamethasone implant were retrospectively reviewed. These 16 patients, 7 men and 9 women, were observed at least 3 months of follow-up. Primary outcome was the change of the central retinal thickness (CRT); secondary outcome was the change of best-corrected visual acuity (BCVA). Any ocular complications were recorded. Results Mean CRT decreased significantly from 486 ± 152.4 μm at baseline to 365.5 ± 91 μm at 30 days (p = .005), to 326 ± 80 μm at 60 days (p = .0004), and to 362 ± 134 μm at 90 days (p = .001). Mean BCVA was 20/105 (logMAR, 0.72 ± 0.34) at baseline and improved significantly (p ≤ .007) at all postsurgery time points. One case of ocular hypertension was observed and successfully managed with topical therapy. No endophthalmitis or other ocular complications were observed. Conclusion Intravitreal slow-release dexamethasone implant combined with cataract surgery may be an effective approach on morphologic and functional outcomes for patients with cataract and diabetic macular edema for at least three months after surgery.

Intravitreal Dexamethasone in Patients with Wet Age-Related Macular Degeneration Resistant to Anti-VEGF: A Prospective Pilot Study

Purpose To evaluate the efficacy and safety of a single intravitreal dexamethasone implant (DXI) combined with intravitreal antivascular endothelial growth factor (anti-VEGF) therapy, in patients with neovascular age-related macular degeneration (wet-AMD) resistant to conventional treatment. Methods In this randomized, controlled pilot study, 16 eyes of 15 patients, unresponsive to anti-VEGF therapy, were enrolled and randomly assigned to two groups: DXI + anti-VEGF (treatment group: 11 eyes) and monthly anti-VEGF alone (control group: 5 eyes). Patients were treated at baseline and followed for 6 months. Best corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters, and fluorescein angiography (FA) were evaluated. Results Eight eyes (72.7%) in the treatment group and 2 eyes in the control group (40%) showed complete retinal fluid resorption (p=0.049). BCVA showed no significant change from baseline in both the treatment group and the control group (p=0.40 and p=0.29, respectively). Both median central foveal thickness (CFT) and median macular volume showed a greater reduction from baseline in the treatment group. Conclusion In patients showing an incomplete response to anti-VEGF therapy, DXI combined with intravitreal anti-VEGF seems to improve retinal fluid resorption without functional advantage. This trial is registered with ACTRN12618001102268.

Gentle endodiathermy of retinal vessels to mark paravascular posterior retinal breaks in highly myopic eyes

Purpose: To show a new method to highlight posterior paravascular retinal breaks, responsible for posterior retinal detachment in highly myopic eyes, by gentle endodiathermy on the nearby retinal vessel, in areas of patchy chorioretinal atrophy. Methods: A standard 25-gauge (25-G) 3-port pars plana vitrectomy with internal limiting membrane (ILM) peeling was performed. A gentle endodiathermy was applied on the vessel close to the retinal break until a clear withe spot became visible. This spot was used as a landmark to identify the retinal break after fluid-air exchange. Results: The retina was attached after a single operation and no retinal redetachment was reported. A complete blood flow restoration in the treated vessel was documented with fluorescein angiography after 5 days. Conclusions: This simple technique may help the vitreoretinal surgeon to identify paravascular retinal breaks after fluid-air exchange. No damage to the retinal vessels undergoing endodiathermy was observed.