Abstract
Purpose :
Intravitreal injections for treating macular oedema secondary to retinal vein occlusion with symptomatic visual reduction are the established as the gold standard regime. Anti-VEGF therapy as first line agents followed by steroid injections like Ozurdex as second line therapy can help in treating recalcitrant macular oedema that fails to improve over time. We sought to determine if there was a real world difference in outcomes of visual acuity and intra-ocular pressure comparing Anti-VEGF followed by Ozurdex against those treated initially with Ozurdex injections in branch and central vein occlusion.
Methods :
Anonymised data was retrieved from Medisoft Electronic Database from 2011 to 2018 on all patients (n=108) treated with Intravitreal therapy. Baseline data on visual acuity (LogMAR) and intraocular pressure was recorded at the end of Year 1 and Year 2. Naive patients were separated in two groups, those with Ozurdex initial therapy (n=97) versus Anti-VEGF treated eyes that proceeded to receive Ozurdex(n=11) as a second line agent. Categorical outcomes were compared using Chi-squared test and absence of normal distribution mandated using Mann-Whitney test. ANCOVA analysis to compare against baseline values was carried out.
Results :
The baseline acuity (0.70±0.36) was lower in the Ozurdex initiated treated group as this represents the group with chronic macular oedema that was treated before Anti-VEGF injections were licensed compared to primary AntiVEGF treated eyes that received secondary Ozurdex therapy with better baseline vision (0.58±0.37). There is a significant difference (p<0.001) with primary Ozurdex treated eyes improving by a mean difference of 0.3LogMAR units compare to Anti-VEGF treated Ozurdex eyes at the end of 2 years. There was no difference in IOP variation between the two groups from baseline assuming therapy was instituted to treat steroid responsive elevation.
Conclusions :
Ozurdex injection to treat macular oedema secondary to retinal vein occlusion is an effective therapy both as a first and second line agent with clinically significant gains achieved even when visual acuity at presentation is reduced compared to Anti-VEGF treated eyes. Raised intra-ocular pressure as a secondary complication of intravitreal steroid application did not appear to change significantly with stability achieved with timely intervention using medical and surgical therapy where indicated.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.