The efficacy of dexamethasone implants following anti-VEGF failure for macular oedema in retinal vein occlusion

Author:

Yap Timothy E12ORCID,Husein Salman2,Miralles de Imperial-Ollero Juan Antonio23,Colizzi Benedetta24,Cordeiro Maria Francesca12,Younis Saad12ORCID

Affiliation:

1. Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK

2. Imperial College Ophthalmic Research Group, Imperial College London, London, UK

3. Department of Ophthalmology, Hospital General Universitario Reina Sofía, Murcia, Spain

4. Department of Ophthalmology, Università Vita-Salute San Raffaele, Milan, Italy

Abstract

Purpose: To investigate the efficacy of intravitreal dexamethasone implants (DEX) after anti-VEGF failure in retinal vein occlusion macular oedema. Methods: Retrospective cohort study of DEX implant (0.7 mg) given after anti-VEGF ‘failure’. Switch to DEX occurred if a ⩽ +5 ETDRS letter gain and ⩽20% reduction in central subfield thickness was present following ⩾6 consecutive anti-VEGF injections. The primary endpoint was VA change 30 days after DEX. Secondary outcomes were peak VA change, VA change at monthly timepoints, percentage achieving 15-letter gain, central subfield thickness (CST) and intraocular pressure (IOP). Results: Sixty-two injections in 62 patients associated with 26% central retinal vein occlusion (CRVO) and 74% branch retinal vein occlusion (BRVO) were eligible. There was a modest, significant improvement in mean VA change at 30 days compared to baseline (+6 letters, 95% CI +2.2 to +9.1 letters, p < 0.01). DEX implant significantly improved mean peak VA change compared to preceding anti-VEGF by +18.1 letters in CRVO ( p = 0.002) and +13.2 letters in BRVO ( p < 0.0001). IOP peaked between 30 and 60 days following injection, with 31% of CRVO and 11% of BRVO patients experiencing an IOP ⩾ 25 mmHg. Conclusion: DEX implant provides useful rescue therapy in cases of anti-VEGF ‘failure’ for macular oedema following retinal vein occlusion, resulting in improved functional outcomes at 30 days.

Publisher

SAGE Publications

Subject

Ophthalmology,General Medicine

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