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Sonali Nagendran, Narendran Nair, Manju Chandran, Geeta Menon; Visual outcomes of intravitreal dexamethasone treatment for retinal vein occlusions in an NHS clinic setting. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2826.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcome of patients with persistent macular oedema secondary to a branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO), treated with intravitreal dexamethasone implants (Ozurdex, Allergan) according to National Institute of Clinical Excellence (NICE) guidance.
A retrospective longitudinal study of 27 patients (13 BRVO patients and 14 CRVO patients) monitored for 1 year following treatment with an intravitreal dexamethasone implant. 52% of patients had previously been treated with bevacizumab injections, macular laser or a combination of both treatments. Treatment with Ozurdex was initiated on average 22 months after diagnosis in BRVO patients and 7 months in CRVO patients. The baseline BCVA was 54.38 letters on the ETDRS scale in BRVO patients and 43.14 letters in CRVO patients.
Mean best corrected visual acuity (BCVA) compared to baseline in BRVO patients was +3.42 letters at one month and +0.77 letters at three months post-injection. In CRVO patients mean BCVA compared to baseline was +5.45 letters at one month and -1.00 letters at three months post-injection. The anatomical response, as determined by OCT imaging, showed a similar trajectory. Subsequent Ozurdex injections elicited a similar response. Injections were repeated on average every 6 months. At 1 year the BCVA was +2.60 letters in BRVO patients and 0 letters in CRVO patients. Previous treatment with bevacizumab and/or macular laser, the inner segment/outer segment junction integrity on OCT imaging and the duration of macula oedema pre-treatment did not affect outcomes. In the BRVO group 1 patient developed ocular hypertension and 1 patient developed a cataract. In the CRVO group 2 patients developed ocular hypertension. Ocular hypertension was controlled with topical therapy in all cases.
This study demonstrates that patients with retinal vein occlusions experience a rapid visual and anatomical improvement in the month following Ozurdex treatment but the effects do not remain beyond 3 months. We recommend shorter treatment times for optimum results. As reported in previous studies, BRVO patients exhibit a better reponse to treatment than CRVO patients. The visual outcomes reported in this study are reduced compared to published trials, which may be due to less restrictive entry criteria for treatment in this study.
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