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Comparison of dexamethasone 0.7mg sustain-released intravitreal implant (Ozurdex) versus intravitreal bevacizumab (Avastin) for refractory diabetic macular edema

Session Details

Session Title: Quick Fire Free Paper Session 04

Session Date/Time: Sunday 29/09/2013 | 11:00-13:00

Paper Time: 11:30

Venue: Hall C (Level 1)

First Author: D.Kar INDIA

Co Author(s):                  

Abstract Details

Purpose:

TO COMPARE THE EFFECTIVENESS OF DEAXAMETHASONE AND BEVACIZUMAB ON MACULAR THICKNESS ON OCT AND VISUAL ACUITY IN LOGMAR DIABETIC MACULAR EDEMA. COMPLICATIONS WERE ALSO EVALUATED

Setting:

KAR’S EYE HOSPITAL, MUMBAI, INDIA

Methods:

ALL THE 25 DIABETIC PATIENTS WITH BILATERAL MACULAR THICKNESS OF MORE THAN 550 MICRONS WERE INCLUDED IN STUDY. ALL THE PATIENTS WERE UNDERWENT FOCAL OR GRID LASER BEFORE SELECTED FOR THE SUDY. THOSE WHO HAVE TAKEN ANY INTRAVITREAL BEFORE AND PATIENTS WITH PRE EXISTING GLAUCOMA WERE EXCLUDED FROM STUDY. IN ONE EYE INTRAVITREAL DEXAMETHASONE IMPLANT (OZURDEX, ALLERGAN INC, IRVINE, CA, USA) INJECTED AND IN OTHER EYE INTRAVITREAL BEVACIZUMAB (AVASTIN, GENENTECH INC, SOUTH SANFRANCISCO, CA, USA) INJECTED. IN OTHER EYE INTRAVITREAL AVASTIN WAS GIVEN EVERY MONTHLY FOR 3 MONTHS. MACULAR THICKNESS ON OCT AND VISUAL ACUITY ON LOGMAR MEASURED PRE INJECTION AND EVERY MONTH POST INJECTION TILL 6 MONTHS. INTRA OCULAR PRESSURE AND ANY OTHER COMPLICATIONS NOTED. ALL THE PATIENTS UNDERWENT STRICT DIABETES AND LIPID CONTROL DURING THE STUDY PERIOD

Results:

AT 6 MONTHS ALL THE EYES WITH DEXAMETHASONE IMPLANTS WERE SHOWED BETTER REDUCTION IN MACULAR THICKNESS THAN BEVACIZUMAB AND ITS STATISTICALLY SIGNIFICANT (P<0.05) AND ALSO THERE IS BETTER IMPROVEMENT IN VISUAL ACUITY ON LOGMAR BUT DIFFRENCE IS NOT STATISTICALLY SIGNIFICANT (P>0.05). 7 PATIENTS OUT OF 25 IN DEXAMETHASONE GROUP (28%) COMPARE TO 2 PATIENTS OUT OF 25 IN BEVACIZUMAB GROUP (8%) HAS DEVELOPED HIGH INTRAOCULAR PRESSURE. THE RAISED IOP WAS MANAGED MEDICALLY BY ANTI GLAUCOMA MEDICATIONS AND NONE NEEDED SURGICAL INTERVENTION. 2 PATIENTS IN DEXAMETHASONE GROUP ( 8%) AND 8 PATIENTS IN BEVACIZUMAB GROUP (32%) HAS MACULAR EDEMA AT THE END OF 6 MONTHS

Conclusions:

DEXAMETHASONE IMPLANT IS PREFERED OVER BEVACIZUMAB IN CASE OF REFRACTORY MACULAR EDEMA. SINGLE INTRAVITREAL INJECTION OF DEXAMETHASONE IMPLANT REDUCES RISK OF MULTIPLE INJECTION OF BEVACIZUMAB SUCH ENDOPHTHALMITIS. GLAUCOMA IS MAJOR CONCERN IN DEXAMETHASONE GROUP BUT CAN BE MANAGED MEDICALLY

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