Intravitreal Dexamethasone Implant Research Articles

Effectiveness of the Dexamethasone Intravitreal Implant for Treatment of Patients with Diabetic Macular Oedema

Diabetic macular oedema (DMO) is a leading cause of vision loss in the working-age population worldwide. Corticosteroid drugs have been demonstrated to inhibit the expression of both the vascular endothelial growth factor (VEGF) gene and other anti-inflammatory mediators, such as prostaglandins. Triamcinolone, fluocinolone and dexamethasone are the main steroids that have been studied for the treatment of macular oedema. Over the last few years, several studies have suggested an important role for dexamethasone in the management of DMO. The dexamethasone intravitreal implant (DEX implant) (Ozurdex®; Allergan, Inc., Irvine, CA) is a novel approach approved by the US Food and Drug Administration (FDA) and by the EU for the intravitreal treatment of macular oedema after branch or central retinal vein occlusion, and for the treatment of non-infectious uveitis affecting the posterior segment of the eye. We reviewed manuscripts that had investigated the pharmacokinetics, efficacy and safety of the DEX implant regarding DMO treatment.

Suspected Bacterial Endophthalmitis Following Sustained-release Dexamethasone Intravitreal Implant: A Case Report

A 58-year-old man admitted to our opthalmology department with the complaint of branch retinal vein occlusion. He was treated with intravitreal Ozurdex in the right eye. Two days after the injection, the patient presented with ocular pain and the visual acuity was hand movement. A diagnosis of endophthalmitis was made. We performed emergent pars plana vitrectomy (PPV) and the implant was removed from the vitreous cavity using a retinal forceps. A combination of vancomycin 1.0 mg and amikacin 0.4 mg was injected intravitreally. However, because of the blurring in the vitreus one week after the procedure, phacoemulsification and a repeat PPV was performed. Five days after the last procedure the signs and symptoms of endophthalmitis were resolved. Our case demonstrated that endophthalmitis could develop after intravitreal implantation of Ozurdex. Surgical removal of the implant and immediate vitrectomy seems to be a useful treatment option in these cases.

Dexamethasone Intravitreal Implant for Treatment of Patients with Persistent Diabetic Macular Edema

Purpose: To report the 6-month anatomical and best-corrected visual acuity (BCVA) response after primary intravitreal dexamethasone implantation (Ozurdex®) in patients with refractory diabetic macular edema (DME). Methods: Retrospective review of the medical records of 58 patients with decreased visual acuity, due to refractory DME, who underwent a single injection of Ozurdex between November 2010 and January 2012, at the Instituto de Microcirurgia Ocular, Barcelona, Spain. Results: At baseline, the mean foveal thickness (FT) was 543.24 ± 156.51 μm. Mean (±SD) values of FT did decrease to 346.82 ± 123.74 μm at month 1 and 341.12 ± 129.64 μm at month 3. Data on the 6-month follow-up showed a mild increase to 420.16 ± 152.15 μm. All of the FT reduction outcomes were statistically significant, with respect to baseline data (p = 0.0001). The baseline BCVA data was 0.66 ± 0.36 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.52 ± 0.32 logMAR (p = 0.0001) and 0.44 ± 0.27 logMAR (p = 0.0001) after 1 and 3 months, respectively. At the last visit (6-month follow-up), the mean BCVA increased to 0.51 ± 0.31 logMAR (p = 0.0001). Conclusions: In this study, intravitreal treatment with a dexamethasone implant safely reduced DME and improved visual acuity in a difficult-to-treat patient population with long-standing refractory DME.

Intravitreal Dexamethasone Implant for Macular Edema following Uncomplicated Phacoemulsification

To retrospectively study the efficacy of a single 0.7-mg dexamethasone intravitreal implant in eyes with refractory macular edema secondary to uncomplicated phacoemulsification and intraocular lens implant. In 11 eyes of 11 consecutive patients with persistent refractory macular edema, secondary uncomplicated cataract extraction, and intraocular lens implant, the injection of 0.7-mg dexamethasone implant was performed at the Clinica Oculistica, University of Bari, Italy. Best-corrected visual acuity (BCVA), central retinal thickness measured by spectral-domain optical coherence tomography, and intraocular pressure (IOP) was evaluated at baseline, 1 month, and 6 months. After a mean follow-up of 6.27 ± 0.47 months, BCVA was significantly increased from 20/40 to 20/22 (p<0.0001), mean central retinal thickness decreased significantly from 462 ± 100 to 276 ± 8 µm (p<0.0001), and IOP did not change significantly (p = 0.053). In no case were postoperative complications observed. A single injection of 0.7-mg dexamethasone intravitreal implant was effective in the treatment of persistent refractory macular edema secondary to uneventful phacoemulsification and in-bag lens implant.

