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Nikolaos Krassas, Natasha Spiteri, Nicholas Beare, Ian A Pearce; Use of dexamethasone implant for refractory CME secondary to uveitis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5308.
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To report effectiveness and safety of dexamethasone implant (Ozurdex) in refractory uveitic cystoid macular edema (CME) cases.
Retrospective case note review of consecutive cases of CME in a tertiary uveitis referral service managed with 700μg intravitreal dexamethasone implant. Patients with intraocular pressure (IOP) greater than 25mmHg or who had a previous significant IOP rise following peri- / intra-ocular steroid were not considered for this treatment.
Fourteen eyes of nine uveitis patients with refractory CME were identified. All were on systemic immunosuppression (diagnosis intermediate uveitis = 5, birdshot chorioretinopathy = 1, anterior uveitis with CME = 2, idiopathic non-occlusive retinal vasculitis = 1). In all patients the CME had an unsatisfactory response to peri- and/or intra-ocular triamcinolone; four patients were also refractory to intravitreal methotrexate, and four patients to intravitreal bevacizumab. The mean age was 47.9 years, mean pre-operative central foveal thickness (CFT) was 539μm and mean pre-operative LogMAR visual acuity was 0.55. The mean change in CFT after a single intravitreal dexamethasone implant was -280μm (SD = 172μm), mean change in LogMAR visual acuity was -0.28 (SD = 0.23). Eight of 14 eyes gained two lines of Snellen visual acuity after a single injection. Ten eyes had repeat dexamethasone implants and the mean time to the first repeat injection was 7.75 months (range 4.25 -16 months). There were no cases of endophthalmitis and seven eyes had cataract surgery following dexamethasone implant. The mean change in IOP was +1.3 mmHg and none of the patients required any additional IOP-lowering treatment or surgery following the intravitreal dexamethasone implant.
In our tertiary uveitis service the introduction of the intravitreal dexamethasone implant has had a substantial impact on the management of refractory CME. The dexamethasone implant is well tolerated, leads to significant reduction in CME and significant visual improvement in 60% of complex uveitic cases with CME. Our data suggests it remains effective for more than 6 months in the majority of cases.
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