Purpose:
To describe dexamethasone (Dex) 0.7 mg sustained-release intravitreal implant (Ozurdex®; Allergan, Irvine, CA) as a surgical adjuvant during repair of complex retinal detachment (RD) with proliferative vitreoretinopathy (PVR).
Methods:
A retrospective consecutive case series with chart review of twenty-two patients undergoing repair of complex RD with PVR. Seven patients (Group 1) had implantation of the Dex implant at the time of surgery and fifteen patients did not (Group 2). Data included patient age, number of prior retinal procedures, use of topical or systemic steroids, intraocular pressure (IOP), and method of implant placement through one month of follow-up.
Results:
There were no statistically significant differences between groups 1 and 2 regarding mean age in years (45.7±24.3 and 50.6±19.3), p=0.62, mean number of prior retinal surgeries (3.0±2.0 and 1.5±1.5), p=0.09, and mean surgical time in hours (4.9±1.9 and 5.6±1.3), p=0.34. Post-operatively, patients in Group 1 required 67% fewer total number of steroid drops (99.4±120.6) than Group 2 (165.6±113.7), p=0.14. Mean total systemic steroid dose for Group 1 (118.6mg±148.6) was 54% lower than that for Group 2 (260.0mg±127.8), p=0.08. Mean IOP in mmHG was 14.7±6.3 in Group 1 and 14.4±6.9 in Group 2, p=0.62. 100% of patients in Group 2 required topical steroids while only 60% did in Group 2, p=0.02. 20% of Group 2 and 70% of Group 1 patients did not require topical steroids beyond one month, p=0.05. 70% of patients that received Dex implants without scleral fixation demonstrated migration along the retinal surface or into the anterior chamber. This was not observed in the two patients who had scleral suture fixation of the implant. There were no recurrent detachments during this follow-up period.
Conclusions:
We have observed that the intraoperative use of Dex was effective as an adjuvant in controlling inflammation and was associated with decreased use of post-operative topical and systemic steroids during the first post-operative month. We recommend scleral fixation of the implant to prevent migration. Randomized controlled trials are required to examine long term results including control of inflammation and recurrent RD rates.
Keywords: retinal detachment • proliferative vitreoretinopathy • inflammation