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Evangelia Papavasileiou, Andre Grixti, Vineeth Kumar, Som Prasad; Our experience with Sequential treatment of macular oedema from retinal vascular occlusions with anti-VEGF agents and Ozurdex. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4661.
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To report our experience with sequential treatment with ant-VEGF agents and dexamethasone 0.7mg sustained-release intravitreal implant (Ozurdex) in patients with macular oedema due to central or branch retinal vein occlusion.
An interventional case series of 31 patients treated with intravitreal anti-VEGF initially and then with Ozurdex was undertaken in our hospital. Included were demographics, underlying disease, BCVA, number of anti-VEGF injections required, IOP measurements, other prior therapies, examination, and adverse events. Patients underwent a comprehensive examination including optical coherence tomography, fluorescein angiography, and fundus photography. Ozurdex was administered in accordance with the manufacturer’s instructions using the 22-gauge applicator device. Patients were re-treated with anti-VEGF agents post Ozurdex injection only if OCT central field thickness increased by 50 microns or vision decreased by 5 letters.
31 eyes of 31 patients were included. 23 patients had macular oedema due to branch retinal vein occlusion and 8 due to central retinal vein occlusion. 4 patients had one previous triamcinolone injection and one had pan retinal photocoagulation. Mean number of intravitreal Anti-VEGF injections pre-Ozurdex was 2.32 and mean number post-Ozurdex dropped to 0.13. Mean OCT central field thickness decreased by -73μm with combined treatment whereas increased by +97.74μm on Avastin monotherapy, prior to treatment with Ozurdex. For BRVO patients the treatment outcomes appear more favourable than CRVO patients. Characteristics of non-responders were the presence of subretinal fluid and epiretinal membrane formation. No serious systemic or ocular treatment-related events occurred.
Our series confirms that sequential treatment with anti-VEGF agents and Ozurdex is effective for treating refractory macular oedema due to retinal vascular occlusions, and is synergistic, providing sustained increases in visual acuity, as well as reduction in central field thickness. In addition, this therapy can provide predictable intervals for re-treatment. This series is, to the best of our knowledge, one of first to report clinical experience with sequential use of anti-VEGF agents and Ozurdex. Further prospective, controlled studies need to be performed to better determine efficacy, duration of effect, and side effects.
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