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Real world experience with dexamethasone 700 mcg intravitreal implant (ozurdex) for the treatment of retinal vein occlusions

Session Details

Session Title: FP-15 Vascular Diseases and Diabetic Retinopathy V

Session Date/Time: Sunday 14/09/2014 | 08:00-10:00

Paper Time: 09:44

Venue: Boulevard D

First Author: : A.Shafi UK

Co Author(s): :    S. MacKenzie              

Abstract Details

Purpose:

To compare our experience and results with the dexamethasone 700 micrograms (mcg) intravitreal implant (OZURDEX) with the GENEVA study and reflect on how ‘real patients in a real setting’ compare with those in the GENEVA study.

Setting:

A district hospital setting in the rural north of England.

Methods:

Retrospective review of chart notes of all patients who have received the dexamethasone 700 mcg (OZURDEX) intravitreal implant for branch or central retinal vein occlusion since its introduction in our practice area 2 years ago. Only patients with at least 6 month follow up were included for data analysis as per GENEVA protocol. Visual acuity (VA) at baseline, 1 month, 3 months and 6 months was recorded. Any confounders, such as previous macular laser, were recorded and any complications secondary to the implant recorded. Intraocular Pressure (IOP) was compared at baseline, 1 month, 3 months and 6 months, as per GENEVA protocol. Central Retinal Thickness at baseline, 3 months and 6 months was also noted.

Results:

64 OZURDEX intravitreal implants were given between January 2012 and August 2013 to 38 eyes. In total 10 implant procedures were excluded; 5 as the case notes were unavailable, 5 due to insufficient length of follow up. 54 OZURDEX implant procedures were consequently included for data analysis. 52% of the implants were given for branch and 48% for central retinal vein occlusion. 5 patients subsequently received an anti-VEGF inhibitor due to insufficient response to the OZURDEX implant. 9% of patients had co-pathology of age related macular degeneration. Over half the patients received just one implant (52%). Ocular hypertension was the most common complication, occurring in just 13% of cases, compared to 24% in the Geneva study. 9% of cases had improvement of at least 3 lines of Snellen Visual Acuity at 1 month (compared to 21% in the Geneva study with 15 or more letters gain), the percentage increasing to 14% at 3 months (22% in Geneva study), and reducing to 3% at 6 months (22% in Geneva study).

Conclusions:

1) No serious complications of intravitreal dexamethasone implant were encountered. 2) Visual acuity improvements were less than that obtained in Geneva study, with approximately 50% less patients reaching 3 line gain at 1 and 3 months (9% and 14% respectively) compared to the Geneva study results (21% and 22% respectively). The reasons (i.e. co-pathologies- ARMD, proportion of pseudophakics, duration of macular oedema, increased proportion of CRVO) will be explored. 3) Visual acuity improvements did not continue to 6 months as shown in the Geneva study. 3 line vision gain was maintained in 22% of patients from 3 to 6 months in Geneva study, whereas in our cohort this reduced from 14% at 3 months to 3% at 6 months. 4) Ocular hypertension occurred in approximately 50% less patients than in the Geneva study (13% versus 24%).

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