Retinal Venous Occlusion Research Articles

Optical Coherence Tomography Angiography

Optical coherence tomography angiography (OCTA) is a new revolutionary non-invasive imaging modality, built on the platform of optical coherence tomography (OCT). This technique works on the principle of ‘decorrelation’ and is still a nascent technology in its infancy with tremendous potential applicability for diagnosing retinal and choroidal vascular diseases. Its non-invasive nature, and the ability to generate images of retinal and choroidal vasculature, allows it to replace and/or supplement the current angiographic gold standards, fluorescein angiography (FA) and indocyanine green angiography (ICGA), if not in all but certainly in most retinal and choroidal pathologies. Still, there exists a major challenge in terms of its wide-scale availability, equipment and processing techniques, presence of artifacts, limitations of imaging capability, and lack of common vocabulary among retinal specialists for interpretation. In this review we intend to describe this novel technique by highlighting its key features, and comparing it with FA and ICGA. We will also discuss its applicability in various clinical scenarios such as diabetic retinopathy, age-related macular degeneration, retinal venous occlusion, choroiditis, and in routine practice. Further studies are needed to more definitively determine OCTA’s utility in the clinical setting and to establish if this technology may offer a non-invasive option of visualizing the retinal vasculature in detail.

Associations with retinal vascular occlusions in a diverse, urban population

ABSTRACTPurpose: Retinal vascular occlusions can lead to sudden and permanent visual impairment or blindness. Few epidemiological studies on retinal vascular occlusions have been conducted, especially on diverse populations.Methods: This is a retrospective case-control study of all incident retinal vascular occlusions occurring during a three and one-half year study period at Montefiore Medical Center, capturing all potential cases by diagnosis codes. Patients with retinal venous occlusions (RVO) and retinal arterial occlusions (RAO) were analyzed separately and compared to age-matched control groups.Results: All potential charts (n = 700) were reviewed, confirming 214 RVO and 35 RAO incident cases. In multivariable analyses, RVO was associated with type 2 diabetes mellitus (OR 2.41, p < 0.001), history of cerebrovascular accident (OR 2.14, p = 0.011), hypertension (OR 1.83, p = 0.004), glaucoma (OR 6.91, p < 0.001), black race (OR 3.72, p < 0.001), and male gender (OR 2.19 p < 0.001). RAO was significantly associated with current and former smoking combined (OR 8.95, p = 0.021) and male gender (OR 2.56, p = 0.038).Conclusion: Cardiovascular risk factors and glaucoma are reaffirmed as significant predictors of retinal vascular occlusions in a diverse patient population. Retinal vascular occlusions are more common in certain races and ethnicities, and further study into this may help identify high-risk individuals based on demographics.

Optical coherence tomography angiography: A comprehensive review of current methods and clinical applications.

OCT has revolutionized the practice of ophthalmology over the past 10-20 years. Advances in OCT technology have allowed for the creation of novel OCT-based methods. OCT-Angiography (OCTA) is one such method that has rapidly gained clinical acceptance since it was approved by the FDA in late 2016. OCTA images are based on the variable backscattering of light from the vascular and neurosensory tissue in the retina. Since the intensity and phase of backscattered light from retinal tissue varies based on the intrinsic movement of the tissue (e.g. red blood cells are moving, but neurosensory tissue is static), OCTA images are essentially motion-contrast images. This motion-contrast imaging provides reliable, high resolution, and non-invasive images of the retinal vasculature in an efficient manner. In many cases, these images are approaching histology level resolution. This unprecedented resolution coupled with the simple, fast and non-invasive imaging platform have allowed a host of basic and clinical research applications. OCTA demonstrates many important clinical findings including areas of macular telangiectasia, impaired perfusion, microaneurysms, capillary remodeling, some types of intraretinal fluid, and neovascularization among many others. More importantly, OCTA provides depth-resolved information that has never before been available. Correspondingly, OCTA has been used to evaluate a spectrum of retinal vascular diseases including diabetic retinopathy (DR), retinal venous occlusion (RVO), uveitis, retinal arterial occlusion, and age-related macular degeneration among others. In this review, we will discuss the methods used to create OCTA images, the practical applications of OCTA in light of invasive dye-imaging studies (e.g. fluorescein angiography) and review clinical studies demonstrating the utility of OCTA for research and clinical practice.

