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Denisse Cornu, Valmore A. Semidey, Felipe Navas, Bernardo Quijano, Nehal R. Patel, Victor H. Gonzalez; Comparing The Eficacy Of Dexamethasone Intravitreal Implant (ozurdex) With Intravitreal Injection Of Bevacizumab Using Visual Acuity And Oct Outcome In Patientes With Refractory Cme Secondary To Retinal Vein Occlusion. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4507.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of the combination of Dexamethasone intravitreal implant and Bevacizumab in patients with diagnosis of CME secondary to CRVO/BRVO using BCVA and central macular thickness (CMT) outcomes
This study was a retrospective analysis of 23 patients with diagnosis of refractory CME secondary to CRVO/BRVO who underwent Ozurdex combined with Avastin, and a posterior series of 2 Bevacizumab (0.05ml) injections every 4 weeks. We evaluated the efficacy of both medications using BCVA and CMT (Heidelberg Spectral Domain OCT) at day 0, week 4 and 24.
All patients had received previous treatment for CME (IV steroids, antiVEGF or both) with an average onset of the disease of 16 months. CRVO patients presented with median VA of 20/400 (range 20/60-HM) and BRVO subjects median VA was 20/400 (range 20/40-HM). In week 4 VA improved in 7 CRVO patients (58%) and in 4 BRVO patients (36%). CMT improved in all 12 CRVO patients. In BRVO subjects CMT improved by more than 10% by more than 10% in 7 patients (63.6%). 2 subsequent doses of Bevacizumab were administrated after week 4 and 8. At week 24, VA remained stable or worse in 10(83%) of the 12 CRVO patients. The same effect was seen in 8(72%) of the 11 BRVO patients. CMT values increased in 7 CRVO patients (58%) and in 9 (81%) BRVO patients after the initial decrease of CMT obtained at wee 4. A rise of intraocular pressure of 10mmHg above the baseline was found in 4(17%) patients at week 4 and in 2(8.6) at week 24.
As is known refractory CME secondary to CRVO/BRVO is a very challenging condition to treat but in this study the combination if Avastin and Ozurdex proved to be beneficial in our patients, showing and improvement in VA and significant increase in CMT at week 4, wich correlates with maximum effect of Avastin and the additional therapy provided by the Ozurdex. At week 24 a significant increase in CMT and lack of VA improvement indicates that the effect of both medications begins to wane. These results suggest that we need to consider retreat these patients before the 6 months.
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