Retinal vein occlusion and the use of a dexamethasone intravitreal implant (Ozurdex®) in its treatment

Abstract

PurposeTo review published data pertaining to the clinical experience with a dexamethasone intravitreal implant (Ozurdex®) with a view to establishing a clinically based therapeutic regime.MethodsA PubMed search using the MeSH terms “retinal vein occlusion” and either “pathophysiology” or “dexamethasone intravitreal implant” was undertaken for manuscripts published until August 2015. The analysis included studies involving minimally 15 patients under a prospective design or 30 under a retrospective design, a minimal follow up of 6 months, and at least 2 intravitreal Ozurdex® injections per eye.ResultsIn the vast majority of eyes, satisfactory outcomes were achieved with retreatment intervals of between 3 and 5 months. Initial evidence indicates a similar efficacy compared to anti-VEGF therapies as a first-line treatment. Safety concerns associated with the long-term and repeated use of Ozurdex® are not borne out by clinical findings: its implantation is not associated with a sustained increase in intraocular pressure (IOP) over time or with the number of applications.ConclusionCompared with anti-VEGF therapies, the burden of retreatment is reduced. In patients with chronic macular edema not responsive to repetitive anti-VEGF therapies, the outcome after dexamethasone implant treatment is encouraging. However, these results are achieved at the expense of side effects typically associated with steroids: in up to 20 % of the Ozurdex®-treated patients, an elevation in IOP, which could be medically controlled in the majority of cases, and cataract formation or progression was observed.

Morphological and Functional Outcomes after Intravitreal Dexamethasone Injection for Macular Edema in Patients with Central Vein Occlusion at 48-Week Follow-Up

“…It was approved for use in the treatment of RVO in the United States of America (USA), Europe, and Switzerland. Several studies showed that intravitreal steroid injections have anti-inflammatory, antiangiogenic, and antivascular permeability characteristics and are effective for treating RVO-related ME [1,2,[6][7][8].…”

Dexamethasone Intravitreal Implant for Early Treatment and Retreatment of Macular Edema Related to Branch Retinal Vein Occlusion: The Multicenter COBALT Study

“…Several therapeutic options, including laser photo­coagulation [5], anti-vascular endothelial growth factor (anti-VEGF) therapies [6], and intravitreal injections of triamcinolone [7, 8] and dexamethasone [9], are available for treating BRVO-associated ME. Evidence for the use of these therapies is accumulating; however, the optimal treatment choice remains unclear.…”

Safety and effectiveness of intravitreal injection of dexamethasone for macular edema secondary to retinal vein occlusion: a meta-analysis

“…However, an intravitreal injection of DEX inevitably leads to some common complications. In this meta-analysis, the data demonstrated that SAEs, such as intraocular hypertension and postoperative cataract, could easily happen in the DEX implant, showing statistically significant differences between before and after medication [17]. Some studies reported that previous pars plana vitrectomy, an open/defective lens capsule, and/or iris defects may increase the risk of DEX implant migration into the anterior chamber [15].…”