Resolution of Persistent Cystoid Macular Edema due to Central Retinal Vein Occlusion in a Vitrectomized Eye following Intravitreal Implant of Dexamethasone 0.7 mg

Abstract

We report the case of a 62-year-old woman with a history of vitreoretinal surgery for vitreous hemorrhage secondary to central retinal vein occlusion (CRVO). Because of the persistence of macular edema (ME), she received 2 intravitreal injections of bevacizumab 0.5 mg (Avastin®, Genentech/Roche) three months after vitrectomy, without functional or anatomical improvement. Six months after vitrectomy, she therefore received an intravitreal implant of dexamethasone 0.7 mg (Ozurdex®). An improvement in her best-corrected visual acuity and central macular thickness, as measured by optical coherence tomography, was detected 7 days after the injection, and complete resolution of the ME and retinal hemorrhages was observed 6 months after the injection. Dexamethasone intravitreal implant might be an effective treatment option in ME secondary to CRVO, also in vitrectomized eyes.

Intravitreal Sustained-Release Steroid Implants for the Treatment of Macular Edema following Surgical Removal of Epiretinal Membranes

“…Sustained-release corticosteroids have the potential to reduce the need for frequent intraocular injections in vitrectomized eyes. However, thus far, only very few studies have attempted to investigate the effect of sustained-release steroid implants in persistent CME following vitrectomy [7,16,18,20] . In a series of 5 patients, Taney et al [17] showed that DEX had a beneficial effect on persistent macular edema after vitrectomy with epiretinal membrane peeling, although treatment frequently required repeated injections.…”

“…Dexamethasone (DEX) intravitreal implant (Ozurdex ® , Allergan, Inc., Irvine, CA, USA and Allergan Pharmaceuticals, Ireland) has been shown to reduce central retinal thickness (CRT) and improve best-corrected visual acuity (BCVA) in patients with macular edema of various etiologies including noninfectious uveitis, diabetes mellitus, and retinal vein occlusion [8][9][10][11][12][13][14][15] . Over the past years, several small case series and anecdotal reports have strengthened the hypothesis that intravitreal steroid implants may be effective in the treatment of refractory CME in vitrectomized eyes [16][17][18][19][20] . However, to date there are no large studies evaluating the efficacy and safety of intravitreal sustained-release steroid implants for the management of CME following vitrectomy and membrane peeling.…”

Inflammation in Retinal Vein Occlusion

“…Given the results of the GENEVA trials, some advocate use of the implant for patients with a relatively short duration of macular edema [48]. Others have suggested that the dexamethasone implant may be useful for less frequent occurrences of macular edema secondary to RVO, such as those occurring in postvitrectomized eyes with CRVO, and those with long-standing BRVO and chronic edema [49, 50]. …”

Rhegmatogenous Retinal Detachment with a High Risk of Proliferative Vitreoretinopathy Treated with Episcleral Surgery and an Intravitreal Dexamethasone 0.7-mg Implant

“…Recently, a sustained-release dexamethasone implant (Ozurdex ® ) proved to be effective for the treatment of macular edema secondary to a variety of underlying diseases with a potentially lower rate of adverse events [7, 8, 9]. We report a case of rhegmatogenous retinal detachment with a high risk of PVR treated with episcleral surgery and an intravitreal dexamethasone 0.7-mg implant (Ozurdex).…”