Analysis of changes in serum levels of endothelin-1 in patients with retinal vein occlusion

Aim. To analyze the level of endothelin-1 in blood serum in patients with retinal venous occlusions. Metods. 60 patients with macular edema due to retinal vein occlusion (RVO) were included in the study. 19 patients were diagnosed with central retinal vein occlusion, 9 of them had non-ischemic type and 10 had ischemic type of central retinal vein occlusion. 41 patients had branch retinal vein occlusion, 23 of them had non-ischemic type and 18 had ischemic type of occlusion. Patients underwent fluorescein angiography and optical coherence tomography fundus imaging. Before intravitreal injection of ranibizumab, the level of endothelin-1 in the blood serum was determined. Analysis was performed in patients’ subgroups depending on the localization of occlusion, type of occlusion, disease relapse, presence of optic disc swelling. &#x0D; Results. Differences in the systemic level of endothelin-1, depending on the localization of occlusion, presence of ischemic type and relapse, the disease was not detected (p ≥0.05). With the development of optic disc swelling, a statistically significant increase in the level of endothelin-1 was noted in peripheral blood: 38.73 fmol/ml in patients with optic disc swelling and 27.65 fmol/ml in patients without it (p=0.018). &#x0D; Conclusion. In patients with optic disc swelling a statistically significant increase of endothelin-1 in blood was revealed.

Quantitative microvascular analysis of retinal venous occlusions by spectral domain optical coherence tomography angiography.

PurposeTo quantitatively evaluate the retinal microvasculature in human subjects with retinal venous occlusions (RVO) using optical coherence tomography angiography (OCTA).DesignRetrospective, cross-sectional, observational case series.ParticipantsSixty subjects (84 eyes) were included (20 BRVO, 14 CRVO, 24 unaffected fellow eyes, and 26 controls).MethodsOCTA was performed on a prototype, spectral domain-OCTA system in the 3x3mm central macular region. Custom software was used to quantify morphology and density of retinal capillaries using four quantitative parameters. The vasculature of the segmented retinal layers and nonsegmented whole retina were analyzed.Main outcome measuresFractal dimension (FD), vessel density (VD), skeletal density (SD), and vessel diameter index (VDI) within the segmented retinal layers and nonsegmented whole retina vasculature.ResultsNonsegmented analysis of RVO eyes demonstrated significantly lower FD (1.64±0.01 vs 1.715±0.002; p<0.001), VD (0.32±0.01 vs 0.432±0.002; p<0.001), and SD (0.073±0.004 vs 0.099±0.001; p<0.001) compared to controls. Compared to the fellow eye, FD, VD and SD were lower (p<0.001), and VDI was higher (p<0.001). FD, VD, and SD progressively decreased as the extent (or type) of RVO increased (control vs BRVO vs CRVO; p<0.001). In the unaffected fellow eye FD, VD and SD showed significant differences when compared to control eyes or affected RVO eyes (p<0.001).ConclusionsQuantitative OCTA of the central 3x3mm macular region demonstrates significant differences in capillary density and morphology among subjects with BRVO and CRVO compared to controls or unaffected fellow eyes in all vascular layers. The unaffected fellow eyes also demonstrate significant differences when compared to controls. OCTA allows for noninvasive, layer-specific, quantitative evaluation of RVO-associated microvascular changes.

