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Levent Akduman, Brad Talley, Dimple Modi; Changing Paradigm in the Treatment of Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1262.
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To review outcomes for patients with retinal vein occlusion after FDA approval and marketing of intravitreal dexamethasone implant.
Medical records of patients with branch or central retinal vein occlusion treated with intravitreal dexamethasone implant laser, after its FDA approval and marketing between August 2009 and May 2010, at a single clinical practice were reviewed. Intravitreal dexamethasone implant was offered and given to eleven consecutive patients starting in August 2009. Initial and final visual acuity (VA), average central foveal zone thickness (CFT) in optical coherence tomography (OCT), prior and successive treatments in this period, and changes in the intraocular pressure (IOP) were noted. All patients had to have at least 3 months follow up (range: 3-9 months).
Eleven patients with retinal vein occlusion were identified. Four eyes had a history of branch retinal vein occlusion (BRVO) that had previously been untreated. Seven eyes had a history of central retinal vein occlusion (CRVO) and four of these eyes had been previously treated with intravitreal bevacizumab. All eyes underwent treatment with intravitreal steroid implant. After initial treatment, all eyes with branch retinal vein occlusion underwent focal grid laser one to four months after steroid implant. Mean initial visual acuity was 20/200 and improved to a mean VA of 20/100 for both BRVO and CRVO combined. Two eyes with BRVO and two eyes with CRVO gained two lines of vision. Three eyes with CRVO had a decline in VA. Two eyes with BRVO and two eyes with CRVO had no change in VA. Mean initial CFT on OCT was 566 microns and improved to 387.7 microns at three-month follow-up. Mean baseline IOP was 18.2 mmHg and increased to 18.36 mmHg. Three patients required treatment with topical glaucoma medications. All previously untreated eyes with CRVO had improvement in VA. Three of the four eyes previously treated with intravitreal bevicizumab worsened after treatment with intravitreal steroid implant but improved when rechallenged with another dose of intravitreal anti-VEGF injection.
Approved and effective treatment modalities have increased within the last year for the management of retinal vein occlusion. The modality should be determined and tailored to each individual patient based on the patient’s expectations, and the response and potential systemic and local side effects of each modality for that individual.
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