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6‐month follow‐up – The SOLO study

To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit. Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.

Intravitreal Dexamethasone Implant for the Treatment of Macular Edema after Retinal Vein Occlusion in a Clinical Setting

To study the efficacy and safety of a new intravitreal implant (sustained release of dexamethasone, Ozurdex®) recently approved in Switzerland for the treatment of macular edema secondary to retinal vein occlusion in a clinical setting. Prospective non-consecutive study of patients with macular edema secondary to central retinal vein occlusion or branch retinal vein occlusion treated with implant of dexamethasone 0.7 mg. Follow-up visits were performed at day 1, week 1 and monthly thereafter. ETDRS best corrected visual acuity, Goldmann tonometry and macular thickness on SD-OCT were registered. Retreatment was carried out on a pro re nata basis starting from month 3. Fifteen eyes of 15 patients were included (8 branch retinal vein occlusions, 7 central retinal vein occlusions). 33% of the patients achieved 3 lines or more of vision gain. The central retinal vein occlusion subgroup showed a mean decline in visual acuity at month 3. A reduction of 36% of macular edema was already observed at day 1. All maculae were dry at month 1. The mean time of recurrence of macular edema for both groups was 4.6 months. A similar reduction of macular edema was obtained after a second implantation. An intraocular pressure increase of ≥ 20% was observed after the first implantation in 53% of patients. Our study showed efficacy and safety of intravitreal dexamethasone implant in the treatment of macular edema due to retinal vein occlusion. Anatomical efficacy was observed at day 1 but seems to have shorter effect than previously published data. No serious side effects were observed.

Local Safety Concerns of Repited Dexamethasone Intravitreal Implant (Ozurdex®) For Macular Diseases

Introduction: The objective of the present study was to analyze the expanding indications for the dexamethasone intravitreal implant (Ozurdex®) in macular edema of varied diseases, and determine its safety concerns. Materials and Methods: We retrospectively reviewed the ophthalmic charts of patients treated with at least one intravitreal injection of Ozurdex® since April 2010 to October 2011. Data regarding complications of the procedure as well as the need for cataract surgery were collected. No patient with the diagnosis of glaucoma was included in the present study. Early recurrences where treated with laser photocoagulation or intravitreal ranibizumab at the discretion of the physician; late recurrences where treated with a new Ozurdex® injection. Results: The causative diseases of ME in the 214 eyes of our sample were: diabetic macular edema (101 eyes of 84 patients); branch retinal vein occlusion (27 eyes of 27 patients with superior temporal branch occlusion; 6 eyes of 6 patients with inferior temporal branch occlusion); central retinal vein occlusion (23 eyes of 23 patients); uveitic macular edema (13 eyes of 11 patients). Patients with other indications such as exudative age-related macular degeneration (27 eyes of 27 patients), and pseudophakic cystoid macular edema (7 eyes of 7 patients). Regarding complications, we found a rate of posterior cataract progression in 69.6% of phakic eyes after receiving a second intravitreal Ozurdex® for the treatment of ME. A significant IOP increase was evidenced in 21.18% of cases following the first Ozurdex® implant. Patients with uveitic macular edema (UME) showed the greatest rate of IOP increase (53.86%) following Ozurdex® implant. In addition, anterior chamber migration of the Ozurdex® implant was seen in 2 cases with lens posterior capsule rupture. Discussion: This is a descriptive study of 214 eyes of 189 patients treated with intravitreal Ozurdex® in real-life conditions, which adds an important value for the retinal physicians. Further long-term studies are warranted in order to establish a more accurate safety profile of Ozurdex® for retinal diseases.

