Abstract
Purpose: :
To evaluate the safety and efficacy of a combination therapy approach using an intravitreal dexamethasone implant (OzurdexTM) plus prompt focal laser for macular edema secondary to retinal vein occlusions (RVO) over a 12 month follow-up period.
Methods: :
Prospective study of 14 patients with RVO (7 CRVO, 7 BRVO) and secondary macular edema were injected with a 0.7 mg intravitreal dexamethasone implant (OzurdexTM; Allergan, Irvine, CA) followed by focal laser within 2 - 4 weeks. Ten patients had failed multiple prior monotherapies including intravitreal anti-VEGF, intravitreal triamcinolone, or focal laser. Complete ophthalmologic exams were performed at day of injection/ laser, 1, 3, 6, 9, and 12 months. Main outcome measures included change in LogMAR BCVA and central macular thickness (CMT) as measured by optical coherence tomography (OCT) at 12 months. Additional treatment with an intravitreal dexamethasone implant followed by prompt focal laser was offered at each visit if a patient had any residual macular edema by OCT.
Results: :
Mean LogMAR BCVA for all patients at baseline was 1.13 with a statistically significant improvement at 12 months (0.83; p<0.01). Mean CMT of all patients at baseline was 472 μm with a statistically significant improvement at 12 months (288 μm; p<0.01). All patients received 4 injections followed by prompt focal laser. No patient experienced a significant adverse event. Four patients experienced an increase in IOP > 10 mmHg from baseline, but were controlled with topical IOP-lowering agents. Five patients underwent cataract extraction in the treatment eye during the 12 month period.
Conclusions: :
Intravitreal injection of a dexamethasone implant followed by prompt focal laser appears to be a safe treatment combination and demonstrated statistically significant improvements in BCVA and CMT over a 12 month period in patients with refractory macular edema secondary to RVO. This approach may be considered in patients with recalcitrant macula edema that is not responding to alternate therapies. Further studies of a larger cohort of patients is currently underway.
Keywords: retina • vascular occlusion/vascular occlusive disease • injection