Serum vitamin D levels in Indian patients with retinal venous occlusions

PurposeTo estimate serum vitamin D (25 OH D) level in patients of retinal vein occlusion (RVO) and compare it with age-matched controls. Methods and materialForty patients above 18years of age with retinal vein occlusion and forty age-matched controls underwent serum vitamin D (Vit D) level estimation using a standard protocol. Student’s t test was used to analyse differences between the mean of two groups. ResultsThe mean age in RVO and control group was 60.25 and 60.73years respectively. The mean (±SD) level of vitamin D in RVO patients was 13.68 (±4.58) ng/mL (range 5.5–24.8), and the 95% CI of mean was 12.21–15.14 with SD 4.58 while in control group it was 23.03 (±2.89) ng/ml (range 18.4–30.1) with 95% CI of mean being 22.11–23.96 with SD 2.89 (p value of <0.005). While comparing the level of Vitamin D based on type of occlusion the mean level of Vit D in CRVO patients was 15.36 (SD 5.30) and in BRVO it was 12.77 (SD 3.96) which was statistically not significant (p=0.08). The odds ratio calculated for RVO cases versus controls was 133.33 which was statistically significant (P<0.05). ConclusionsThere is a paucity of published literature on level of Vit D in RVO. This study shows significantly lower levels of serum vitamin D in Indian patients with retinal vein occlusion as compared to age matched controls. Establishment of this correlation has possible implications for prophylaxis or treatment of RVOs.

The Burden of Retinal Venous Occlusion: An Assessment of Fellow Eyes in 1000 Cases

To assess retinal vein occlusion (RVO) clinical features to create a simulation model quantifying the preference-based, patient value gain (benefit) and cost-utility (cost-effectiveness) of RVO therapy. Retrospective analysis data integrated with patient utilities and an ocular cost-utility model for RVO. One thousand consecutive Wills Eye Hospital Retina Service RVO patients seen from January 2010 through April2011. Value-Based Medicine analysis assessing the demographic features and vision in affected eyes and fellow eyes of RVO patients. Presenting vision, final vision, conversion incidence of fellow eyes to RVO, and patient value gain in quality-adjusted life-years (QALYs). Among 1000 patients, 332 (33.2%) presented with central retinal vein occlusion (CRVO), 53 (5.3%) with hemiretinal vein occlusion (HRVO), and 615 (61.5%) with branch retinal vein occlusion (BRVO). Mean follow-up for the entire RVO cohort was 3 years. One hundred and one patients (10.1%) had bilateral baseline RVO and, among the 826 unilateral cases seen more than once, 37 (4.5%) developed a fellow-eye RVO, a unilateral-to-bilateral conversion rate of 1.5%/year. Among the 101 baseline bilateral cases, 66% (66/101) had the same RVO variant bilaterally (CRVO/CRVO, HRVO/HRVO, or BRVO/BRVO). Mean CRVO baseline vision was 20/63-2 and final vision was 20/63-1 (P= 0.16). Thirty percent of patients had less than or equal to baseline fellow-eye vision. Within combined HRVO/BRVO cohorts, mean baseline vision was 20/50-2 and final vision was 20/50+1 (P= 0.0004). Thirty percent of patients also had less than or equal to baseline fellow-eye vision. The proportion of RVO patients with fellow-eye vision less than or equal to the RVO primary-eye baseline vision increased to 44% by year16. Thirty percent of all RVO patients had less than or equal to baseline vision in the fellow eye. Among unilateral RVO cases, 1.5%/year developed fellow-eye RVO. These findings have implications for cost-utility analysis, because bilateral vision loss yields greater QALY loss and an increased financial burden compared with unilateral loss. Referent to total therapeutic QALY gain (100%), if a treated RVO was always considered the better-seeing eye, the actual clinical scenario demonstrates that the average CRVO patient gains 38% as much value and the average HRVO/BRVO patient gains 37% as much.

Congenital protein C deficiency with renal vein thrombosis and central retinal venous occlusion in a term neonate due to novel mutation in the PROC gene

Severe protein C (PC) deficiency is a rare disorder caused by homozygous or compound heterozygous genetic anomalies. PC deficiency is inherited as autosomal dominant, and most patients are heterozygous for a genetic defect. Homozygous or compound heterozygous for a mutation or other genetic defect affecting PC is typically due to inheritance of an abnormal allele from both parents. In the neonatal period, homozygous PC deficiency is usually associated with the development of severe, and often fatal, purpura fulminans and disseminated intravascular coagulation and if untreated is incompatible with life. Here, we report a case of congenital PC deficiency due to novel homozygous mutation in the protein coding gene (PROC) in a term neonate which presented with severe purpura fulminans, perinatal right renal vein thrombosis (RVT), bilateral adrenal hemorrhage, and early neonatal central retinal venous occlusion with retinal detachment. Perinatal RVT and early neonatal central retinal vein occlusion have not been reported previously in the literature.