Vascular Changes in Eyes Treated with Dexamethasone Intravitreal Implant for Macular Edema after Retinal Vein Occlusion

To evaluate the angiographic findings in eyes from 2 clinical trials of the dexamethasone intravitreal implant (DEX implant) 0.7 mg in the treatment of macular edema (ME) after branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Post hoc analysis of pooled data from 2 identical phase 3 clinical trials. Patients with vision loss as a result of ME (≥ 6 weeks' duration) after BRVO or CRVO for whom angiographic data were available (n = 329 eyes). Fluorescein angiography (FA) results assessed by masked, certified graders using standardized grading protocols. The primary outcome measure in the parent studies was change from baseline in best-corrected visual acuity. Prospectively defined secondary outcomes included FA measurements (to assess macular capillary leakage, neovascularization, and nonperfusion) and optical coherence tomography results (to assess central retinal thickness [CRT]). At baseline, 42% of eyes in the DEX implant group and 38% of eyes in the sham group had unreadable assessments because of hemorrhage. At day 180, significantly fewer DEX implant-treated eyes (2%) than sham-treated eyes (9%) had unreadable assessments because of hemorrhage (P = 0.029). Among eyes with gradable assessments, the incidence of nonperfusion remained fairly steady from baseline to day 180. The proportion of eyes with active neovascularization increased from baseline to day 180 in the sham group, but stayed relatively constant in the DEX implant group (P = 0.026 for DEX vs. sham). The mean area of overall nonperfusion and the mean area of macular capillary nonperfusion increased from baseline to day 180 in both treatment groups (no statistically significant between-group difference). There was a statistically significant positive correlation between changes in macular leakage and changes in CRT in both the DEX implant group (r = 0.22; 95% confidence interval, 0.03-0.40; P = 0.023) and the sham group (r = 0.29; 95% confidence interval, 0.10-0.46; P = 0.003). This study demonstrated that the clinical improvements observed with the DEX implant were accompanied by significant improvements in vascular parameters and suggests that treatment with the DEX implant may be associated with some clinically significant improvements in angiographic findings, specifically active neovascularization.

Longstanding refractory pseudophakic cystoid macular edema resolved using intravitreal 0.7 mg dexamethasone implants

BackgroundRefractory pseudophakic cystoid macular edema (PCME) following cataract surgery has long posed a challenge to clinicians, but intravitreal injections with a sustained delivery 0.7 mg dexamethasone implant has emerged as a promising therapy for this condition.ObjectiveTo present a case of longstanding and refractory PCME with complete remission through 189 days of follow-up after two successive injections with intravitreal dexamethasone implants.Case reportA 59-year-old male had experienced metamorphopsia for approximately 4 years and had been diagnosed with PCME 15 months earlier. Since the time of the diagnosis, the condition had been refractory to both subtenon triamcinolone acetonide and a total of five injections with intravitreal ranibizumab. After the last injection with ranibizumab, central subfield mean thickness was 640 μm, and the best corrected visual acuity was 78 Early Treatment Diabetic Retinopathy Study letters. Following an intravitreal injection with a dexamethasone implant, the macular edema resolved at the next follow-up. The macular edema returned 187 days after the first injection and was treated with another intravitreal dexamethasone implant. Again, the macular edema subsided completely, and best corrected visual acuity improved to 84 Early Treatment Diabetic Retinopathy Study letters, a condition which was maintained through an additional 189 days of follow-up.ConclusionChronic PCME is traditionally a difficult condition to treat, but we are encouraged by the optimal response experienced with intravitreal sustained release dexamethasone implants in our patient whose longstanding PCME had been refractory to previous treatments with both subtenon triamcinolone and intravitreal ranibizumab. In this case, the condition appeared to be fully reversible once inflammation was controlled, but the need for monitoring and repeated injections remains an issue of concern.

Treatment of refractory uveitic macular edema with dexamethasone intravitreal implants in a pediatric patient with bilateral granulomatous idiopathic panuveitis: a case report

BackgroundMacular edema is a common complication of uveitis and represents a therapeutic challenge, especially in children. Recently, intravitreal dexamethasone implants have been shown to decrease intraocular inflammation and to control uveitic macular edema in patients with non-infectious intermediate or posterior uveitis.FindingsAn 11-year-old boy with bilateral granulomatous idiopathic panuveitis and orbital inflammation experienced macular edema refractory to topical steroids and subcutaneous methotrexate. He was treated with off-label bilateral injections of dexamethasone intravitreal implant. Three months later, his vision had improved from 20/200 in both eyes to 20/30 in the right eye and 20/40 in the left eye. Optical coherence tomography showed complete resolution of the cystoid macular edema and subretinal fluid in both eyes.ConclusionsThis is a rare report of the use of bilateral dexamethasone intravitreal implant in a pediatric patient. The implants achieved complete resolution of the uveitic macular edema with no adverse events 3 months post-implantation.

