Abstract
Purpose :
Intravitreal therapy (IVT) with sustained-release dexamethasone 0.7 mg steroid implant (Ozurdex®) requires use of a 22-gauge applicator needle, which may cause patient discomfort. We therefore performed a single-centre, prospective consecutive case series to audit pain and patient tolerability with Ozurdex® over a twelve-month period.
Methods :
A prospective consecutive case series of all Ozurdex® procedures performed by a single surgeon at Sunderland Eye Infirmary, a tertiary eye hospital based in the United Kingdom, was done. Besides topical 0.4% oxybuprocaine hydrochloride, all patients received subconjunctival 2% lignocaine injection at the Ozurdex® implantation site. Data including patient age, gender, laterality, diagnosis, number of steroid implants, post-procedure pain score via Numeric Pain Rating Scale (NPRS) and any post-procedure complications was recorded. Patients were counted on more than one occasion if they attended for a repeat intravitreal steroid implant on a four to six monthly basis during the study period.
Results :
246 eyes (118 male, 128 female) were treated with Ozurdex® injections during the study period. Pain scores ranged from 0 to 10, with a mean of 1.51 ±1.80. 91.9% cases experienced no or mild pain while only 8.1 % experienced moderate-to-severe pain ( > 5 pain score). Over 1/3 of injections (n=87) caused no reports of pain and no significant differences were found in pain scores when comparing age (p=0.25), gender (p=0.997), laterality (p=0.59), diagnosis (p= 0.17) and number of steroid implants (p=0.70) using analysis of variance (ANOVA) or t-test as appropriate (p<0.05 considered significant). Only one serious complication- a mild case of vitreous haemorrhage (VH)- was recorded in a patient with a previous history of VH secondary to Ozurdex® implant and was associated with underlying clopidogrel use.
Conclusions :
This series evaluating pain scores following IV Ozurdex® implantation demonstrates a high patient tolerability and safety profile despite its relatively large-gauge applicator compared to the needle required for anti-vascular endothelial growth factor IVT that is often used for similar indications. This is true across a range of different potential influencing factors tested, which revealed no significant influence on pain scores. VH is a rare complication but one that clinicians should be alert for in the presence of underlying risk factors.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.