Combination of Ranibizumab and Dexamethasone intravitreal implant for macular edema secondary to retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the differences in the efficacy and safety of combination of intravitreal dexamethasone(Ozurdex)and ranibizumab or monotherapy of ranibizumab in eyes with macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: Patients diagnosed with non-ischemic RVO-ME by fluorescein fundus angiography in our hospital from June 2020 to December 2022 were selected. All patients were initially treated with intravitreal injection of ranibizumab(0.5 mg), and 42 patients(42 eyes)who had central retinal thickness(CRT)≥300 μm after 2 wk were included. They were randomly divided into combined treatment group and monotherapy group. The combined treatment group(21 eyes)received Ozurdex intravitreal injection immediately, while the monotherapy group(21 eyes)was treated with ranibizumab intravitreal injection by 3+pro re nata(PRN). The changes of best corrected visual acuity(BCVA), CRT, and intraocular pressure before and at 2 wk, 1, 2, 3, 4, 5, and 6 mo after treatment were recorded, and the ocular or systemic complications were observed.RESULTS:The BCVA and CRT of all patients at 2 wk, 1, 2, 3, 4, 5, and 6 mo after treatment were significantly better than those before treatment(all P<0.01). There were statistical significance in the BCVA and CRT between two groups at 2 and 3 mo after treatment(all P<0.05). The most significant increase of BCVA in the combined treatment group occurred at 2 mo after treatment. The mean recurrence time of macular edema in the monotherapy group was 1.45±0.53 mo, with 4.21±0.78 injection times of ranibizumab. None of the patients showed serious complications after treatment. The most common complications in the combined treatment group were subconjunctival hemorrhage and elevated intraocular pressure, which were manageable with topical ocular hypotensive agents, and no patient required antiglaucoma or cataract surgery.CONCLUSION: Compared with monotherapy of ranibizumab, intravitreal injection of dexamethasone combined with ranibizumab can significantly improve the visual acuity and effectively reduce the macular edema in the treatment of RVO-ME, with a long duration of efficacy and less intravitreal injection of drugs.

Efficacy of Dexamethasone intravitreal implant combined with anti-VEGF drug in the treatment of retinal vein occlusion / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the efficacy and safety of dexamethasone intravitreal implant combined with anti-VEGF drug and anti-VEGF drug monotherapy in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME).METHODS: A total of 133 patients(133 eyes)diagnosed with central retinal vein occlusion(CRVO)or branch vein occlusion(BRVO)secondary to macular edema in the Xiamen Eye Center of Xiamen University from June 2019 to December 2020, including 48 patients with CRVO-ME and 85 patients with BRVO-ME were analyzed. All patients were randomly assigned to monotherapy or combination therapy. The monotherapy group(66 eyes)received a monthly injection of conbercept for consecutive 3mo, followed by monthly follow-up visits; The combination therapy group(67 eyes)received once intravitreal dexamethasone implantation, and conbercept was injected once 1wk later, followed by monthly follow-up visits.All patients in the two treatment groups were evaluated at baseline and every subsequent visit until 6mo after treatment with the best corrected visual acuity(BCVA), macular central retinal thickness(CRT), and injection times of conbercept and ocular and systemic adverse events associated with intravitreal injection therapy were recorded.RESULTS: At 1, 2, 3 and 6mo after treatment, the BCVA and CRT in both groups were significantly improved than before.But there was no significant difference in the improvement of BCVA and CRT(P >0.05). From the initial intravitreal injection to 6mo, the injection times of the monotherapy group and the combination therapy group were 3.56±0.12 and 2.96±0.17 times, respectively. The injection times of the combination therapy group were significantly lower than those of the monotherapy group(P=0.004). Both the incidences of intraocular hypertension and cataract in the combination therapy group were higher than those in the anti-VEGF monotherapy group.CONCLUSION: dexamethasone intravitreal implant combined with anti-VEGF drugs is an effective method for the treatment of RVO-ME, with significantly improved visual acuity and significantly lower CRT; The combined treatment regimen can reduce the times of injections and achieve similar results to anti-VEGF drug monotherapy. However, monitoring of intraocular pressure and cataract progression is required.

