First Author: P.Ozdal TURKEY
Co Author(s): F. Koc H. Tırhıs 0 0 0 0 0 0 0 0 0
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To report the 6-month outcomes of the dexamethasone intravitreal implant (DEX implant) in eyes with vision loss due to refractory or recurrent macular edema (ME) associated with retinal vein occlusion (RVO) or non-infectious uveitis.
A total of 20 patients (22 eyes) with ME as a result of RVO or non-infectious uveitis that received a single injection of 0.7 mg DEX implant in Ulucanlar Eye Training and Research Hospital and followed up for at least 6 months were included in this retrospective case series.
Eleven eyes of 11 patients who received a DEX implant for the treatment of refractory ME due to RVO were included in RVO group. 11 affected eyes of 9 patients who treated with DEX implant because of ME despite systemic ± local treatment were included in uveitis group. For each patient slit-lamp biomicroscopy, measurement of intraocular pressure (IOP), measurement of best-corrected visual acuity (BCVA) with standardized Early Treatment Diabetic Retinopathy Study protocol and measurement of the central macular thickness (CMT) with optical coherence tomography were performed. Patients included had CMT of >300 μm and had undergone previous treatments for ME. Patients were evaluated at baseline and days 1, 30, 60, 90 and 180 posttreatment. The primary outcome measures were improvement in BCVA, reduction of CMT and occurrence of adverse events.
There were no statistically significant difference between two groups according to the age, gender, lateralization of the eye, baseline mean BCVA letter score, baseline mean CMT, baseline mean IOP and lens status. There were 6 (54.5%) eyes of 6 patients with branch retinal vein occlusion and 5 (45.5%) eyes of 5 patients with central retinal vein occlusion in RVO group. Of the 11 eyes in uveitis group (two patients presented with bilateral ME) 6 (54.5%) had intermediate, 3 (27.3%) had posterior and 2 (18.2%) had panuveitis. In RVO group statistically significant changes from baseline were observed in BCVA (at 30, 60, 90 days, p<0.05) and CMT (at 30, 60, 90 days, p<0.05). Furthermore statistically significant changes from baseline were observed in BCVA (at 30, 60, 90, 180 days, p<0.001) and CMT (at 30, 60, 90, 180 days, p<0.05) in uveitis group. All cases of increased IOP were managed with topical medications. The rate of increased IOP was similar for each groups but cataract occurred significantly more frequently in uveitis group (p<0.05). Of the 10/11 (90.9%) eyes that responded to implant, 2/10 (20%) subsequently relapsed and underwent a second DEX implant injection in both groups.
The Dex implant is a good therapeutic option in eyes unresponsive to other treatment regimens with ME secondary to RVO and non-infectious uveitis. The DEX implant seems to be effective in preventing recurrence of ME in these cases. Improvement in BCVA peaked at 60 days and then started to decline, with the decline being more rapid in the RVO group than in the uveitis group. Quantitatively the response to DEX implant treatment in both groups was similar but the response in the uveitis group was greater than in the RVO group on the 180th day.