Abstract
Purpose :
The standard of care for the treatment of retinal vein occlusion (RVO) with cystoid macular edema (CME) is serial treatment with intravitreal anti-vascular endothelial growth factor (anti-VEGF). While most patients respond to this, some have refractory CME requiring combination treatment with dexamethasone intravitreal implant (Ozurdex). The purpose of this study was to evaluate the safety and efficacy of posterior sub-Tenon’s kenalog (PSTK) injection as an adjunctive treatment to intravitreal anti-VEGF in refractory CME from RVO.
Methods :
A single center, multiple physician, IRB-approved retrospective chart review was done of all patients with RVO from October 2013 to October 2016. Inclusion criteria were patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) and refractory CME on serial intravitreal anti-VEGF. Patients with known glaucoma or posterior subcapsular cataract (PSC) were excluded. Outcome measures included pre- and post-PSTK central macular thickness (CMT), best corrected visual acuity (BCVA), and anti-VEGF injection interval. A t-test was used to analyze the data.
Results :
Ten patients (mean age 71.6 years, 70% male, 30% female) with RVO (8 BRVO, 2 CRVO) met the criteria for the study. Mean pre-PSTK CMT was 379 microns and mean post-PSTK CMT was 304 microns (p=0.014). Mean pre-PSTK BCVA was logMAR 0.39 and mean post-PSTK BCVA was logMAR 0.266 (p=0.10). Mean extension of anti-VEGF injection interval was 14.2 days. There were zero cases of endophthalmitis or other significant adverse reactions. One patient developed PSC and two patients developed intraocular pressure rises that were treated effectively with single-drop therapy.
Conclusions :
In this study PSTK reduced CME with statistical significance, showed a trend toward improved BCVA, and extended the anti-VEGF injection interval by greater than 2 weeks, in the setting of a reasonable safety profile. The modest trend in BCVA improvement was not statistically significant but this is to be expected with chronic and refractory CME. The anatomic markers of fluid resolution are a greater indication of its treatment efficacy. PSTK is also an extremely cost-effective treatment compared to other existing combination treatments for RVO and should be considered as a useful adjunct in the management of refractory cases.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.