Efficacy and visual related quality of life of Ozurdex in the treatment of RVO-ME / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the clinical efficacy, complications and visual related quality of life(VRQoL)of Ozurdex in the treatment of macular edema secondary to retinal vein occlusion(RVO-ME). <p>METHODS: Totally 30 patients with ME, which had developed secondary to either CRVO(13 eyes)or BRVO(17 eyes), were monitored for 6mo after treatment with Ozurdex in the Department of Ophthalmology of our Hospital. We measured the best corrected visual acuity(BCVA), intraocular pressure(IOP), central macular thickness(CMT)at different time after treatment(1wk, 1mo, 2mo, 3mo, 4mo, 5mo, and 6mo after treatment), and we also measured the Chinese version vision related quality of life questionnaire-25(CVRQoL-25)at 3mo after treatment and compared them separately with the ones measured before treatment to evaluate the efficacy, adverse reactions and the visual related quality of life. <p>RESULTS: Generalized estimation equation results showed that BCVA, CMT and IOP all had differences at different time points(<i>P</i><0.001). A BCVA increase was achieved and CMT decreased in all patients at any time point after the onset of treatment(<i>P</i><0.001). The changes of BCVA and CMT were the largest in the 2mo compared to the baseline(<i>P</i><0.001). The score of CVRQol-25 at 3mo after treatment was significantly higher than that before treatment and then the central retinal thickness decreased and a BCVA increased compared to the baseline level(<i>P</i><0.01). The score of CVRQoL-25 at 3mo was negatively correlated both with the LogMAR BCVA evaluated before treatment and at 3mo after treatment(<i>r</i>s= -0.717, -0.746, all <i>P</i><0.001); Meanwhile, the score of CVRQoL-25 was also negatively correlated with CMT at 3mo after treatment(<i>r</i>s= -0.862,<i> P</i>=0.001). In 19 eyes(63%)of the patients with RVO-ME,a relapse was observed after a follow-up time of 1-3mo and the average recurrence time was(2.8±0.5)mo. In follow-up of 6mo, about(2.3±0.4)intravitreal Ozurdex injections per eye was observed. The increase in IOP was observed at 1wk, 1, 2, 3mo after pretherapy(<i>P</i><0.05). The mean IOP values reached a peak at 2mo after injection, which rose(7.85±0.32)mmHg above the baseline level(<i>P</i><0.05)and decreased to normal at 4mo after treatment. 10% of patients had an elevation in IOP above 25mmHg, which could be medically controlled and 4 eyes(13%)of patients had cataract formation, two of which needed to surgery. <p>CONCLUSION: Ozurdex proved to be efficacious with increase in visual acuity and reduction of central retinal thickness and improve the visual function-related quality of life of RVO-ME patients. After single injection of Ozurdex, visual acuity benefited for 2-3mo. 63% of the patients relapsed at about 3mo after treatment. Adverse reactions associated to the use of Ozurdex include the formation of cataracts and an increase in IOP.

Comparison between Ozurdex and intravitreal anti-vascular endothelial growth factor treatment for retinal vein occlusion–related macular edema: A systematic review and meta-analysis of randomized controlled trials

This systematic review aimed to evaluate the effectiveness and safety of intravitreal dexamethasone (DEX) implant and intravitreal anti-vascular endothelial growth factor (VEGF) treatments for macular edema (ME) secondary to retinal vein occlusion (RVO), central retinal vein occlusion (CRVO), and branch retinal vein occlusion (BRVO). The electronic databases comprehensively searched for the studies that compared DEX with anti-VEGF treatments in patients suffering from RVO-related ME. The effectiveness was estimated using best-corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP). All data were analyzed by Review Manager (RevMan) 5.3. According to the meta-analysis from five randomized control trials, both DEX implant and anti-VEGF agent treatments were effective, but no significant differences in BCVA and CRT were observed between these two treatments. Novartis' two studies indicated that anti-VEGF agents significantly reduced the CRT compared with DEX implant at 6 months [weighted mean difference: 158.53 ?m, 95% confidence interval (CI): (71.09, 245.96), P= 0.0004]. Furthermore, anti-VEGF agents showed some advantages on cataract formation [risk ratio (RR): 3.43, 95% CI: (1.35, 8.71), P= 0.009] and other adverse events [RR: 1.19, 95% CI: (1.09, 1.31), P= 0.0002] without heterogeneity (P = 0.20, I2 = 35%). Anti-VEGF agents were also effective treatments for cataract formation or less adverse events for RVO-related ME. In contrast, DEX implant had higher risk for IOP elevation and lower cataract incidence than anti-VEGF agents. Hence, complementary and alternative treatments are expected.

Macular cytomegalovirus retinitis following dexamethasone intravitreal implant combined with phacoemulsification

A 60-year-old diabetic patient, who had undergone a renal transplant 2 years earlier, presented with sudden decrease in vision in his left eye (LE). He had undergone phacoemulsification combined with intravitreal dexamethasone implant injection in his LE 2 months earlier, for coexistent cataract and diabetic macular edema. Examination revealed necrotizing retinitis with hemorrhages in the macula. A diagnosis of cytomegalovirus retinitis was made, which was confirmed on vitreous polymerase chain reaction. Intravitreal and systemic ganciclovir led to the resolution of retinitis and improvement of visual acuity over a follow-up of 9 months.