Impending Central Retinal Vein Occlusion

Central retinal vein occlusion (CRVO) may present with varied clinical manifestations, ranging from mild blurred vision and scattered retinal hemorrhages to severe vision loss, optic nerve swelling, pronounced retinal hemorrhages, collateral retinal vessel formation and neovascularization. Impending CRVO, also known as partial CRVO, is a relatively poorly-defined sub-classification of the CRVO condition. Those affected are either asymptomatic or may complain of mild, often transient episodes of blurring of vision and present with venous dilation and tortuosity but only a few widely scattered flame-shaped retinal hemorrhages. As an impending CRVO may be the prodromal phase of an acute CRVO, this diagnosis requires careful monitoring of the patient for progression. The following case outlines the differential diagnosis, sequelae and inter-professional management of an impending central retinal venous occlusion.

Stereo OCT angiography in macular diseases

PurposeTo present stereo optical coherence tomography angiography (SD OCT‐A) images of patients with different macular pathologies.MethodsA series of patients with macular pathologies underwent OCT‐A imaging with the Heidelberg Engineering SPECTRALIS OCT2 device. In addition, these patients underwent OCT B and C scans, color fundus photographies and fluorescein and ICG angiographies. The OCT‐A images were then computerized in a manner to give stereo images. Slabs of different thicknesses were analyzed and are presented.ResultsThirty seven eyes with different macular diseases (10 exsudative AMD, 16 diabetic retinopathies, 10 retinal venous occlusions, 1 acute macular placoid pigmented epitheliopathy) were included and analyzed.Stereo OCT‐A allowed to show the vascular abnormality and its impact on the retina and the choroid. The swelling of the retina was highlighted in stereo viewing.ConclusionsStereo OCT‐A is a new additive technique to OCT imaging. It gives a global assessment of the central retina pathology highlighting retinal swelling.This technique needs perfect segmentation to achieve good stereo images and improvements are currently needed.

No evidence for thrombophilia in patients with retinal venous occlusion: a systematic GRADE‐based review

Retinal venous occlusion represents a common retinal disorder that untreated often leads to severely reduced vision. While general risk factors for vascular disease are known to increase the risk of an event, the role of thrombophilia is controversial. The purpose of this systematic review was to evaluate the evidence for thrombophilia investigation in patients presenting with retinal venous occlusion. Eligible studies were identified by a MESH-based search in PubMed 11-13 of March 2015. The level of evidence was stated according to the guidelines published by the GRADE working group using three levels for quality of evidence: high, moderate and low. A total of 118 studies relating to the study question were identified. After excluding case stories, commentaries, cross-sectional studies and reviews/expert opinions, 28 original papers and two meta-analyses were included in the final qualitative synthesis. The majority of studies were small case-control studies, and only one large cohort study was identified. No randomized controlled trials were retrieved. All the studies were categorized as low quality of evidence. Systematic thrombophilia screening in patients presenting with retinal venous occlusion cannot be recommended.

Bilateral retinal venous occlusion in Fabry disease

Bilateral retinal venous occlusion in Fabry disease

The early effects of intravitreal anti vascular endothelial growth factor agents on intraocular pressure and central corneal thickness.

