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Josh O Wallsh, Charlotte Luths, Esmeralda Gallemore, Ron Gallemore; Initial eight years of experience with the intravitreal dexamethasone implant: A retrospective chart review. Invest. Ophthalmol. Vis. Sci. 2018;59(9):81.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the initial eight years of results from the intravitreal dexamethasone implant (DEX) in patients treated for retinal vein occlusion (RVO) or uveitis at a busy retina practice within a diverse socioeconomic community.
A retrospective chart review from a single retina practice of patients receiving treatment with DEX since its FDA approval in June 2009. The amount of DEX treatments was counted along with any concurrent therapies during the studied period, most notably intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Visual acuity (VA) was converted from Snellen to logarithm of minimal angle of resolution (logMAR) and central macular thickness (CMT) assessed with high resolution optical coherence tomography. Pre-treatment data was collected from the initial DEX treatment visit and post-treatment data at the subsequent visit at least four weeks after the last DEX treatment. Intraocular pressure and cataract progression were also documented.
In total, 227 eyes from 203 patients received 887 DEX treatments over an average of 58 weeks. In the branch RVO (n=71) cohort, VA improved significantly from 0.84 ± 0.08 to 0.76 ± 0.07 logMAR (p << 0.05). Similarly, the central RVO (n=44) and uveitis (n=124) cohorts demonstrated improvements in VA of 0.99 ± 0.09 to 0.96 ± 0.8 and 0.63 ± 0.05 to 0.62 ± 0.05 logMAR, respectively. Although these improvements were not significant (p = 0.68 and 0.92, respectively). Across all patient cohorts CMT decreased significantly from 375.9 ± 9.0 to 323.6 ± 6.0 µm (p < 0.001). Concurrent treatment with intravitreal anti-VEGF injections was noted in 51.1% of patients; however, both this group and the group treated with DEX alone were noted to have a mean improvement in VA of 0.03 logMAR (p = 0.99). Intraocular pressure increased significantly from 14.9 ± 0.3 to 16.2 ± 0.4 mmHg (p < 0.001) and nine (4.0%) eyes required Ahmed valve placement for steroid induced glaucoma. Of phakic eyes, 41.8% (n=33) had cataract progression or underwent cataract surgery.
While extensive DEX therapy over a sustained period offers visual benefits these results continue to be impaired by cataract development. Interestingly, while combination therapy with anti-VEGF injections should theoretically offer visual benefits, the patients in this study receiving DEX alone appreciated equivalent improvements.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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