Pars plana vitrectomy and re-directing a dexamethasone implant into vitreous cavity following misdirected entry into the crystalline lens

A known diabetic patient presented with diabetic macular edema (DME) and nonproliferative diabetic retinopathy in both eyes with a vision of 6/18, N12in the right eye and 4/60, N36in the left eye (LE). The patient had undergone injection of dexamethasone implant in the LE which got misdirected into the crystalline lens. The patient was taken up for phacoemulsification with intraocular lens implantation along with vitrectomy and posterior vitreous detachment induction, and redirection of the dexamethasone implant into the vitreous cavity. The DME resolved over the next 3 months

The efficacy of intravitreal dexamethasone implant as the first-line treatment for retinal vein occlusion-related macular edema in a real-life scenario

Purpose: This study evaluated the effect of intravitreal dexamethasone implant (IDI; Ozurdex) injection for treating macular edema in patients with branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO). Methods: This prospective study included 40 eyes of 40 patients with nonischemic BRVO and 31 eyes of 31 patients with nonischemic CRVO who received IDI injection as the first-line treatment for macular edema. The best-corrected visual acuity (BCVA) value before and after the treatment; intraocular pressure; optic coherence tomography findings; and all ocular examination findings, including central foveal thickness (CFT) measurement and fluorescein angiography findings, were evaluated for each patient. Results: After the IDI injection, BCVA value increased (P < 0.001) and CFT value decreased (P < 0.001) in both groups. The recurrence rates of CFT elevation after the first and the second Ozurdex injections were 65.0% and 65.3%, respectively, in patients with BRVO and 70.9% and 68.1%, respectively, in patients with CRVO. A statistically significant correlation was observed between preinjection CFT value and postinjection recurrence of CFT elevation (P = 0.017). Conclusion: Treatment with the IDI injections resulted in significant short-term improvement in CFT and BCVA values in patients with clinically significant RVO-related macular edema. Moreover, we observed that high preinjection CFT value was associated with a risk of postinjection recurrence of CFT elevation.

A Case of Retinal Hemorrhage Following a Dexamethasone Intravitreal Implant

PURPOSE: To report a case of retinal hemorrhage after a dexamethasone (Ozurdex®, Allergan, Irvine, CA, USA) intravitreal implant injection in macular edema (ME) secondary to central retinal vein occlusion (CRVO). CASE SUMMARY: A 60-year-old woman visited our hospital for ME secondary to CRVO in the right eye. Intravitreal bevacizumab injection and vitrectomy was conducted three times, but ME did not improve. Then, dexamethasone intravitreal implant was injected without any problems. Right after the dexamethasone intravitreal implant injection, retinal hemorrhage (2 disc diopter size) was observed in the infero-temporal area on fundus examination. Retinal hemorrhage completely disappeared 1 month after injection without other treatment. CONCLUSIONS: A case of dexamethasone intravitreal implant associated with retinal hemorrhage has not been previously reported in Korea. Althrough retinal hemorrhage was observed, it resolved spontaneously without treatment.

Experiencia del Implante de Dexametasona Intravítreo para el tratamiento de Edema Macularen Barranquilla, Colombia / Experience with intravitreal dexamethasone implant for macular edema treatment in Barranquilla, Colombia

Objetivos: Mostrar la experiencia y resultados del tratamiento con el implante intravítreo de Dexametasona (Ozurdex) para el edema macular (EM) secundario a patologías vítreo retinianas en una Clínica Oft almológica en Barranquilla - Colombia. Métodos: Reporte de casos retrospectivo, 22 historias clínicas desde el mes de enero del 2012 a mayo del 2016. Se incluyeron datos de pacientes pseudofáquicos con historia clínica de EM secundario a Retinopatía diabética, DMRE húmeda multitratada con Anti VEGF, Oclusión venosa retiniana central (OVCR), uveítis, postoperatorio de cirugía vitreorretiniana por desprendimiento de retina y pelaje de membrana epirretiniana. Las variables registradas fueron edad, sexo, agudeza visual mejor corregida (AVMC), presión intraocular (PIO), subtipo de EM, etiología del EM, respuesta del EM a los 4 meses de tratamiento valorada por OCT. Se utilizó la prueba de T de Wilcoxon para muestras pareadas. Resultados: Edad promedio de 68 años, 61.9% mujeres y 42.86% hombres. En la distribución del EM por OCT de todos los casos en estudio, 54.5% de los casos presentó un EM predominantemente quístico y 45.5% presentó un EM predominantemente difuso. La AVMC de base fue de 0.45 +/- 0.41 logMAR (R: 0 ­ 2 LogMAR) y la AVMC posterior a los 4 meses del tratamiento fue de 0.40 +/- 0.44 logMAR (R: 0 ­ 2 LogMAR, P: 0.476). La PIO presentó picos de elevación durante los meses 1 y 2 posterior al tratamiento en 59.9%, siendo manejada satisfactoriamente con antihipertensivos oculares. Los grosores maculares promedios previos y a los 4 meses del implante fueron de 372.13 µm (R:184 ­ 661 µm) y de 300.18 µm (R: 176 ­ 495 µm) en su grosor foveal central respectivamente. El grupo de EM quístico tuvo una reducción promedio de 121.41 µm (IC 95% 31.07 ­ 211.75, P: 0.013), el grupo de EM difuso tuvo reducción promedia de 13.66 µm (IC 95% -8.94 ­ 36.27, P: 0.201). Conclusiones: Se muestra la experiencia y efectividad del tratamiento con ozurdex intravítreo en el EM asociado a diversas patologías. Se encontró una respuesta con disminución de grosores maculares a 4 meses del tratamiento, con una mayor respuesta por parte del subtipo de EM predominantemente quístico y el EM secundario a OVCR como mejor respondedor de acuerdo a su etiología. Los picos de PIO fueron manejados adecuadamente con antihipertensivos tópicos, no se reportaron otros efectos adversos en la evolución de los pacientes.