To investigate the early effects of two intravitreal (IV) anti vascular endothelial growth factor agents (anti-VEGF), bevacizumab and ranibizumab, on intraocular pressure (IOP) and central corneal thickness (CCT) within the first post-injection month. This prospective study comprised 109 eyes of 109 adult cases who had IV bevacizumab or ranibizumab injections because of age-related macular degeneration (ARMD), retinal venous occlusion (RVO), diabetic retinopathy, and macular edema or central serous chorioretinopathy (CSCR). None of the cases had medical histories of any kinds of glaucoma or increased IOP and IV injection before and all of them underwent a detailed ocular examination including measurements of IOP by non-contact tonometer and CCT by ultrasonic pachymeter pre-injection. IOP measurements were repeated at 30min and 1st, 7th, and 30th day after the injection. CCT measurements were repeated at the 7th and 30th post-injectionday. Paired sample t tests were used for the statistical analysis in order to evaluate the significance of changes in IOP and CCT. The mean age of 56 male and 53 female cases was 63.58±11.04years. Fifty-six cases (51.4%) had diabetic retinopathy, 33 cases (30.3%) had ARMD, 11 cases (10.1%) had RVO, and 9 cases (8.3%) had CSCR. Bevacizumab was used in 97 (89%) cases and ranibizumab was used in 12 (11%) cases. The IOP increased significantly 30min after the injection (p<0.001) but significant decreases were observed at the 1st, 7th, and 30th day post-injection (p<0.001). No significant differences were observed in CCT between pre-injection and 7th and 30th post-injection day values (p=0.924 and p=0.589, respectively). Intravitreal bevacizumab and ranibizumab injections can cause hyper acute increase in IOP because of vitreal expansion but this effect is generally reversible in non-glaucomatous cases.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF RETINAL VENOUS OCCLUSION.

To noninvasively evaluate the retinal microvasculature in human subjects with retinal venous occlusions using optical coherence tomography angiography and assess potential clinical applications. This was a prospective, observational study of adult human subjects with clinical and imaging findings demonstrating retinal venous occlusion. Subjects underwent complete ophthalmic examination and fluorescein angiography as appropriate for their standard of care. Optical coherence tomography angiography was performed on a prototype spectral domain-OCTA system in 3 mm × 3 mm and 6 mm × 6 mm regions centered on the fovea and parafoveal areas. Retinal vasculature was assessed within three horizontal slabs consisting of the superficial, middle, and deep retina. The vasculature within each slab was reconstructed using intensity contrast-based algorithms and visualized as en-face images. Optical coherence tomography angiograms were manually segmented to verify the accuracy of the automated segmentation algorithms. Optical coherence tomography angiography was able to demonstrate almost all of the clinically relevant findings in 25 subjects with acute and chronic retinal venous occlusion. These findings were consistent with clinical, anatomic, and fluorescein angiographic findings including areas of impaired vascular perfusion, retinal atrophy, vascular dilation, shunt vessels, and some forms of intraretinal edema. Optical coherence tomography angiography is an investigational method that generates high-resolution, noninvasive angiograms that qualitatively illustrate most of clinically relevant findings in retinal venous occlusion. Optical coherence tomography angiography corresponds well with fluorescein angiograms and in many cases provides more detailed anatomic and blood flow information. Optical coherence tomography angiography, in conjunction with standard spectral domain-OCT, is at least equally as effective as fluorescein angiography for evaluation and management of the macular complications of retinal venous occlusions.

Quantifying metamorphopsia in patients with diabetic macular oedema and other macular abnormalities.

To quantify subjective visual metamorphopsia in newly diagnosed patients suffering from diabetic macular oedema (DME) and other macular abnormalities and to evaluate anti-VEGF treatment effect. Patients with DME, subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) or retinal venous occlusion (RVO) were recruited. Metamorphopsia score (Mscore) was calculated using M-Charts at baseline and at the end of a series of anti-VEGF injections. Fifteen eyes of 10 patients with DME, 14 eyes of 13 patients with AMD-CNV and five patients with RVO were included in this study. At baseline, positive Mscore was observed in 46.6% of eyes with DME, 50% of eyes with AMD-CNV and four of five eyes with RVO. Treatment led to a complete metamorphopsia reduction (Mscore=0) in 71.4% of DME patients, 35.7% of AMD and 0% of RVO patients. We suggest that the M-charts may serve as an additional test for diagnosis and follow-up, complementary to morphological evaluation by imaging, in diabetic patients facing their first anti-VEGF treatment.

The causes of hyperreflective dots in optical coherence tomography excluding diabetic macular edema and retinal venous occlusion§.

