Session Title: Vascular Diseases and Diabetic Retinopathy II
Session Date/Time: Friday 12/09/2014 | 11:00-13:00
Paper Time: 12:20
Venue: Boulevard C
First Author: : P.Prakash UK
Co Author(s): : D. Hanumunthadu S. Arghandawi
To review the current practice and to evaluate the efficacy of intravitreal dexamethasone in retinal vein Occlusion with macular oedema, in a busy district general hospital with 2 injections or less in the first year.
This was a single centre retrospective analysis of all the patients who underwent Ozurdex implants for retinal vein occlusion with macular oedema as per NICE guidelines between November 2011- December 2013.As per the local guidelines retreatment was not possible prior to 4-6 months.
A total of 42 eyes of 41 consecutive patients were included.20(48.7%) had Central Retinal Vein Occlusion(CRVO) and 21(51.8%) had Branch retinal vein Occlusion with macular oedema(BRVO) were included as per NICE guidelines(NICE TA 229, July 2011). This included all patients with CRVO and BRVO patients with macular haemorrhage or no response to previous laser treatment. Evaluation of case notes for patient data at successive follow up visits including visual acuity outcomes, central foveal thickness and intraocular pressure (IOP).
Mean follow up time was 15.3 months(5-26 months). Mean follow ups in the given period was 7.0. 24 (57%) patients had 1 injection, 17 (40%) patients had 2 injections, and 2 (4%) patients had 3 injections during the follow-up period. The mean time interval between the first two injections was 221 days(range 5-11 months) and 316 days(range 6-13 months) between the second and the third. In the BRVO group, 6 (29%) patients showed a visual acuity gain of more than 15 letters, 9 (43%) patients showed a gain of 1 to 15 letters, 6 (29%) showed loss of up to 15 letters with loss of more than 15 letters. In the CRVO group, 6 (29%) patients showed visual acuity gain of more than 15 letters, 2 (10%) showed gain of up to 15 letters, 8 (38%) showed loss of up to 15 letters and a 5 (24%) patients showed loss of more than 15 letters . Maximal change in IOP was found at 6 weeks after treatment and had a mean increase in IOP of 4mmHg. 1 patient required cataract surgery during the follow up period. 1 patient developed sterile uveitis post-operatively and had no further treatment.
Long-term visual acuity outcomes with intravitreal dexamethasone show significant improvement in visual acuity. Short-term changes in IOP require prompt treatment. With less than 2 injections in the first year and lesser follow ups, intravitreal dexamethasone could be used as a first line therapy in a majority of RVO with Macular oedema in indicated patients. This is a promising alternative to monthly antivegf injections and would reduce the burden of medical retina clinics. However head to head comparison is desirable to assess long term efficacy.