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Ankoor R Shah, Abdulrahman Mubarak Alfaran, Jeremy Wolfe; Efficacy of Dexamethasone Intravitreal Implant Treatment in Eyes Previously Treated with Intravitreal Anti-Vascular Endothelial Growth Factor Therapies for Retinal Vein Occlusion.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3933.
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To evaluate the efficacy of intravitreal dexamethasone implants (IDI) in eyes previously treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapy for vein occlusions.
This is a retrospective chart review of all patients receiving anti-VEGF therapy (Ranibizumab or Bevacizumab) who subsequently underwent IDI placement for treatment of vein occlusion at Associated Retinal Consultants offices between June 2010 and June 2013 as identified by billing records. A total of 42 patients were identified. Of those patients 23 had visual acuity, intraocular pressure (IOP), and optical coherence tomography (OCT) measurements done at times of the study parameters. Non-responders were identified as those patients with < 25% reduction in central retinal thickness (CRT) on OCT after a given treatment. Two-tailed paired t-tests were used for statistical analysis.
Of the 23 patients evaluated, initial visual acuity and CRT improved from 0.806 to .497 (logMAR, p=0.00019) and from 509 to 370 (microns, p=0.0007) at one month after a single intravitreal anti-VEGF injection. A significant subset of patients (n=12) were non-responders by study criteria of which most (n=11) remained non-responders despite an average of 5.92 anti-VEGF injections. For these patients, IDI treatment improved visual acuity and CRT from 0.446 to .284 (logMAR, p=0.023) and from 478 to 264 (microns, p=0.014) at 1-month.
IDI appears efficacious for treatment of vein occlusions after anti-VEGF therapy has been initiated. A subset of patients that are non-responders can be identified as early as one month post anti-VEGF treatment. IDI lead to significant improvement in visual acuity and CRT for these non-responders.
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