Purpose : To investigate the causes of hyperreflective dots (HRDs) in spectral domain optical coherence tomography (OCT) excluding diabetic macular edema (DME) and RVO (retinal vein occlusion).Patients and Methods : The medical records of 56 patients with HRDs documented by OCT were reviewed retrospectively. The patients with DME and RVO were excluded from the study in order to prevent misdiagnosing hard exudates or HRDs. The causes, unilaterality or bilaterality of HRD and demographic properties of the patients with HRD were evaluated.Results : Sixty four eyes of 56 patients having HRDs were included in this study. Of the patients with HRD, 17 (30.36%) were women and 39 (69.64%) were men. The ages of patients were between 13 to 84 years (median 60.18 years). The causes of HRD were as follows: papilledema in 4 eyes (6.25%), active neovascular age related macular degeneration (AMD) in 33 eyes (51.56%), familial dominant drusen in 2 eyes (3.13%), central serous chorioretinopathy in 19 eyes (29.69%) and commotio retina in 2 eyes (3.13%), choroidal folds in one eye (1.56%), branch retinal artery occlusion in one eye (1.56%), central retinal artery occlusion in one patient (1.56%) and Best vitelliform macular dystrophy in one eye (1.56%). The most common cause of HRD was AMD. The causes of HRDs in both eyes were AMD and papilledema.Conclusion : The most common causes of HRDs excluding DME and RVO seem as active exudative AMD. The presence of HRDs in retinal diseases might affect the decisions and the results of the treatment and the prognosis of diseases.

Efficacité des implants intravitréens de dexaméthasone dans l’œdème maculaire hors occlusions veineuses : résultats sur une cohorte de 80 patients

The intravitreal dexamethasone implant has shown efficacy in the treatment of macular edema (ME) arising after retinal venous occlusions (central or branch), and in the treatment of non-infectious uveitis. The purpose of this study was to evaluate the efficacy of this implant in the treatment of other diffuse macular edemas with an inflammatory mechanism. We carried out a retrospective cohort study over 2 years: from January 2012 to December 2013, including all patients who received at least one injection of intravitreal dexamethasone implant, excluding venous occlusions and non-infectious uveitis. The primary study parameter was the progression of visual acuity. The study protocol had the approval of the institutional review board of the respective clinical ethics committees, and was conducted in accordance to the tenets of the Declaration of Helsinki. Eighty patients were included. Eighty-eight percent of patients were pseudophakic. The indications for treatment were: diabetic ME when anti-VEGF were ineffective (53%), ME after retinal detachment (RD) (22%), ME of Irvine-Gass syndrome (16%), ME after endophthalmitis (4%), macular telangiectasia (4%), ME secondary to retinitis pigmentosa (1%). The mean ETDRS visual acuity was 53.7 letters prior to injection, improving to 62.3 letters after injection (P<0.001). The average gain in visual acuity was 6.7 letters [4.53;8.84] (P<0.001) in patients treated for diabetic ME, 9.6 letters [6.1;13.1] (P<0.001) in patients with ME after RD, and 15.2 letters [10.25;20.28] (P<0.001) for Irvine-Gass syndrome. The mean duration of efficiency was 4.6 months, with a median of 3.8 months. The intravitreal dexamethasone implant appears to be an effective second-line treatment even in patients with diabetic ME after failure or in the case of contraindication of anti-VEGF. It is also effective and well tolerated in patients with ME after RD, as well as in patients with Irvine-Gass syndrome.

Photoplethysmographic measurement of various retinal vascular pulsation parameters and measurement of the venous phase delay.

