Intravitreal steroid implants

The caudal approach to the epidural space involves the use of a Tuohy needle, an intravenous catheter, or a hypodermic needle to puncture the sacrococcygeal membrane . Injecting local anaesthetic at this level can result in analgesia and/or anaesthesia of the perineum and groin areas. The caudal epidural technique is often used in infants and children undergoing surgery involving the groin, pelvis or lower extremities. In this population, caudal epidural analgesia is usually combined with general anaesthesia since most children do not tolerate surgery when regional anaesthesia is employed as the sole modality.

Several processes have been implicated in the breakdown of the blood-retinal barrier that leads to ME, including the production of inflammatory mediators (., prostaglandins and interleukin-6), increased amounts of vascular permeability factors (., vascular endothelial growth factor) and the loss of endothelial tight junction proteins.  Corticosteroids are thought to have beneficial effects on these processes, but delivering therapeutic concentrations of any medication to the retina while limiting systemic exposure presents a challenge.  Intra-vitreal injections of the corticosteroid triamcinolone have shown promise in the treatment of ME.  Dexamethasone, a more potent corticosteroid than triamcinolone, has been shown to produce high intra-vitreal levels of the drug, however, a short intra-ocular half-life after intra-vitreal injection (approximately 3 hours) has led to the investigation of other delivery methods.  

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.

About 1/1000 people will develop a serious eye infection. The day after the injection your eye should be comfortable, there should be very little pain. If your eye starts to get red, with misty vision ( there may be no pain ), perhaps 2-5 days after the injection, you should suspect an infection and attend your eye department urgently. In Birmingham this is the Birmingham and Midland Eye Centre Casualty at the
Birmingham & Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH
Tel: 0121-554 3801. Avastin , infection..preventing .

The FAME (Fluocinolone Acetonide in patients with diabetic Macular Edema) studies assessed 953 eyes of patients with persistent DMO after one or more laser therapy treatments. 22 Patients were randomised in a 1:2:2 ratio between sham injection (n=185), μg/d Iluvien ® implant (Alimera Sciences, Georgia, US) (n=375), or μg/d Iluvien implant (n=393). At 36 months, % ( μg/d) and % ( μg/d) of all Iluvien treated eyes showed a ≥15 letter improvement compared to % of sham eyes (p=). Subgroup analysis also showed a significant benefit in patients with chronic DMO (disease duration >3 years) treated with Iluvien (≥15 letter improvement in 34% of patients treated with μg/d and % receiving μg/d dose compared to % in the sham group). In terms of adverse events, % of patients underwent cataract surgery. Furthermore, IOP lowering drops had to be initiated in % of those receiving the Iluvien implant with a further % requiring an incisional IOP lowering procedure in the μg/d group that was eventually licensed.

Intravitreal steroid implants

intravitreal steroid implants

About 1/1000 people will develop a serious eye infection. The day after the injection your eye should be comfortable, there should be very little pain. If your eye starts to get red, with misty vision ( there may be no pain ), perhaps 2-5 days after the injection, you should suspect an infection and attend your eye department urgently. In Birmingham this is the Birmingham and Midland Eye Centre Casualty at the
Birmingham & Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH
Tel: 0121-554 3801. Avastin , infection..preventing .

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