Switch of Intravitreal Therapy for Macular Edema Secondary to Retinal Vein Occlusion from Anti-VEGF to Dexamethasone Implant and Vice Versa.

Amelie Pielen,Thomas Ness,Bernd Junker,Anima Desiree Bühler,Sonja Ute Heinzelmann,Daniel Böhringer

doi:10.1155/2017/5831682

Amelie Pielen, Thomas Ness + Show 4 more

Open Access

https://doi.org/10.1155/2017/5831682

Copy DOI

Abstract

Purpose To evaluate the anatomical and functional outcome of intravitreal dexamethasone implant for macular edema secondary to central (C) or branch (B) retinal vein occlusion (RVO) in patients with persistent macular edema (ME) refractory to intravitreal antivascular endothelial growth factor (VEGF) treatment compared to treatment naïve patients and to dexamethasone-refractory eyes switched to anti-VEGF. Methods Retrospective, observational study including 30 eyes previously treated with anti-VEGF (8 CRVO, 22 BRVO, mean age 69 ± 10 yrs), compared to 11 treatment naïve eyes (6 CRVO, 5 BRVO, 73 ± 11 yrs) and compared to dexamethasone nonresponders (2 CRVO, 4 BRVO, 69 ± 12). Outcome parameters were change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by spectral-domain optical coherence tomography. Results Mean BCVA improvement after switch to dexamethasone implant was 4 letters (p = 0.08), and treatment naïve eyes gained 10 letters (p = 0.66), while we noted no change in eyes after switch to anti-VEGF (p = 0.74). Median CFT decrease was most pronounced in treatment naïve patients (−437 μm, p = 0.002) compared to anti-VEGF refractory eyes (−170 μm, p = 0.003) and dexamethasone-refractory eyes (−157, p = 0.31). Conclusions Dexamethasone significantly reduced ME secondary to RVO refractory to anti-VEGF. Functional gain was limited compared to treatment naïve eyes, probably due to worse BCVA and CFT at baseline in treatment naïve eyes.

Highlights

Visual impairment secondary to central or branch retinal vein occlusion (CRVO, BRVO) is mostly caused by macular edema
The search for patients treated for macular edema secondary to BRVO or CRVO resulted in 47 patients
intraocular pressure (IOP) increase independent of a switch occurred more frequently after intravitreal treatment with dexamethasone implant compared to anti-VEGF

Summary

Introduction

Visual impairment secondary to central or branch retinal vein occlusion (CRVO, BRVO) is mostly caused by macular edema. Intravitreal treatment with either anti-VEGF (vascular endothelial growth factor) or corticosteroids is efficacious and safe [1,2,3]. Dexamethasone implant (Ozurdex, Allergan, Ireland) is a device approved for macular edema secondary to RVO [16, 17] and diabetes. Pivotal trials that led to approval were conducted in parallel so that head-to-head comparison between anti-VEGF agents and dexamethasone implant was missing until very recently. Treatment for macular edema could be initiated with both options and should consider the individual ophthalmological disposition and the patients’ circumstances (characteristics to consider are, among others, age, lens status, presence of glaucoma, and mobility)

Methods

Results

Discussion

Conclusion