Real-world observational multicenter study of intravitreal dexamethasone implant (Ozurdex®) in Uveitis: Baseline characteristics, clinical outcomes and reinjection frequency

Abstract

Purpose: To audit the characteristics, clinical outcomes and treatment patterns of intravitreal dexamethasone implant (Ozurdex®) in Uveitis.

Methods: Retrospective, observational, multicenter study in 4 european hospitals (2 United Kingdom, 2 Spain). Indication, uveitis type, diagnosis, visual acuity (VA), intraocular pressure (IOP), phakic status, number of injections, time to reinjection and complications rate were collected.

Results: Eighty-two eyes (63 patients, mean age 47.4, female:male ratio 2.8:1) received 139 Ozurdex injections in a 32 months period (November 2010-July 2013). Mean number of injections was 1.6±0.8 (mean±standard deviation) with a mean follow up of 15.4±9.8 months. Single injection was performed in 52.4% of cases, 30.4% required 2 injections, and 17.0% ≥3 injections. Cystoid macular oedema (CMO) (60.9%), vitritis (25.6%), and combined CMO+vitritis (10.9%) were the most common indications. Most frequent anatomical locations were intermediate uveitis (37.8%), posterior uveitis (23.1%) and panuveitis (21.9%), and most frequent diagnosis were undifferentiated (45.1%), Birdshot chorioretinopathy (14.6%), sarcoidosis (7.3%) and multiple sclerosis (7.3%). Baseline VA and vitreous haze score (VHS) was 0.71±0.4 and 0.66±0.8, at 1st month was 0.53±0.4 and 0.14±0.4, 3rd month 0.49±0.4 and 0.21±0.4, 6th month 0.60±0.5 and 0.27±0.5 and 12 months 0.54±0.5 and 0.15±0.3 respectively. Raised IOP (≥21 mmHg) was observed in 45.8% of the cases and 44.9% required treatment during the follow up period. The percentage of pseudophakic patients increased from 51.2% at baseline to 56.1% at final follow up. There were 2 cases of implant dislocation to the anterior chamber and one case of endophthalmitis. No cases of retinal detachment were observed.

Conclusions: The use of Ozurdex in uveitis provides good outcomes with regards to VA and VHS measurements but requires repeated injections, with risk of postoperative complications. The reinjection frequency has to be considered during choice of intraocular steroid treatments.

Keywords: 746 uveitis-clinical/animal model