Effect of dexamethasone intravitreal implant (Ozurdex®) on corneal endothelium in retinal vein occlusion patients

Abstract

BackgroundTo assess corneal endothelial cell changes after intravitreal dexamethasone (DEX) implant (Ozurdex®) injection in patients with macular edema secondary to retinal vein occlusion (RVO).MethodsTwenty-two eyes of 22 patients were assessed prospectively after intravitreal 0.7 mg DEX implant injection. Twenty-two eyes of 22 healthy volunteers served as control group. Corneal endothelial cell parameters including endothelial cell density (ECD), coefficient of variation of cell size (CV), percentage of hexagonality (Hex) and central corneal thickness (CCT) were analyzed before and 1 and 3 months after injection by specular microscopy. The results of the study were compared statistically.ResultsThere were 17 (77.3%) patients with branch RVO and 5 (22.7%) patients with central RVO. Mean intraocular pressure (IOP) was 14.73 mmHg before injection, 17.05 mmHg at 1 month and 17.15 mmHg at 3 months after injection. Mean IOP at 1 and 3 months were significantly higher than pre-injection value (p = 0.002 and p = 0.003, respectively). There was a statistically significant reduction in mean ECD at 3 months after injection compared to pre-injection and 1 month (p = 0.013, p = 0.009, respectively) in the injected eyes. Mean ECD showed no significant difference in the uninjected fellow eyes during the follow up (p>0.05). Mean CV and Hex did not reveal a statistically significant difference in injected and uninjected fellow eyes (p > 0.05). No significant change was observed in mean CCT values during the follow up (p = 0.8).ConclusionIntravitreal dexamethasone implant may cause a transient reduction in corneal endothelial cell density in short term without changing cell morphology.

The corneal effects of intravitreal dexamethasone implantation

“…Ilhan and colleagues 3 reported that 0.7-mg IDI application probably had no side effects on the corneal endothelium at 6 months in patients with macular edema caused by RVO. In another study, Güler and colleagues 17 show that IDI application had decreased ECD in RVO patients third month after injections. They did not find any decrease in ECD at first month, while we found decrease at first month.…”

Changes in corneal endothelial density following scleral buckling surgery for rhegmatogenous retinal detachment: a retrospective cross-sectional study

“…Similar to those intraocular interventions mentioned above, SB also showed negative effects on HCEC in our study. In another prospective study published recently, the dexamethasone intravitreal implant also lead to the decrement of ECD in patient with retinal venous occlusion [45]. Accordingly, the use of corticosteroid in patient received SB should be caution to prevent double injury to the HCEC.…”

Ocular Disease Therapeutics: Design and Delivery of Drugs for Diseases of the Eye

“…The authors concluded that this could be due to some kind of chemical toxicity and that these effects should be given consideration while using the implant in compromised corneas prior to decision making. 382 The consideration of intraocular steroid therapy as a secondline treatment is basically attributed to their unfavorable side effects profile, which involves elevated IOP and cataract formation. 383 However, Ozurdex has demonstrated favorable effects in this context, as the increase in IOP after Ozurdex is relatively lower than that observed with other steroids.…”

“…Other explorations on DEX implants have validated their efficacy in ocular diseases without significant ocular complications. , Recently, another study by a research group reported that the DEX implant exerted a transient reduction in endothelial cell density, with no change in the cell morphology observed in the injected eyes. The authors concluded that this could be due to some kind of chemical toxicity and that these effects should be given consideration while using the implant in compromised corneas prior to decision making …”