J Korean Ophthalmol Soc.  2015 Jan;56(1):39-46. 10.3341/jkos.2015.56.1.39.

Short-Term Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Branch Retinal Vein Occlusion

• Kang SA
• Kim JW
• Kim CG
• Lee TG
• Lew YJ
• Kim JH

• KMID: 2216152
• DOI: http://doi.org/10.3341/jkos.2015.56.1.39

Abstract

PURPOSE
To evaluate short-term outcomes of intavitreal dexamethasone implant in macular edema secondary to branch retinal vein occlusion (BRVO).
METHODS
A retrospective review of medical records was performed for 24 patients (24 eyes) who were diagnosed with macular edema secondary to BRVO. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured before the injection and at 1 and 3 months after the injection. The values measured before and after the treatment were compared. In addition, the association between duration of symptoms and 3-month changes in BCVA was evaluated.
RESULTS
In 24 eyes, the logarithm of minimal angle of resolution BCVA before the injection and 1 and 3 months after the injection was 0.56 +/- 0.25, 0.42 +/- 0.26 and 0.45 +/- 0.27, respectively. The CFT was 550.2 +/- 116.5 microm, 270.3 +/- 101.5 microm, and 356.6 +/- 173.7 microm, respectively. When compared with the baseline values, the BCVA at 3 months was significantly improved (p = 0.018) and the CFT was significantly decreased (p < 0.001). There was a significant negative association between the duration of symptoms and 3-month changes in BCVA (p = 0.032, r = -0.375). Elevated intraocular pressure was observed in 3 eyes (12.5%).
CONCLUSIONS
Intravitreal dexamethasone implant was found effective in treating macular edema secondary to BRVO. However, rebound macular edema and deterioration in visual acuity after 1 month suggest further studies with longer follow-ups are necessary.

Keyword

Clinical outcome; Dexamethasone; Ozurdex; Retinal vein occlusion

MeSH Terms

Dexamethasone*
Humans
Intraocular Pressure
Macular Edema*
Medical Records
Retinal Vein Occlusion*
Retrospective Studies
Visual Acuity
Dexamethasone

Figure

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  Figure 1. Optical coherence tomography based classification of macular edema in branch retinal vein occlusion, as recommended by Park and Rho.13 (A) Diffuse thickening of the entire retinal layer. (B) Focal thickening of the retina. (C) Macular edema with serous retinal detachment (asterisk).

• 

  Figure 2. Changes in logarithm of minimal angle of resolution (log MAR) best-corrected visual acuity (A, BCVA) and central foveal thickness (B) in eyes with macular edema secondary to retinal vein occlusion that were treated with intravitreal dexamethasone implant. Statistical analysis was performed using paired t-test and repeated measures analysis of variances with a Bonferroni’s correction.

• 

  Figure 3. Fundus photography (A, B) and optical coherence tomography (right column) images in an eye with branch retinal vein occlusion. (A) A fundus photography taken at diagnosis. (B) A fundus photography taken 3 days after intravitreal injection of dexamethasone implant. An arrow indicates intravitreal implant. Optical coherence tomography images showing macular microstructure at diagnosis (C), 1 month after intravitreal injection of bevacizumab (D), and 3 month after intravitreal injection of dexamethasone implant (E). The best-corrected visual acuity improved from 20/200 to 20/60 after injection of dexamethasone implant.

• 

  Figure 4. Changes in best-corrected visual acuity (BCVA, A) and central foveal thickness (CFT, B) before and one month after intravitreal injection of dexamethasone implant, according to the duration of branch retinal vein occlusion (BRVO). Positive values indicate improvement in BCVA or decrease in CFT, whereas negative values indicate deterioration in BCVA or increase in CFT. There was a significant negative association between the change in BCVA and the duration of BRVO (A, p = 0.032, r = -0.375), whereas the association between the change in CFT and the duration was not significant (B, p = 0.625). log MAR = logarithm of minimal angle of resolution.

• 

  Figure 5. Changes in best-corrected visual acuity (BCVA) and central foveal thickness in eyes with macular edema secondary to branch retinal vein occlusion when divided into 2 groups, according to the characteristic of macular edema. (A, B) Closed circle (solid line, n = 18) indicates eyes with diffuse thickening of the entire retinal layer, whereas a closed square (dashed line, n = 6) indicates eyes with focal thickening of the retina. (C, D) Closed circle (solid line, n = 7) indicates eyes with serous retinal detach-ment, whereas a closed square (dashed line, n = 17) indicates eyes without serous retinal detachment.

Reference

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