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Anjum Faruk Koreishi, Mark Dacey, Alan Palestine; Dexamethasone Intravitreal Implant for Refractory Macular Edema in Retinitis Pigmentosa. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3809.
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© ARVO (1962-2015); The Authors (2016-present)
To examine the efficacy of dexamethasone intravitreal implant (Ozurdex; Allergan, Inc; Irvine, CA) in the treatment of macular edema in retinitis pigmentosa that is refractory to other treatments.
A retrospective chart review of 7 eyes of 5 patients with retinitis pigmentosa and macular edema that had been treated without resolution of the macular edema. Primary outcome measure was macular edema, measured using macular thickness (MT) on spectral domain optical coherence tomography. Secondary outcome measures were visual acuity (VA) and intraocular pressure (IOP). These were measured prior to implantation of 0.7mg dexamethasone intravitreal implant and monthly after treatment. Follow up ranged form 1 to 5 months post implant.
Macular thickness at 1 month improved by 28.6%, from 441 to 315 microns. All eyes showed improvement in MT. IOP at 1 month increased by 41.5%, from 13.4 to 19 mmHg, but spikes were limited to three eyes. Visual acuity at 1 month improved 14.8%, from 0.477 to 0.407 LogMAR units. Three eyes had improved VA, four were stable. At 2 months, MT was 22.2% lower than pre-treatment and one eye showed increased MT. At 3 months MT was 22.4% lower, with one other eye having worse MT. At 5 months, two additional eyes showed worse MT. The results were not statistically significant due to small study size.
Retinitis Pigmentosa affects the peripheral retina, causing visual field defects and nyctalopia. Macular edema is associated with retinitis pigmentosa, and causes loss of central vision. Current treatments for macular edema include topical and oral carbonic anhydrase inhibitors, intraocular and periocular steroids, and anti-VEGF agents. In our series, macular edema was longstanding due to failure of prior treatments. Dexamethasone intravitreal implant was shown to anatomically improve macular edema in all eyes at 1 month. Visual acuity improved in three eyes at 1 month and were stable in four. IOP increased in three eyes at 1 month requiring topical treatment, then normalized. MT in one eye with severe edema increased 2 months post-injection, increased in another eye at 3 months, and two other eyes at 5 months. The lack of visual acuity improvement in some cases may be due to retinal damage from longstanding macular edema. Earlier use of dexamethasone intravitreal implants have a good safety profile and may lead to better visual acuity outcomes.
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