Utility of Anterior Segment OCT Measurements for Predicting Severe Eye Pressure Increase after Intravitreal Dexamethasone Implant

Background/aims: To assess the utility of non-contact anterior segment ocular coherence tomography (AS-OCT) measurement of the angle recess width (AR) to predict eyes prone to intraocular pressure (IOP) spikes after injection of intravitreal dexamethasone implant in patients with CRVO and BRVO. Methods: Cohort study with fellow-eye control of 34 patients with gonioscopically open angles and RVO undergoing intravitreal injection of dexamethasone implant (Ozurdex). All participants received pre-injection AS-OCT in both eyes using spectral domain Cirrus OCT. Independent masked assessors measured the AR width using electronic imaging calipers. IOP was monitored prior to implant placement, and monthly for 6 months thereafter. Comparisons between AR width and degree of steroid response, phakic status, gender, and prior history of glaucoma were analyzed. Results: Seven eyes (20%) developed severe IOP spikes (IOP ≥ 30 mmHg). There was a highly significant (p=0.0085) difference in angle recess width between severe responders (175.0 ± 27.1 μm) and those eyes with less severe response (272.9 ± 24.3 μm). There was also strong correlation between the AR width in study and fellow eyes (mean 248.1 ± 19.8 vs. 261.9 ± 22.6 μm; R2=0.67). Conclusions: This study reaffirms the potential utility of AS-OCT measurement of AR width as a practical means for helping identify eyes at high risk of ocular hypertension after intravitreal corticosteroid administration.

Comparative Effectiveness of the Dexamethasone Intravitreal Implant in Vitrectomized and Non-vitrectomized Eyes With Macular Edema Secondary to Central Retinal Vein Occlusion

To compare duration and efficacy of the dexamethasone (DEX) intravitreal implant in vitrectomized (pars plana vitrectomy [PPV] group) and non-vitrectomized eyes (control group) with macular edema related to central retinal vein occlusion (CRVO). Eyes that received the DEX implant for CRVO related to macular edema were included in a retrospective chart review. Outcomes measured were best-corrected visual acuity (BCVA) and central macular thickness (CMT). Fifteen eyes were included in the study. Eight of 15 eyes had prior vitrectomy. Mean BCVA was 20/160 in both groups. Baseline mean CMT was 550 μm (PPV group) and 556 μm (control group, P = .70), and improved to 307.5 μm (PPV group) and 316.3 μm (control group) (P = .90) after implant. The BCVA was 20/125 (PPV group) and 20/200 (control group) (P = .60). Time to next procedure was similar in both groups. This retrospective study shows similar CMT reductions with DEX implant treatment for CRVO-related macular edema in vitrectomized and non-vitrectomized eyes.

Expounding newer vistas in VEGF

Expounding newer vistas in VEGF

RELEASE AND VELOCITY OF MICRONIZED DEXAMETHASONE IMPLANTS WITH AN INTRAVITREAL DRUG DELIVERY SYSTEM

Ozurdex, a novel dexamethasone (DEX) implant, is released by a drug delivery system into the vitreous cavity. We analyzed the mechanical release aperture of the novel applicator, obtained real-time recordings using a high-speed camera system and performed kinematic analysis of the DEX application. Experimental study. : The application of intravitreal DEX implants (6 mm length, 0.46 mm diameter; 700 μg DEX mass, 0.0012 g total implant mass) was recorded by a high-speed camera (500 frames per second) in water (Group A: n = 7) or vitreous (Group B: n = 7) filled tanks. Kinematic analysis calculated the initial muzzle velocity as well as the impact on the retinal surface at approximately 15 mm of the injected drug delivery system implant in both groups. A series of drug delivery system implant positions was obtained and graphically plotted over time. High-speed real-time recordings revealed that the entire movement of the DEX implant lasted between 28 milliseconds and 55 milliseconds in Group A and 1 millisecond and 7 milliseconds in Group B. The implants moved with a mean muzzle velocity of 820 ± 350 mm/s (±SD, range, 326-1,349 mm/s) in Group A and 817 ± 307 mm/s (±SD, range, 373-1,185 mm/s) in Group B. In both groups, the implant gradually decelerated because of drag force. With greater distances, the velocity of the DEX implant decreased exponentially to a complete stop at 13.9 mm to 24.7 mm in Group A and at 6.4 mm to 8.0 mm in Group B. Five DEX implants in Group A reached a total distance of more than 15 mm, and their calculated mean velocity at a retinal impact of 15 mm was 408 ± 145 mm/s (±SD, range, 322-667 mm/s), and the consecutive normalized energy was 0.55 ± 0.44 J/m (±SD). In Group B, none of the DEX implants reached a total distance of 6 mm or more. An accidental application at an angle of 30 grade and consecutively reduced distance of approximately 6 mm may result in a mean velocity of 844 and mean normalized energy of 0.15 J/m (SD ± 0.47) in a water-filled eye. The muzzle velocity of DEX implants is approximately 0.8 m/s and decreases exponentially over distance. The drag over time in vitreous is faster than in water. The calculated retinal impact energy does not reach reported damage levels for direct foreign bodies or other projectiles.

