Abstract
Background and Objective: Sustained-release dexamethasone intravitreal implant is an effective treatment for macular edema secondary to retinal vein occlusion (RVO) but ocular hypertension is a side effect. This study evaluated whether the addition of a single combination IOP-lowering medication will reliably control intraocular pressure (IOP) for those patients. Study Design/Patients and Methods: Retrospective chart review of 62 patients that underwent multiple injections of combination anti-VEGF and sustained-release dexamethasone intravitreal implant for macular edema secondary to RVO. IOP spikes were treated with brimonidine 0.2% - timolol 0.5%. IRB approval was obtained. Results: The average elevated IOP requiring treatment was 28.6 mmHg. The average IOP after adding brimonidine 0.2% - timolol 0.5% was 16.7 mmHg. 100 percent of treatment cycles had an IOP< 30 mmHg after starting treatment. Conclusions: Using one combination IOP-lowering drop can reliably control the ocular hypertension that occurs secondary to combination therapy for macular edema in RVO.
Highlights
Background and ObjectiveSustained-release dexamethasone intravitreal implant is an effective treatment for macular edema secondary to retinal vein occlusion (RVO) but ocular hypertension is a side effect
Occlusion can occur either in the central retinal vein (CRVO) or branches of the retinal veins (BRVO) that combine to form the central vein. Both Branched Retinal Vein Occlusion (BRVO) and Central Retinal Vein Occlusion (CRVO) are associated with significant impairments in vision-related quality of life [3]
The purpose of the present study is to demonstrate that the addition of brimonidine 0.2% - timolol 0.5% drops is an effective therapy in mitigating the intraocular pressure (IOP) increase following administration of subsequent intravitreal antiVEGF and dexamethasone combination therapy for RVO
Summary
Macular edema secondary to retinal vein occlusion (RVO) is a common cause of vision loss in older persons, the second most common retinal vascular disease after diabetic retinopathy, affecting sixteen million persons worldwide [1]. In a study comparing monotherapy with intravitreal dexamethasone versus combination therapy with anti-VEGF, 23.8% of the patients. This retrospective study reviewed the charts of 62 patient eyes, which underwent multiple injections of combination intravitreal anti-VEGF and intravitreal dexamethasone for macular edema secondary to retinal vein occlusion (RVO) from September 2009 to June 2014. Patients were monitored for decreased visual acuity of more than 6 Snellen chart letters, an increased thickness on OCT of more than 50 microns from their baseline, or more than 300 microns overall If they met one of these criterions, they were retreated with an intravitreal anti-VEGF and 2 weeks later with intravitreal dexamethasone. The baseline elevated IOP was recorded and compared to post-combigan treatment IOP spikes for all time points as well as monthly comparisons extending to 12 months
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