Abstract
The purpose of this study was to determine the safety and effectiveness of simultaneous vitreous injection of dexamethasone implant and ranibizumab on macular edema secondary to central retinal vein occlusion (CRVO). We conducted a 6-month retrospective self-control study. Twenty-five patients diagnosed with macular edema secondary to CRVO were enrolled in this study. The patients received intravitreal injection of dexamethasone implant and ranibizumab. The changes in best corrected visual acuity (BCVA), central retinal thickness (CRT) and interocular pressure (IOP) before and at 2w, 1, 2, 3, 4, 5, 6 m after injection were recorded and compared. The adverse reactions in eyes and whole body were observed. The BCVA of all patients at 2 w (61.8 ± 5.42), 1 m (68.68 ± 5.23), 2 m (70.8 ± 5.8), 3 m (68.44 ± 5.61), 4 m (65.76 ± 5.76), 5 m (67.08 ± 5.57), and 6 m (70.12 ± 5.46) after surgery were significantly higher than that before surgery (52.2 ± 5.06,p < 0.01), and CRT of all patients at 2w (393.36 ± 52.66 um), 1 m (334.52 ± 32.95 um), 2 m (298.800 ± 29.97 um), 3 m (309.080 ± 28.78 um), 4 m (345.48 ± 39.81 um), 5 m (349.080 ± 29.88 um), and 6 m (309.76 ± 30.41 um) after surgery were significantly reduced than that before surgery (583.76 ± 121.09 um, p < 0.01). Macular edema recurred in an average of 4.44 ± 0.51 months after treatment, and those patients received combined treatment again. During follow-up, the most common adverse reactions were subconjunctival hemorrhage and increased intraocular pressure, with the incidence of 22% (11/50) and 18% (9/50) respectively. In all cases, the increased intraocular pressure could be controlled by a single intraocular pressure reducing drug. No patient needed to receive anti-glaucoma surgery. The overall incidence of lens opacity was 4% (2/50). After the first injection, no case showed lens opacity. After re-injection, 2 patients (2 eyes) (8%) developed lens opacity. None of the patients showed serious ocular adverse reactions or systemic complications such as vitreous hemorrhage, retinal detachment, endophthalmitis, uveitis or ocular toxicity. The simultaneous vitreous injection of dexamethasone implant and ranibizumab can significantly improve the visual acuity and anatomical prognosis in macular edema secondary to central retinal vein occlusion (CRVO-ME) patients, exhibiting good safety and effectiveness.
Highlights
Retinal vein occlusion (RVO) is a retinal vascular disease common in middle-aged and elderly people
Intravitreal anti-VEGF agents and intravitreal corticosteroid agents are the effective therapies for central retinal vein occlusion (CRVO)-macular edema (ME) (Singer et al, 2012; Qian et al, 2018)
American Academy Of Ophthalmology and EURETINA clarified that anti-VEGF drugs such as ranibizumab and aflibercept are the first-line treatment for RVO-ME, while panretinal laser photocoagulation (PRP) and glucocorticoid are the second-line treatment for RVO-ME (Pulido et al, 2016; Schmidt-Erfurth et al, 2019)
Summary
Retinal vein occlusion (RVO) is a retinal vascular disease common in middle-aged and elderly people. The current treatment methods for macular edema secondary to central retinal vein occlusion (CRVO-ME) include surgical treatment, laser treatment, intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) drugs, glucocorticoids and other preparations. Dexamethasone intravitreal implant (Ozurdex, Allergan) is a biodegradable sustainedrelease implant loaded with 0.7 mg dexamethasone (Robinson and Whitcup, 2012; Bucolo et al, 2018) It is the only glucocorticoid drug approved by the US Food and Drug Administration and the European Union for treating RVOME. A single intravitreal injection of Ozurdex can maintain the effective drug concentration in the eye for 3–6 months, and it can be used for RVO patients with poor anti-VEGF treatment efficacy (Manousaridis et al, 2017; Houben et al, 2018; Li et al, 2018). In this study, we explored the effectiveness and safety of simultaneous injection of dexamethasone intravitreal implant and ranibizumab in the treatment of CRVO-ME patients
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