First Author: R.Bourkiza UK
Co Author(s): D. Edison R. Ranjendram R. Hamilton
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To assess the clinical outcome and safety of intravitreal steroids (Ozurdex® and triamcinolone) in the treatment of diabetic macular edema (DME)
Outpatient injection units across 4 sites of Moorfields Eye Hospital, a UK National Health Service clinical setting.
Retrospective analysis of electronic medical record (EMR) notes and paper case notes, and review of optical coherence tomography (OCT) imaging of consecutive patients treated with intravitreal Ozurdex® and triamcinolone for DME between July 2015 and December 2016. Data was collected on age, gender, ocular co-morbidity, previous treatment, intraoperative complications, ETDRS visual acuity (VA), and OCT Central Macular Thickness (CMT) prior to injection and at 1/12, 3/12 and 6/12 post-injection, high intra-ocular pressure (IOP) and treatment. High IOP was defined as IOP>21mmhg.
37 patients had full data (23 male; 14 female). Mean age was 65 (44-85). A total of 43 injections were performed between November 2015 and December 2016, of which 39 were first injection episodes (27 Ozurdex®; 12 Triamcinolone). Mean follow-up was 7.42 months (1-17 months). Mean baseline VA was 57.65 letters. Mean baseline CMT was 391.05 μm. At one month, mean change in VA was +3.97 letters (p<0.05), and mean change in CMT was -79.79 μm (p<0.05). At 3-month follow up, mean change in VA was +2.46 letters (p =0.054), and mean change in CMT was -89.32 μm (p<0.05). At 6 months, these were +1.17 letters (p= 0.27) and -48.88 μm (p<0.05) respectively. 6 cases (16.2%) required re-treatment with the same agent (5 after Ozurdex® and 1 after Triamcinolone) at a mean interval of 6 months (3-10 months) 7 patients (18.9%) required subsequent treatment in the form of Lucentis or Eylea® and 3 (8.1%) required Iluvien® implant. 7 patients (18.9%) had high IOP at any time point after injection. All 7 required treatment (medical, none required glaucoma surgery).
Although there was a statistically significant improvement in the OCT Central Macular Thickness at all follow-up intervals after intravitreal steroids for DME, the change in visual acuity was not significant, and more than a third of cases required subsequent treatment. High IOP occurred in less than a fifth of patients and responded to medical treatment.