First Author: A.Mohite UK
Co Author(s): M. Denmark S. Shafquat 0 0 0 0 0 0 0 0 0
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Recent studies suggest the effect of Ozurdex lasts significantly less than the 6 months it was originally purported to, and national guidelines were re-written in 2012 to allow for re-injection after 4 months. As yet, however, there is no evidence for more than two injections over a 12-month period and there is no guidance on frequency of follow-up post treatment. Utilising these guidelines, we report our outcomes of intravitreal Ozurdex to determine its efficacy in reducing cystoid macular oedema (CMO), improving vision, and its duration of action. We also aimed to establish subjective pain patients felt during the injection procedure.
All cases of central vein occlusions (CRVO’s) or branch vein occlusions (BRVO’s) that met the NICE-defined inclusion criteria and underwent treatment between 1st February 2012 and 31st July 2013 at Russell’s Hall Hospital (Dudley, UK) were included in this study.
A retrospective case note review was carried out. Visual acuities (VA’s), intraocular pressure (IOP), treatment-related complications (eg. steroid responder if IOP > 22mmHg) and optical coherence tomography (OCT) scans were recorded pre-treatment, and then at each follow-up prospectively. A Topcon® 100 FD OCT machine was used. Central retinal thickness (CRT) was measured for each scan by a single observer retrospectively. All cases were given 700 microgram dexamethasone intravitreal injection in theatre using a standardised aseptic technique by a single surgeon, and after administration of topical and subconjunctival local anaesthesia. Patients were all prescribed topical antibiotic drops 3 days pre-treatment and 5 days post-treatment. Subjective pain scores were recorded immediately after treatment for each injection on a 10-point validated visual analogue scale. Scores were classified as mild (between 0 and 3), moderate (between 4 and 6) and severe (above 7). The post-treatment follow-up protocol of four visits was set as follows to maximise cost-effectiveness in a busy NHS setting: 1-14 days, 28-42 days, 56-84 days, and 84-168 days.
62 (39 patients) received injections. Mean age was 74.9 years (range 42.5 – 91.2), with 53.8% being female and 54.0% of cases being right-eyes. Mean starting VA and CRT was 0.95 logMAR and 652.4 microns respectively, with a mean delay of 31.0 days between listing for and receiving treatment. Maximal improvement in VA and CRT was noted at the third follow-up with values of 0.83 logMAR and 420.5 microns respectively at a mean of 67.6 days. At the fourth follow-up (mean 129.9 days) both mean VA and CRT worsened again, with values of 1.02 logMAR and 516.3 microns respectively. Twenty-five cases needed re-injection based on recurrence of CMO on OCT, at a mean of 156.6 days or 5.2 months. 51.3% of patients required only one injection, 35.9% required two, and 12.8% required three injections during the study period. 14.0% (8/57) of cases were true steroid responders, while 3 cases with known ocular hypertension and 2 known glaucoma eyes also developed raised IOP. Only one developed intractable glaucoma not controllable with topical treatment. One case developed a tractional retinal detachment at day 60 and required vitreoretinal surgery. Pain scores were mild in 92.3% of cases, and moderate in the remaining 7.7%.
Our results suggest intravitreal Ozurdex is effective in significantly reducing CMO and improving visual acuity after all types of retinal vein occlusions for an average time of 5 months. Patients report very little pain during the procedure using topical and sub-conjunctival local anaesthesia. The benefit in longstanding CMO following vein occlusions needs to be investigated further.