Management of macular edema secondary to branch retinal vein occlusion-combined treatment with intravitreal bevacizumab and ozurdex implant

Abstract

To evaluate the efficacy and safety of a dexamethasone implant in combination with intravitreal bevacizumab injection in the management of macular edema secondary to branch retinal venous occlusion. 10 eyes were prospectively investigated. Each eye was treated with intravitreal bevacizumab followed by intravitreal ozurdex at a two-week interval. Recurrence of macular edema was treated with ozurdex only. Patient were evaluated preoperatively with BCVA, IOP, OCT and fundus evaluation and followed up at 15 days, 2months and 4months of ozurdex injection. Fallow up all patient for 1 year duration. Mean BCVA at presentation was 0.81 log mar, and that improved to after 15 days of intravitreal bevacizumab was 0.55 log mar. At 15 days, 2 months and 4 months of intravitreal ozurdex implantation mean BCVA was 0.54logmar, 0.54 log mar and 0.6logmar respectively. Mean central foveal retinal thickness at presentation was 538 µm and reduced to 235 µm, after intravitreal bevacizumab. At 15 days, 2 months and 4 months after intravitreal ozurdex implantation mean central foveal retinal thickness was 182.14 µm, 189.28 µm and 352.14 µm respectively. Mean Intraocular pressure (IOP) was elevated about 1 mm of Hg after bevacizumab, about 3 mm of Hg after 4 months of ozurdex with using single anti glaucoma medication and one patient had progression of cataract after 2 injection of ozurdex. Combined treatment of intravitreal bevacizumab and ozurdex shows better and a sustained functional outcome. Increased intraocular pressure and cataract formation can be potential concerns and should be monitored.