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Whitney Lynn Thorpe-Klinsky, David G Dodwell, Darrel Krimmel; Extended Ozurdex (Dex Implant) Therapy of Macular Edema Secondary to Retinal Vein Occlusion.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3754.
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© ARVO (1962-2015); The Authors (2016-present)
Determine the efficacy and safety of 8 or more DEX implants for the treatment of macular edema (ME) secondary to a central (CRVO) or branch (BRVO) retinal vein occlusion (RVO).
Single-center, retrospective consecutive chart review of RVO patients with ME who were treated with a minimum of 8 DEX implants. All patients had received prior anti-VEGF and/or triamcinolone therapy prior to a DEX implant, and 17 of 18 patients received anti-VEGF injections during their course of DEX implant therapy. Re-treatment with DEX implant was performed when recurrent intraretinal fluid was observed on optical coherence tomography (OCT). ME was quantified by central subfield thickness (CST). Visual acuity (VA), intraocular pressure (IOP), and OCT data was collected every 4-6 weeks, per standard of care.
220 DEX implants were injected in 18 eyes of 18 patients with RVO (5-CRVO and 13- BRVO) with a mean of 12.2 (8-22) DEX implants per eye. Mean follow-up after the first DEX implant was 42.2 (25.8-59.0) months. Mean interval between DEX implants was 17 weeks. During 737 total months of patient follow up, 150 anti-VEGF injections were performed for a mean of 2.46 anti-VEGF per eye per year. Mean Snellen VA change from baseline to study end in all RVO patients was +1.7 lines (p<0.002, paired T-test), with + 2.1 lines in CRVO and +1.6 lines in BRVO patients. 44.4% of patients improved ≥2 lines and 22.2% of patients improved ≥3 lines. CST decreased significantly from baseline after injections 1-9, 11, and 13 (p<0.041, paired T-test). Mean baseline CST of 335 (237-674) decreased to a mean final CST of 272 (191-359) (p<0.018, paired T-test). Mean highest IOP elevation from baseline was +12.1 mmHg (6-21). 44.4% of patients experienced an IOP ≥ 25 mmHg at one time during the study. 3/18 (16.7%) of patients experienced an IOP ≥ 25 mmHg after injections #8 and above. Of those three, two required 1 additional drop and one required 2 additional drops. 1/18 patients (5.9%) required incisional surgery for IOP elevation after their first DEX implant. All other elevations were managed with IOP lowering drops.
RVO patients treated with ≥ 8 DEX implants demonstrated improvement in VA and CST during an extended course of intravitreal therapy. IOP elevations were well controlled.
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