Retinal vein pulsation properties are altered by glaucoma, intracranial pressure (ICP) changes, and retinal venous occlusion, but measurements are limited to threshold measures or manual observation from video frames. We developed an objective retinal vessel pulsation measurement technique, assessed its repeatability, and used it to determine the phase relations between retinal arteries and veins. Twenty-three eyes of 20 glaucoma patients had video photograph recordings from their optic nerve and peripapillary retina. A modified photoplethysmographic system using video recordings taken through an ophthalmodynamometer and timed to the cardiac cycle was used. Aligned video frames of vessel segments were analyzed for blood column light absorbance, and waveform analysis was applied. Coefficient of variation (COV) was calculated from data series using recordings taken within ±1 unit ophthalmodynamometric force of each other. The time in cardiac cycles and seconds of the peak (dilation) and trough (constriction) points of the retinal arterial and vein pulse waveforms were measured. Mean vein peak time COV was 3.4%, and arterial peak time COV was 4.4%. Lower vein peak occurred at 0.044 cardiac cycles (0.040 seconds) after the arterial peak (P = 0.0001), with upper vein peak an insignificant 0.019 cardiac cycles later. No difference in COV for any parameter was found between upper or lower hemiveins. Mean vein amplitude COV was 12.6%, and mean downslope COV was 17.7%. This technique demonstrates a small retinal venous phase lag behind arterial pulse. It is objective and applicable to any eye with clear ocular media and has moderate to high reproducibility. ( http://www.anzctr.org.au number, ACTRN12608000274370.).

Efficacy of dexamethasone intravitreal implants in macular oedema excluding venous occlusions : results about 80 patients

AbstractPurpose The dexamethasone intravitreal implant has shown efficacy in the treatment of macular edema (ME) of non‐infectious uveitis and retinal venous occlusions. The aim was to evaluate the efficacy of this implant in the treatment of other diffuse macular edemas with an inflammatory mechanism.Methods Retrospective cohort study over 2 years : from January 2012 to December 2013, including all patients who received at least one injection of intravitreal dexamethasone implant, excluding venous occlusions and non‐infectious uveitis. The primary endpoint was the change in visual acuity.Results 80 patients were included. The indications of treatment were : diabetic ME when anti‐VEGF were ineffective (53%), ME after retinal detachment(RD)(22%), ME of Irvine Gass syndrome(16%), ME after endophtalmitis(4%), macular telangiectasia(4%), ME of retinitis pigmentosa(1%). The mean ETDRS visual acuity was 53.7 letters before injection, 62.3 letters after injection (p&lt;0.001). The average gain in visual acuity was 6.7 letters [4.5;8.8](p&lt;0.001) in patients treated for diabetic ME, 9.6 letters[6.1;13.1] (p&lt;0.001) for ME after RD, and 15.2 letters[10.2;20.2] (p&lt;0.001) for Irvine Gass syndrome. The mean duration of efficiency was 4.6 months, with a median of 3.8 months.Conclusion The intravitreal implant of dexamethasone appears to be an effective second‐line treatment even in patients with diabetic ME after failure of anti‐VEGF. It is also effective and well tolerated in patients with ME after RD, and Irvine Gass syndrome.

Outcomes of combination therapy with dexamethasone implant and bevacizumab in macular edema related to vascular occlusions

AimTo evaluate the anatomical and visual outcomes as well as the safety of combination therapy with dexamethasone intravitreal implant (0.7 mg) and bevacizumab in macular edema secondary to vascular occlusions. MethodsIn this interventional, prospective case series all patients received dexamethasone implant and bevacizumab in a single sitting. Patients diagnosed with retinal venous occlusion were monitored for changes in visual acuity and macular thickness. All patients underwent detailed ocular examination, best corrected visual acuity (BCVA), and optical coherence tomography examination at baseline and at Week 1, Month 1, and monthly thereafter for 6 months. ResultsTwenty four eyes of 24 treatment-naïve patients (central retinal venous occlusion, n = 9; branch retinal venous occlusion, n = 15) were identified. BCVA improved in 23 patients (95.83%) during the study period. Mean BCVA gained was 0.313 ± 0.26 (85.3% of final gain) and 0.367 ± 0.34 at Week 1 and Month 6, respectively. The percentage of patients who gained ≥2 lines were 52% at Week 1 and 68% at Month 6. The mean macular thickness reduced by 350.9 μm at Week 1 and the maximum treatment effect was seen at Month 2 (379.1 μm). Recurrence of macular edema was seen in 37.5% (9/24) of the eyes. Reinjection was needed, on average, at approximately 3.7 months from the first injection. ConclusionThis study demonstrates that the combination therapy of bevacizumab and dexamethasone implant given simultaneously is safe and synergistic resulting in significantly early and sustained visual recovery and decreased macular edema in patients having retinal vein occlusions.