First Author: I.Zakieh UK
Co Author(s): S. Syed
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The purpose of this study was to investigate the impact on visual acuity, central retinal thickness, intraocular pressure and cataract status in patients with macular oedema and retinal vein occlusion treated with intravitreal Ozurdex® (dexamethasone) implant.
This was a retrospective case note review of patients treated with an Ozurdex® implant within a fourteen-month period in a district general hospital in the UK.
The case notes of patients receiving an Ozurdex® implant within a fourteen-month period were obtained and reviewed. We looked at the initial diagnosis date of retinal vein occlusion (RVO) and macular oedema (MO), whether this was branch (BRVO) or central (CRVO), previous treatment, including previous Ozurdex® implant and time from diagnosis to receiving the first Ozurdex® implant. We documented visual acuity (VA) (Snellen chart), central retinal thickness (CRT) and intraocular pressure (IOP) at diagnosis, before listing for this particular Ozurdex® implant, and postoperatively. We also recorded the best VA and highest IOP documented within the six-month postoperative period. In addition, we documented whether there was any prior ocular comorbidity, in particular a diagnosis of ocular hypertension or glaucoma, any new diagnosis of glaucoma, measures taken to reduce IOP, and the cataract status at diagnosis and after treatment. Finally, we also recorded patient outcomes at the time of the case note review (14 to 24 months after receiving this particular intravitreal Ozurdex®).
Of 54 eyes from 54 patients, 61% (30) had BRVO with MO and 49% (24) CRVO with MO: 31 patients had MO on diagnosis of RVO. In those with BRVO, 6 patients developed MO afterwards (mean of 121 days). In those with CRVO, 5 patients developed MO afterwards (mean of 251 days). 57% (31) had prior Ozurdex® implants (mean 1, range 1-5). Mean preoperative VA was 6/36, mean VA postoperatively was 6/24. Mean VA increase of 1 line postoperatively with 33% (18 patients) achieving a ≥2 line increase. Mean decrease between pre- and postoperative CRT was 328μm (range 20-1063 μm). Mean IOP change was +3.2mmHg during a 6 month postoperative period. 11% (5 patients) had ≥10mmHg rise in postoperative IOP, 12.5% (6) commenced IOP-lowering medication and 2% (1) received laser treatment. 21% (9) were pseudophakic at diagnosis. 35% (15) had a documented cataract, 47% (7) of which worsened. 44% (19) had no cataract: 32% (6) of these developed a cataract. 20% (11) had no documented cataract status. 27% (12 patients) required cataract surgery. Outcomes: In 24% (13), the MO resolved after this implant, 19% (10) declined further treatment, 46% (25) required further management including additional Ozurdex® implants (19 patients).
Our study offers real-world outcomes in patients with macular oedema secondary to retinal vein occlusion treated with intravitreal Ozurdex®. Additionally, it demonstrates the effects on both naïve patients and those treated with repeated Ozurdex® injections, as well as allowing us to review the outcome fourteen to twenty four months after receiving the implant. We found that the Ozurdex® implant improved VA and decreased CRT. Adverse side effects on IOP were limited as only 11% (5 patients) had a rise of ≥10mmHg postoperatively, 12.5% (6 patients) had to be newly commenced on IOP-lowering medication, 2% (1) received selective laser trabeculoplasty and no patients required surgery to lower IOP. A significant number of patients either had worsening of cataracts (7 out of 15 patients) or a new development of cataract (6 out of 19 patients), with 12 patients requiring cataract surgery. This confirms the suitability of Ozurdex® for treatment of this cohort of patients.