Two or More Dexamethasone Intravitreal Implants Used as Monotherapy or Combined With Other Therapy in Retinal Vein Occlusion

Abstract

Purpose: To evaluate the safety and efficacy of treatment with ≥2 dexamethasone intravitreal implants (DEX implants) as monotherapy versus combined with other treatments for macular edema due to branch or central retinal vein occlusion (RVO).

Methods: This was a subgroup analysis of a 26-center chart review of 289 patients with RVO who were treated with ≥2 DEX implants and followed for 3-6 months after the last implant. Efficacy was evaluated by changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline. Safety measures included intraocular pressure (IOP).

Results: DEX implant was used as monotherapy in 84 (29.1%) patients and combined with other RVO treatments in 205 (70.9%) patients. Mean number of DEX implants administered during the study period was 3.1 in the monotherapy group and 3.3 in the combination therapy group (P=.344). After the first through sixth DEX implant injections, mean gain in BCVA from baseline ranged from 0.6 to 3.4 lines in patients treated with monotherapy and 1.3 to 2.8 lines in patients treated with combination therapy. Mean decreases in CRT from baseline ranged from 165 to 230 µm with monotherapy and 136 µm to 175 µm with combination therapy. A similar percentage of patients in the monotherapy and combination therapy groups gained at least 3 lines in BCVA (52.4% and 46.3%, respectively) and achieved a CRT of ≤250 µm (63% and 66%, respectively) during the study period. Increased intraocular pressure was the most common adverse event. IOP ≥25 mm Hg occurred in 25.0% of patients in the monotherapy group and 37.1% of patients in the combination therapy group (P=.048). IOP-lowering medication was used secondary to retina treatment in 23.8% of patients in the monotherapy group and 31.2% of patients in the combination therapy group. One (1.2%) patient in the monotherapy group and 3 (1.5%) patients in the combination therapy group underwent glaucoma laser surgery during the study period. An additional 5 (2.4%) patients in the combination therapy group underwent glaucoma incisional surgery during the study period.

Conclusions: Use of ≥2 DEX implants either as monotherapy or in combination with other RVO treatments is safe and effective for both reducing CRT and improving BCVA in patients with branch or central RVO.

Keywords: 749 vascular occlusion/vascular occlusive disease • 487 corticosteroids • 748 vascular endothelial growth factor