Traitement combiné par photothérapie dynamique et implant intravitréen de dexaméthasone (Ozurdex®) pour un hémangiome choroïdien circonscrit

We report a case of symptomatic circumscribed choroidal hemangioma (CCH) treated by photodynamic therapy (PDT) combined with injection of an intravitreal dexamethasone implant (IDI) (Ozurdex(®)). A 39-year-old woman was referred to our outpatient clinic for a progressive decrease in vision of her right eye, measured at 20/25, due to subretinal exudation (SRE) associated with juxtapapillary CCH. Basal diameter of the CCH was 6mm, and its height was 2mm. Treatment consisted of injection of an IDI followed 15 days later by PDT with a single spot covering the tumor (intensity of 600 mW/cm(2) for 83 seconds [50 J/cm(2)]). Six weeks after PDT, we noted improvement of the vision to 20/20, complete resolution of SRE, and tumor flattening. No side-effects were observed. Anatomic and functional results remained unchanged over 9 months of follow-up. This case suggests that IDI (Ozurdex(®)) potentiates the effect of PDT with less risk of local side-effects than triamcinolone acetonide. Further evaluation of this protocol remains necessary. Nonetheless, combined treatment with injection of IDI followed 15 days later by PDT for the treatment of symptomatic CCH may prove to be a sound alternative to radiotherapy and may be more efficacious than PDT alone.

Comparative Effectiveness of the Dexamethasone Intravitreal Implant in Vitrectomized and Non-vitrectomized Eyes With Macular Edema Secondary to Central Retinal Vein Occlusion

Comparative Effectiveness of the Dexamethasone Intravitreal Implant in Vitrectomized and Non-vitrectomized Eyes With Macular Edema Secondary to Central Retinal Vein Occlusion

Repeated Intravitreal Dexamethasone Implant (Ozurdex®) for Retinal Vein Occlusion

Purpose: To evaluate the effects of repeated intravitreal dexamethasone implant (IDI) (Ozurdex®) in eyes with macular edema (ME) due to retinal vein occlusion (RVO). Methods: We reviewed the charts of patients with RVO-related ME, who received repeated Ozurdex IDI (0.7 mg) on an ‘as-needed’ basis. Main outcome measures included changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), retreatment interval, and incidence of side effects. Results: A total of 33 eyes were included for analysis. Retreatment with Ozurdex was judged necessary after 4.7 ± 1.1 months from the first IDI (1st IDI) and 5.1 ± 1.5 months from the second IDI (2nd IDI). Baseline BCVA was 0.65 ± 0.43 logMAR; it significantly improved to 0.50 ± 0.42 logMAR after 1.4 ± 0.7 months from the 1st IDI (peaking efficacy) (p < 0.001) and to 0.48 ± 0.44 logMAR after 1.8 ± 0.8 months from the 2nd IDI (peaking efficacy) (p < 0.001). CMT decreased from 636 ± 217 µm (baseline) to 300 ± 114 µm, 1.4 ± 0.7 months after the 1st IDI (p < 0.001), and to 298 ± 91 µm, 1.8 ± 0.8 months after the 2nd IDI (p < 0.001). A rebound effect was recorded in 7 eyes after the 1st IDI (mean 168 ± 158 µm) and in 4 eyes after the 2nd IDI (mean 215 ± 199 µm). All eyes with a rebound effect improved again after a 2nd intravitreal Ozurdex injection. No serious adverse events were observed; 12 eyes developed a transient IOP increase, and cataracts were extracted in 2 eyes. Conclusion: Repeated intravitreal Ozurdex on an ‘as-needed’ basis, with a retreatment interval <6 months, may produce long-term clinically meaningful benefits in the treatment of ME due to RVO, without other significant side effects than expected after intraocular corticosteroid treatment.

