Session Title: Vascular Diseases and Diabetic Retinopathy IV
Session Date/Time: Sunday 20/09/2015 | 09:00-10:30
Paper Time: 09:16
First Author: : A.Higham UNITED KINGDOM
Co Author(s): : M. Cox C. Baker S. Jacob
PURPOSE:The National Institute of Clinical Excellence recommended the intravitreal dexamethasone implant 0.7mg, Ozurdex (DEX) for treating macular oedema (MO) secondary to retinal vein occlusion (RVO) in July 2011. We aimed to evaluate the efficacy and safety of using DEX in a routine clinical setting.
Retrospective case note review of all patients receiving DEX implants across three hospitals in the Heart of England Foundation Trust.
All patients who had received at least one DEX implant for MO secondary to RVO between 1 December 2011 and 1 November 2014 were included. Data were collected from paper and electronic notes. Details of best corrected visual acuity (BCVA), central retinal thickness (CRT) and complications were obtained from patient notes at baseline and after each implant. CRT values were taken as the highest value in the foveal area on ocular coherence tomography. All visual acuities were converted from Snellen to logMAR. Data was entered using Microsoft Excel and analysed using Excel and SPSS version 22.
141 eyes were included of 139 patients (65 central retinal vein occlusion, 76 branch retinal vein occlusion). 245 dexamethasone implants were administered during this period and 44% of patients required more than one implant. After the 1st implant there was a significant improvement in visual acuity (<0.005) with a mean improvement of 10 letters. 39% of eyes gained at least 15 letters. 36% of patients had received laser, anti- vascular endothelial growth factor or triamcinolone treatment prior to initiation of DEX implants. Of those who had received previous treatment there was no statistical improvement in their BCVA from baseline to final BCVA (p=0.511). Anatomically, looking at the entire patient group there was a significant reduction in CRT from baseline to final CRT (<0.005), with a mean reduction of 213μm (127 SD). Regarding complications, 44/141 (31.2%) eyes were treated for raised intraocular pressure during this period. Most patients were managed with topical treatment, but 3 needed oral acetazolamide initially and 1 needed cyclodiode laser treatment. 1 patient developed endophthalmitis and 2 had vitreous haemorrhage. The mean time interval between the administration of the 1st and 2nd implants was 36.8 weeks. 40/139 (29%) patients were ultimately switched to Ranibizumab.
Within this setting of routine clinical practice with a range of patient baseline comorbidities and a real life follow up schedule there was still an improvement both anatomically and functionally for those patients treated with DEX for MO secondary to RVO. Patients who were treatment naïve at baseline had significant improvements in BCVA, unlike those who had received previous treatments prior to DEX, perhaps unsurprisingly because these patients had a shorter duration of MO. Both earlier initial treatment and retreatment of those who relapse quickly could benefit patients and improve long term results. Combination or sequential therapy of anti-VEGF and dexamethasone implants may be a promising option.