Comparison of Intravitreal Bevacizumab Upload Followed by a Dexamethasone Implant versus Dexamethasone Implant Monotherapy for Retinal Vein Occlusion with Macular Edema

Abstract

Purpose: To compare the efficacy and safety of three intravitreal bevacizumab upload injections followed by a dexamethasone implant versus dexamethasone implant monotherapy in eyes with macular edema due to retinal vein occlusion. Methods: Sixty-four eyes of 64 patients were included in this prospective, consecutive, nonrandomized case series: group 1 consisted of 38 patients (22 with central retinal vein occlusion, CRVO, 16 with branch retinal vein occlusion, BRVO) treated using a dexamethasone implant (Ozurdex) alone; group 2 consisted of 26 patients (14 CRVO, 12 BRVO) treated with three consecutive intravitreal bevacizumab injections at monthly intervals followed by a dexamethasone implant. In case of recurrence, both cohorts received further dexamethasone implants. Preoperatively and monthly best corrected visual acuity (BCVA, ETDRS), central retinal thickness (Spectralis-OCT), intraocular pressure, and wide-angle fundus photodocumentation (Optomap) were performed. The primary clinical endpoint was BCVA at 6 months after initiation of therapy. Secondary endpoints were central retinal thickness and safety of the therapy applied. Results: In group 1, an increase in BCVA of 2.5 (±1.6) letters in the CRVO and of 13.0 (±3.2) letters in BRVO patients was seen after 6 months, in group 2 of 5.9 (±0.4) letters (CRVO) and 3.8 (±2.4) letters (BRVO), which was not statistically significant. When comparing the two treatment groups with respect to the type of vein occlusion, there was a significant advantage for BRVO patients for the dexamethasone implant monotherapy (BRVO patients in group 1, p = 0.005). Central retinal thickness showed a significant reduction after 6 months only in patients of group 1, both for CRVO (p = 0.01) and BRVO (p = 0.003). First recurrence after the first dexamethasone implant injection occurred after 3.8 months (mean) in CRVO and 3.5 months in BRVO patients (group 1), versus 3.2 and 3.7 months, respectively, in group 2. In group 1, 63.6% with CRVO and 50% with BRVO showed an increased intraocular pressure after treatment; in group 2, 57.1% with CRVO and 50.0% with BRVO, respectively. Conclusion: In CRVO, there was no difference between the two treatment strategies investigated. However, in BRVO, dexamethasone implant monotherapy was associated with better functional outcome.

Penetration Force, Geometry, and Cutting Profile of the Novel and Old Ozurdex Needle: The MONO Study

“…The novel DDS applicator is a well-established applicator system to apply sustained release of DEX-implants into the vitreous cavity. With favorable confidence in intravitreal DEX injections (17,18,19) among treating physicians, the sharper novel DDS needle will increase in use as confirmed by our measurements in this experimental study.…”

Branch Retinal Vein Occlusion

“…Byun et al [ 183 ], in a study of 134 consecutive patients that were treated with either intravitreal triamcinolone or intravitreal bevacizumab for macular edema caused by BRVO, found that both were equally effective for improving visual acuity; however, the intravitreal triamcinolone group showed a longer mean duration of improvement and less disease recurrence and required fewer injections. Mayer et al [ 184 ] reported that in BRVO, dexamethasone implant monotherapy was associated with better functional outcome than intravitreal bevacizumab upload followed by a dexamethasone implant. Kwon et al [ 178 ], on a review of medical records of the patients treated with intravitreal triamcinolone with macular edema secondary to BRVO, found that the natural history was the same as that from this treatment at 12 months.…”

Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion

“…[5][6][7][8][9] We previously described the response to a pharmacological treatment of macular edema associated with RVO using the present treatment strategy with an Ozurdex monotherapy as a first-line treatment regime compared with an anti-VEGF-loading dose using three bevacizumab injections followed by a dexamethasone implant. 10 However, with regard to the potential side effects of a long-term treatment using dexamethasone, such as a raise of intraocular pressure and cataract formation, we feel the importance to report on the safety and efficacy over a 12-month follow-up of our patients.…”