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Nicole Koulisis, Stavros N. Moysidis, Bruce Burkemper, Brian Do, Andrew A Moshfeghi, Hossein Ameri, Amir H Kashani, Narsing A Rao, Mark S. Humayun, Damien C Rodger; The Effect of the Vitreous on the Localization and Outcomes of Intravitreal Injections of Sustained-Release Dexamethasone Implants. Invest. Ophthalmol. Vis. Sci. 2018;59(9):82. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To study the effect of the vitreous on the localization of the intravitreal sustained-release dexamethasone implant (IVD) and the outcomes of these injections in eyes with native vitreous compared to vitrectomized eyes.
The clinical exams, multimodal imaging, treatment, and outcomes were reviewed from the medical records of all patients receiving treatment with IVD (Ozurdex). Twenty-seven patients met inclusion criteria. Statistical analysis was performed comparing the complications and outcomes of IVD injections in eyes with native vitreous versus vitrectomized eyes.
Of 78 total IVD injections, 68 were performed in 33 eyes (mean injections 2.1) of 24 patients with native vitreous and 10 were performed in 4 vitrectomized eyes (mean injections 2.5) of 3 patients. The average age was 64±2.4 years in the group with native vitreous and 44±3.6 years in the vitrectomized group (p<0.01). In the group with native vitreous, there were 51 eyes with macular edema (ME) secondary to non-infectious uveitis, 23 with ME secondary to retinal vascular disease, and 4 with recalcitrant ME after intraocular surgery. In the vitrectomized group, there were 5 eyes with non-infectious uveitis, 4 with retinal vascular disease, and 1 with recalcitrant ME after intraocular surgery. IVD implant localization was noted in the chart in 69% of eyes with native vitreous compared to 50% of vitrectomized eyes (p=0.30). The implant localized to the retinal surface in 6.8% of eyes with native vitreous compared to 100% of vitrectomized eyes (p<0.001), and the implant was noted overlying the inferior retina in all of these cases. Vitreous hemorrhage (VH) occurred in 3 of 68 (4.4%) eyes with native vitreous compared to in 1 of 10 (10%) vitrectomized eyes (p=0.55) and resolved with monitoring in all cases. Collectively, logMAR VA improved from 0.53±0.06 to 0.45±0.05 at 15 weeks (p=0.03). ME resolved in 24 of 65 cases after 4.4±0.6 weeks with duration 11±1.1 weeks.
Vitreous status influences IVD implant localization during intravitreal injections. Vitrectomized eyes have a significantly higher incidence of implant localization to the inferior retina compared to eyes with native vitreous. There is no significant difference in rates of VH or other outcomes in vitrectomized eyes compared to eyes with native vitreous treated with IVD. There were no retinal tears or detachments.
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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