Abstract
Purpose :
To determine the effect of switching from Ozurdex to Iluvien in patients with NIPU
Methods :
Data were collected retrospectively from medical records and ocular coherence tomography images. We looked at visual acuity (VA), central macular thickness (CMT), intraocular pressure (IOP) and complications three months pre and post treatments with Ozurdex and Iluvien. Patients with NIPU who received both Ozurdex and Iluvien were included. Primary outcomes were control of inflammation as measured by VA and CMT 3 months pre and post treatment, and need for rescue treatment. Secondary outcomes were IOP and complications. Statistical significance was assessed using the student t-test, with a significance level of p<0.05
Results :
Fourteen eyes of 8 patients were analysed. Both treatments were equally efficacious in control of inflammation, no significant changes in VA before or after switching from Ozurdex to Iluvien (VA 0.3 to 0.2 logMAR post treatment with Ozurdex vs. 0.1 to 0.2 LogMAR post treatment with Iluvien). Average CMT improved in both groups, 374μm pre Ozurdex, to 317μm 3 months post treatment, and 348μm to 332μm 3 months post Iluvien.
A significant rise in IOP was seen in both groups, from 12 ± 3 mmHg to 17 ± 6 mmHg with Ozurdex and 14 ± 4 mmHg to 24 ± 9 mmHg pre and post Iluvien (p<0.010). On average patients reported slower restoration of vision following Iluvien than with previous Ozurdex implants
Conclusions :
Our case study shows no significant difference in control of inflammation in NIPU between Ozurdex and Iluvien implants, but a difference in steroid-induced ocular hypertension. Both groups had an increase in median IOP 3 months post treatment, Iluvien causing a more marked pressure rise. Three patients (6 eyes) required treatment in the form of selective laser trabeculoplasty, trabeculectomy and glaucoma drops to reduce IOP 1-3 months post Iluvien implants. Patients also noticed VA didn't improve as quickly with the Iluvien implants. Doctors found the Iluvien injector to be less efficient than the Ozurdex, it was more difficult to use and required more preparation.
Price comparison between the 2 implants is also a factor that needs considering, Iluvien costing £5,500 [ii] and Ozurdex costing £870[iii] per implant. Median requirement for Ozurdex implants for the 3 years prior to switching was 3, equating to a cost of £2,610.
This is a 2021 ARVO Annual Meeting abstract.