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Amelie Pielen, Daniel Böhringer, Sonja U Heinzelmann, Thomas Ness, Bernd Junker; Intravitreal Dexamethasone Implant for Macular Edema Secondary to Retinal Vein Occlusion that is Refractory to Intravitreal Anti-VEGF compared to treatment naïve Edema. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3901.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the anatomical and functional outcome of intravitreal dexamethasone implant for macular edema secondary to central (C) or branch (B) retinal vein occlusion (RVO) in patients with persistent macular edema refractory to intravitreal anti-vascular endothelial growth factor (VEGF) treatment compared to treatment naïve patients and to dexamethasone-refractory eyes switched to anti-VEGF.
Retrospective, observational study including 30 eyes with macular edema secondary to RVO previously treated with anti-VEGF (8 CRVO, 22 BRVO, mean age 69 +/- 10 years), compared to 11 treatment naïve eyes (6 CRVO, 5 BRVO, mean 73 +/- 11 years), compared to dexamethasone non-responders (2 CRVO, 4 BRVO, mean 69 +/- 12 years). Eyes that did not respond to three or more consecutive intravitreal anti-VEGF injections were treated with dexamethasone implant. Outcome parameters were change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by spectral-domain optical coherence tomography (SD-OCT) before and after treatment initiation or switch, respectively.
Mean BCVA improvement after dexamethasone implant (mean 1.6 applications, min 1, max 2) in anti-VEGF refractory eyes was 4 letters (change in logMAR -0.42 to -0.36, p= 0.08), treatment naïve eyes gained 10 letters (-1.07 to -0.82, p=0.66), while we noted no change in eyes refractory to dexamethasone implant after switch to anti-VEGF (-0.55 to -0.52, p=0.74). Median CFT decrease was most pronounced in treatment naïve patients (from 675 µm [580;810] to 238 µm [188;348], change -437 µm, p=0.002) compared to anti-VEGF refractory eyes (from 455 µm [323; 542] to 285 µm [219;460], change -170 µm, p=0.003) and dexamethasone-refractory eyes (from 555 µm [395;675] to 398 µm [245;535], change -157 µm, p=0.31).
Intravitreal dexamethasone significantly reduced macular edema due to RVO that was refractory to anti-VEGF. Functional gain was limited in comparison. Dexamethasone implant efficacy was higher in treatment naïve eyes. This could be due to significantly worse BCVA and higher CFT at baseline in treatment naïve eyes. Factors to predict patients’ response to anti-VEGF or corticosteroid therapy remain to be determined.
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