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Joshua K. Fernandes, Paulpoj Chiranand, Seenu M. Hariprasad; Evaluation Of An Intravitreal Dexamethasone Implant (OzurdexTm) Plus Prompt Focal Laser For Macular Edema Secondary To Retinal Vein Occlusions. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1258.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the safety and efficacy of an intravitreal dexamethasone implant (OzurdexTM) plus prompt focal laser for macular edema secondary to retinal vein occlusions (RVO)
Prospective study of 12 patients with RVOs (5 CRVO, 7 BRVO) and secondary macular edema were injected with a single 0.7 mg intravitreal dexamethasone implant (OzurdexTM; Allergan, Inc, Irvine, CA) followed by focal laser within 2 - 4 weeks. Eight out of the twelve patients had failed multiple prior monotherapies including intravitreal agents and focal laser. Complete ophthalmologic exams were performed at day of injection/laser, 1, 3, and 6 months. Main outcome measures included change in LogMAR BCVA and central macular thickness (CMT) as measured by optical coherence tomography. An additional rescue treatment with an intravitreal dexamethasone implant followed by prompt focal laser was offered after 3 mon if a patient had a gain of <5 letters BCVA or a decrease of < 50 µm in CMT.
Mean LogMAR BCVA for all patients at baseline was 0.99 with a statistically significant improvement in mean LogMAR BCVA observed at 1 mon (0.88 +/- 0.67; p=0.03) and 3 mon (0.81 +/- 0.68; p=0.02), but did not achieve significance by 6 mons (0.86 +/- 0.69; p=0.15). Mean CMT among all patients at baseline was 415 µm (range 246-820 µm) with a statistically significant improvement in mean CMT at 1 mon (283 µm; p=0.018) and 3 mon (279 µm; p=0.036), but did not achieve significance by 6 mon (407 µm; p=0.84). All patients were given one additional rescue treatment between 3-5 mon after initial treatment. No patient experienced an adverse event. Only one patient experienced an increase in IOP > 10 mmHg from baseline, which was controlled with a topical IOP-lowering agent.
A single intravitreal injection of a dexamethasone implant followed by prompt focal laser appears to be a safe treatment combination and demonstrated statistically significant improvements in BCVA and CMT over a 3 mon period in patients with macular edema secondary to RVOs. This effect began to regress at 6 mon, which could be related to the severe, recalcitrant nature of the patient population included in the study (mean duration of macular edema = 11 +/- 12 mon despite multiple prior monotherapies) and need for a shorter treatment interval. Further studies over a longer follow-up period are currently underway.
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