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Antonio Capone, Michael Singer, David Dodwell, Richard Dreyer, Kean Oh, Daniel Roth, John Walt, Lanita Scott, David Hollander; Retrospective Study of Two or More Dexamethasone Intravitreal Implant 0.7 mg Injections for Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2820.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the efficacy, safety and reinjection interval of dexamethasone intravitreal implant (DEX implant) 0.7 mg in the treatment of macular edema due to branch (BRVO) or central (CRVO) retinal vein occlusion.
A retrospective chart review of patients who received ≥2 injections of DEX implant was conducted at 26 sites. Additional concomitant RVO treatments were permitted. The primary efficacy endpoint was mean change in best-corrected visual acuity (BCVA; number of lines) from baseline to 4-20 weeks following last DEX implant injection. Additional efficacy assessments included percentages of patients with BCVA increase of ≥2 or ≥3 lines versus baseline and change in central retinal thickness (CRT) from baseline. Safety measures included adverse events, intraocular pressure (IOP), and surgical interventions.
A total of 289 patients were included; 54.3% with BRVO and 45.7% with CRVO. Mean (SD) time from RVO diagnosis to first DEX implant was 18.4 (23.39) months. Most received 2-6 DEX implants (mean 3.2; range 2-9). Mean time between DEX injections was 5.6 months. The mean (SD) change in BCVA from baseline to 4-20 weeks after the last DEX was 1.0 (3.51) line (range -13 to +12 lines) (p<0.0001); responses were similar with each additional injection. The majority (62.9%) of patients experienced BCVA improvement ≥2 lines from baseline; 48.1% had ≥3 line improvement. Significant reduction of CRT also occurred with results consistent from 1-6 injections; 65.3% of patients achieved CRT ≤250 µm at any time point. CRT findings were generally similar in patients with BRVO and CRVO. After initial DEX implant treatment, there were no additional concomitant therapies in 29% of patients. In patients who received anti-VEGF injections, mean (SD) time from first DEX implant to first anti-VEGF injections was 179.9 (125.16) days. There were no unexpected safety findings. Increases in IOP were generally well-controlled with IOP-lowering medication. At the final visit: 91.5% of patients (260/284) had an IOP of ≤21 mmHg, only 14 patients (4.9%) had an IOP ≥25 mmHg, and 5 patients (1.8%) had an IOP ≥35 mmHg. During the study 1.7% patients underwent incisional glaucoma surgery.
The DEX implant is safe and effective with repeat injections and when utilized alone and with common adjunctive RVO treatments.
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