Rebound Effect After Intravitreal Dexamethasone Implant for the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion

To report on the rebound macular edema (ME) effect following dexamethasone implant for the treatment of nonischemic central retinal vein occlusion (CRVO). Twenty-one patients affected by ME secondary to central retinal vein occlusion (CRVO) underwent an implant of dexamethasone (700 μg) in a compassionate use program. The patients were followed up monthly. The Early Treatment Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA), central retinal thickness (CRT) on optical coherence tomography (OCT), and intraocular pressure were registered at monthly intervals. Retreatments were carried out on a pro-re-nata (PRN) basis starting from the third month. Both BCVA and CRT improved in all cases. A rebound effect, characterized by a recurrence of ME in excess of the baseline value, occurred in 3 cases (13%) at months 3 and 4. Visual acuity accordingly dropped at the higher CRT values in the 3 cases displaying the rebound effect. Additional treatment with dexamethasone implant led to both a recovery in visual acuity and reduction in CRT. A rebound effect can occur after dexamethasone implant for the treatment of ME related to CRVO, but does not affect functional or anatomical recovery when retreatment is provided. The retreatment rate with dexamethasone implant should be adapted to suit the patient's response.

Evolution of Vitreomacular Traction Following the Use of the Dexamethasone Intravitreal Implant (Ozurdex) in the Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion

To report a case of worsening of vitreomacular traction (VMT) after the dexamethasone intravitreal implant (Ozurdex; Allergan, Inc., Irvine, CA) for the treatment of macular edema secondary to central retinal vein occlusion (CRVO). A 71-year-old man who presented with macular edema secondary to CRVO was treated by intravitreal injections of bevacizumab followed by Ozurdex. VMT developed during the course of treatment and became more evident when macular edema resolved after treatment with Ozurdex. VMT may become apparent and worsen after resolution of macular edema treated with intravitreal Ozurdex.

Effect of the Duration of Macular Edema on Clinical Outcomes in Retinal Vein Occlusion Treated with Dexamethasone Intravitreal Implant

To assess the effect of duration of macular edema (ME) on clinical outcomes after treatment with dexamethasone intravitreal implant 0.7 mg (Ozurdex; Allergan, Inc, Irvine, CA) in patients with ME following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Post hoc analysis of pooled data from 2 randomized, controlled trials. Patients with vision loss resulting from ME of 6 weeks' duration or more after BRVO or CRVO (n = 690). The relationship between ME duration at the time of first treatment and treatment outcomes was assessed using logistic regression. Other factors potentially associated with ME duration or patient outcomes were adjusted for in the analyses. The proportion of patients achieving at least 15 letters improvement in best-corrected visual acuity (BCVA) or at least 200-μm or more reduction in central retinal thickness 6 or 12 months after the first treatment with dexamethasone intravitreal implant 0.7 mg. In the 6-month analysis, each 1-month increase in ME duration was associated with a significantly lower likelihood of achieving a BCVA improvement of 15 letters or more (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.83-0.94; P<0.001) or a CRT reduction of 200-μm or more (OR, 0.91; 95% CI, 0.86-0.97; P<0.01) 6 months after treatment. In the 12-month analysis, increased ME duration was associated with a significantly lower likelihood of achieving BCVA improvement of 15 letters or more improvement in BCVA (OR, 0.85; 95% CI, 0.76-0.95; P<0.01) 12 months after treatment; duration was not significantly associated with the likelihood of a CRT reduction of 200-μm or more at 12 months. In general, the effect of ME duration on outcomes was stronger and statistically significant in BRVO patients, but weaker and not statistically significant in CRVO patients. In eyes with retinal vein occlusion, longer ME duration at the time of first treatment with the dexamethasone intravitreal implant 0.7 mg was associated with a significantly lower likelihood of achieving clinically meaningful improvements in vision or CRT 6 or 12 months after treatment. This suggests that prompt treatment for retinal vein occlusion, particularly BRVO, may be associated with improved clinical outcomes. Proprietary or commercial disclosure may be found after the references.