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Gad Heilweil, Valentina Franco-Cardenas, Robert Beardsley, Jean-Pierre Hubschman, Steven D. Schwartz; Short Term Results Of A Single Dose Dexamethasone Intravitreal Implant, In Eyes With Chronic Macular Edema Secondary To Vein Occlusion Refractory To Prior Anti-vegf Treatments. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3240.
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Evaluate the efficacy of dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) in eyes with chronic macular edema (ME) associated with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) refractory to anti-VEGF therapy.
Retrospective case series. Twenty four eyes of 23 patients with persistent macular edema secondary to CRVO (9 eyes) BRVO (14 eyes) and HRVO (1 eye) were included. All eyes had vein occlusions with persistent ME for more than 6 months and received a minimum of 3 anti-VEGF intravitreal injections prior to dexamethasone intravitreal implant. Outcomes studied included: change of visual acuity (VA), intraocular pressure (IOP) and central foveal thickness (CFT) by SD OCT at 3 months follow up.
Mean duration of vein occlusion prior to treatment was 17.8+11.2 months (range: 6-42 months) and mean number of prior intravitreal anti-VEGF treatments was 6.7+4.22 (range: 3-18). At the 3 month follow up, mean CFT showed a statistically significant decrease from 408.9µ+171.9µ to 306.6+80.34µ (P=0.005) .Converted LogMAR VA decreased from 0.55+0.38 to 0.50+0.37, however this was not found to be statistically significant (P=0.14). VA improvement of ≥ 3 lines was found in 3/24 eyes (12.5%) while 1 eye (4.1%) lost more than 3 lines. Mean IOP rose from 15.75+3.34 to 17.33+3.71 (P=0.055) with 2/24 (8.3%) patients requiring topical treatment.
This retrospective case series showed that a single dexamethasone intravitreal implant seems safe and effective in reducing macular edema (CFT) secondary to long standing vein occlusion in eyes that are refractory to prior anti-VEGF therapy. The absence of statistically significant improvement in VA may reflect irreversible photoreceptor damage in this cohort or insufficient follow up necessary to observe functional improvement following anatomic edema resolution. Larger scale case studies with longer follow up may be necessary to evaluate the role of dexamethasone intravitreal implant in this group of patients.
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