The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario

Abstract

Purpose:This study evaluated the effect of intravitreal dexamethasone implant (IDI; Ozurdex) injection for treating macular edema in patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).Methods:This prospective study included 40 eyes of 40 patients with nonischemic BRVO and 31 eyes of 31 patients with nonischemic CRVO who received IDI injection as the first-line treatment for macular edema. The best-corrected visual acuity (BCVA) value before and after the treatment; intraocular pressure; optic coherence tomography findings; and all ocular examination findings, including central foveal thickness (CFT) measurement and fluorescein angiography findings, were evaluated for each patient.Results:After the IDI injection, BCVA value increased (P < 0.001) and CFT value decreased (P < 0.001) in both groups. The recurrence rates of CFT elevation after the first and the second Ozurdex injections were 65.0% and 65.3%, respectively, in patients with BRVO and 70.9% and 68.1%, respectively, in patients with CRVO. A statistically significant correlation was observed between preinjection CFT value and postinjection recurrence of CFT elevation (P = 0.017).Conclusion:Treatment with the IDI injections resulted in significant short-term improvement in CFT and BCVA values in patients with clinically significant RVO-related macular edema. Moreover, we observed that high preinjection CFT value was associated with a risk of postinjection recurrence of CFT elevation.

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

“…Reid et al [22] showed that the risk of cataract formation is higher in patients receiving multiple IDI injections. Nevertheless, cataract may form because of long-term steroid secretion after a single injection [10]. Meyer and Schönfeld did not reveal any cataract progression at 6 months after intravitreal injection of Ozurdex [23].…”

“…Simsek et al [10] showed a statistically significant improvement (p < 0.001) of CFT 4 months after intravitreal dexamethasone injection. Moreover, they observed the recurrence of CFT elevation in 65.3% of patients in the BRVO group and in 68.1% in the CRVO group 4 months after the second injection of intravitreal dexamethasone implant.…”

“…In the SOLO study, the improvement in BCVA in the BRVO group was from 0.6 to 0.45 logMar after 24 weeks after the treatment, and in the CRVO group, VA increased from 0.7 to 0.52 logMar after 24 weeks [15]. Simsek et al [10] showed in their study that BCVA improved significantly compared with baseline (p � <0.001) after the second injection of Ozurdex intravitreal implant. Mayer et al [16] demonstrated an improvement in BCVA by 6.6 ± 1.7 letters in the CRVO group and by 7.8 ± 2.9 letters in the BRVO group.…”

“…e National Institute for Health and Care Excellence recommends the dexamethasone 0.7 mg intravitreal implant as an option for the treatment of ME following CRVO and BCVO when treatment with laser photocoagulation has not been beneficial or was not considered because of the extent of the hemorrhage [10]. e rationale for the use of steroids for ME is that steroids lessen retinal capillary permeability and stop the expression of the VEGF gene and the metabolic pathway of VEGF.…”

Commentary on “Intravitreal dexamethasone implant for management of treatment-naïve retinal vein occlusion”

“…The article “The efficacy of intravitreal dexamethasone implant as the first -line treatment for retinal vein occlusion-related macular edema in a real-life scenario”[ 1 ] addresses an important question. In this article, the authors have shared their experience with the use of IDI in eyes with macular edema secondary to RVO, which have not received any other prior treatment.…”