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Ashwinee Ragam, Anton M Kolomeyer, Natasha V Nayak, David S Chu; The use of Ozurdex in patients with chronic, recurrent uveitis undergoing anterior segment surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5808.
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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.
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.
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.
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.
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