The clinical outcomes of intravitreal dexamethasone implant as the first-line treatment in retinal vein occlusion related macular edema

Aim: To investigate the alterations in central macular thickness (CMT), best-corrected visual acuity (BCVA) and intraocular pressure (IOP) after intravitreal dexamethasone implant (IDI; Ozurdex) injections in patients with treatment-naive central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)-related macular edema in clinical practice.Material and Methods: Totally 41 eyes of 41 patients diagnosed with BRVO or CRVO, who were treatment-naive and treated with only intravitreal dexamethasone implants, were retrospectively investigated. Anterior and posterior segment examinations were performed with a slit lamp bio-microscope. BCVA was assessed using Snellen chart and then converted to logarithm of minimum angle of resolution (log MAR) units before statistical analysis and CMT measurements were performed with spectral domain optical coherence tomography.Results: The mean age of patients was 65.95 ±6.164 years (range: 51-78). Central retinal vein was occluded in 14 patients while branches were occluded in remaining 27 patients. The patients were followed for 14.93±1.942 months (median: 15, range: 12-20 months). The mean number of injections was 2.83±0.803 (median: 3, range: 1-4). BCVA was significantly better in all time periods after treatment (p: 0.001). There was a significant decrease in CMT in all time periods after treatment compared with pre-treatment values (p: 0.001). During follow-up period, IOP was determined to be higher than 25 mm-Hg in 5 patients, and cataract was diagnosed in 6 patients.Conclusion: Intravitreal dexamethasone injection is an effective mode of treatment in patients with RVO-associated macular edema. Its side effects are not severe or common. However the patients should be kept under follow-up for recurrences.

PDF

___

1. Noma H, Funatsu H, Yamasaki M, et al. Aqueous humour levels of cytokines are correlated to vitreous levels and severity of macular oedema in branch retinal vein occlusion. Eye (Lond) 2008;22:42-8.
2. Rehak M, Wiedemann P. Retinal vein thrombosis: pathogenesis and management. J Throm-bosis and Haemostasis 2010;8:1886-94.
3. Feltgen N, Pielen A, Hansen L, et al. Intravitreal drug therapy for retinal vein occlusion–pathophysiological mechanisms and routinely used drugs. Klin Monbl Augenheilkd 2010;227:681-93.
4. Adelman RA, Parnes AJ, Bopp S, et al. Strategy for the management of macular edema in ret-inal vein occlusion: the European VitreoRetinal Society macular edema study. BioMed Res Int 2015;2015: 694690.
5. Rezar-Dreindl S, Eibenberger K, Pollreisz A, et al. Effect of intravitreal dexamethasone implant on intra-ocular cytokines and chemokines in eyes with retinal vein occlusion. Acta Ophthalmol. 2017;95:e119-e127.
6. Haller JA, Bandello F, Belfort R, Jr, et al. Randomized, sham-controlled trial of dexame-thasone intravitreal implant in patients with macular edema due to retinal vein occlu-sion. Ophthalmology. 2010;117:1134e3-1146.e3.
7. Garweg JG, Zandi S. Retinal vein occlusion and the use of a dexamethasone intravitreal implant (Ozurdex®) in its treatment. Graefes Arch Clin Exp Ophthalmol 2016;254:1257-65.
8. Simsek M, Citirik M, Ozates S, et al. The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario. Indian J Ophthalmol. 2018;66:831-6.
9. Niro A, Sborgia G, Sborgia A, et al. Analysis of Morphologic and Functional Outcomes in Macular Edema due to Central Retinal Vein Occlusion Treated with Intravitreal Dexamethasone Implant. J Ophthalmol 2018;2018:5604632.
10. Kanra AY, Ardagil Akçakaya A, Arı Yaylalı S, et al. The efficacy and safety of intravitreal dexamethasone implant for the treatment of macular edema related to retinal vein occlusion: real-life data and prognostic factors in a turkish population. Turk J Ophthalmol 2017;47:331-7.
11. Li X, Wang N, Liang X, China Ozurdex in RVO Study Group. Safety and efficacy of dexamethasone intravitreal implant for treatment of macular edema secondary to retinal vein occlusion in Chinese patients: randomized, sham-controlled, multicenter study. Graefes Arch Clin Exp Ophthalmol 2018;256:59-69. 12.
Blanc J, Deschasse C, Kodjikian L, Safety and long-term efficacy of repeat-ed dexamethasone intravitreal implants for the treatment of cystoid macular edema secondary to retinal vein occlusion with or without a switch to anti-VEGF agents: a 3-year experience. Graefes Arch Clin Exp Ophthalmol. 2018;256:1441-8.
13. Joshi L, Yaganti S, Gemenetzi M, et al. Dexamethasone implants in retinal vein occlusion: 12-month clinical effectiveness using repeat injections as-needed. Br J Ophthalmol 2013;97:1040-4.
14. Singer MA, Capone A Jr, Dugel PU, et al. Two or more dexamethasone intravitreal implants as monotherapy or in combination therapy for macular edema in retinal vein occlusion: sub-group analysis of a retrospective chart review study. BMC Ophthalmol 2015;15:33.
15. Eter N, Mohr A, Wachtlin J, Dexamethasone intravitreal implant in retinal vein occlusion: re-al-life data from a prospective, multicenter clinical trial. Graefes Arch Clin Exp Ophthalmol. 2017; 255:77-87.
16. Proença Pina J, Turki K, Labreuche J, et al. Efficacy and Safety in Retinal Vein Occlusion Treated with at Least Three Consecutive Intravitreal Dexamethasone Implants. J Ophthalmol 2016;2016:6016491.