Abstract
Purpose:
Patients with chronic ocular inflammation are at risk for inflammation flare-up and/or intraocular pressure (IOP) spike following eye surgery. Typically, such patients receive oral corticosteroids (CS) to reduce post-operative complications. Systemic CS are not without adverse effects; therefore, local delivery of CS may be preferred. In this study, we describe the use of Ozurdex (dexamethasone intravitreal implant) during anterior segment surgery in patients with chronic, recurrent uveitis.
Methods:
Retrospective chart review of patients with chronic, recurrent uveitis receiving Ozurdex injection during anterior segment surgery. Data recorded from pre-injection and 1- and 3-month post-injection visits included visual acuity (VA, reported in logMAR), IOP, medications, inflammation grade, and clinical findings. T-tests (pre-injection vs. 1- and 3- months post-injection) were performed with statistical significance accepted at p<0.05.
Results:
12 patients (12 eyes) were included (mean ± SD age, 48.9 ± 15.9 years; 83% female; 58% African American). All patients had chronic anterior uveitis or panuveitis and 58% had an associated systemic inflammatory disease. Eight (67%) patients were using systemic anti-inflammatory/immunomodulating agents prior to receiving Ozurdex. Ozurdex implant was placed during complex cataract extraction with (n=8) or without (n=1) intraocular lens (IOL) implantation, and IOL explantation alone (n=2) or combined with anterior vitrectomy (n=1). Mean ± SD follow-up after Ozurdex was 9.4 ± 8.2 months (range, 3.0-30.9 months). Mean logMAR VA pre-injection (1.123) significantly improved at 1-month (0.402; p<0.001) and at 3-months (0.518; p=0.004) post-injection. There was no significant difference in mean ± SD IOP pre-injection (13.5 ± 4.5 mm Hg) vs. 1-month (14.7 ± 3.6 mm Hg) or 3-months (15.5 ± 4.5 mm Hg) post-injection. One patient experienced an inflammatory flare-up at post-injection month-2 (IOP >40 mm Hg, finger counting vision) attributed to her uveitis and underwent glaucoma drainage implantation. Eleven (92%) patients had inflammation quiescence at 1-month post-injection, and 10 (83%) at 3-months post-injection.
Conclusions:
Ozurdex implant successfully controlled inflammation and IOP up to 3-months post-operatively in eyes with chronic, recurrent uveitis. Further studies are necessary to determine the long-term utility of Ozurdex implantation in such patients.
Keywords: 557 inflammation •
561 injection •
432 autoimmune disease