Purpose: To show the experience and results of the treatment with intravitreal dexamethasone implant (Ozurdex) for macular edema secondary to vitreous retinal pathologies at an ophthalmologic clinic in Barranquilla, Colombia. Methods: Retrospective case reports study. We reviewed 22 clinical records from January 2012 to May 2016 that met the inclusion criteria. Pseudophakic patients data with clinical history of macular edema (ME) secondary to diabetic retinopathy, wet AMD multitreated with Anti VEGF, Central Retinal Vein Occlusion (CRVO), Uveitis, postoperative vitreoretinal surgery due to retinal detachment and epiretinal membrane peeling were included. The variables recorded were age, sex, best corrected visual acuity (BCVA), intraocular pressure (IOP), subtype of ME, etiology of ME, ME response at 4 months of treatment assessed by OCT. Th e Wilcoxon T test was used for paired samples. Results: Th e average age was 68 years. According to sex there were 61.9% female and 42.86% male. In the distribution of ME by OCT of all the cases under study, 54.5% of the cases had a predominantly cystic ME and 45.5% had a predominantly diff use ME. Th e baseline BCVA was 0.45 +/- 0.41 logMAR (R: 0-2 LogMAR), the BCVA aft er 4 months of treatment was 0.40 +/- 0.44 logMAR (R:0-2 LogMAR, P: 0.476). IOP showed elevation peaks during months 1 and 2 posttreatment in 59.9%, being satisfactorily managed with ocular antihypertensives. The mean macular thickness prior to and at 4 months of Ozurdex was 372.13 µm (R: 184 - 661 µm) and 300.18 µm (R: 176 - 495 µm) at its central foveal thickness, respectively. Th e cystic ME group had a mean reduction of 121.41 µm (95% CI 31.07 - 211.75, P: 0.013); the diff use ME group had a mean reduction of 13.66 µm (95% CI -8.94 - 36.27, P: 0.201). Conclusions: We show our experience and the eff ectiveness of treatment with intravitreal ozurdex in ME associated with various pathologies. We found a response with a decrease in macular thickness at 4 months of treatment, with a higher response by the subtype of a predominantly cystic ME and ME secondary to CRVO as the best responder according to its etiology. IOP peaks were handled adequately with topical antihypertensives, no other adverse eff ects were reported in the evolution of patients.

A Case of Repeated Dexamethasone Implantation in a Suspected Patient with IRVAN Syndrome

PURPOSE: In the present study, a case of repeated intravitreal dexamethasone implantation for a suspected idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) syndrome associated with recurrent exudative retinal detachment and macular edema is reported. CASE SUMMARY: A 39-year-old female who underwent steroid pulse therapy due to Vogt-Koyanagi-Harada disease in the left eye was referred for exudative retinal detachment and macular edema. Best corrected visual acuity (BCVA) was 1.0 in the right eye and 0.5 in the left eye. Cystoid macular edema combined with serous retinal detachment was observed on spectral-domain optical coherence tomography. Fluorescein angiography revealed neovascularization and multiple macroaneurysms with fluorescein leakage in the left peripapillary area. Severe peripheral capillary non-perfusion and fluorescein leakage were also observed in both eyes. Intravitreal dexamethasone implantation was performed in the left eye and macular edema showed wax-and-wane pattern. No edema was observed after 4 additional dexamethasone implantations, however, preretinal hemorrhage occurred in the peripapillary area during treatment. Seventeen months after initiation of treatment, BCVA was 0.6 in the left eye and dry macula was maintained. CONCLUSIONS: Repeated intravitreal dexamethasone implantation was effective for recurrent macular edema in a patient suspected with IRVAN syndrome.

One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion

PURPOSE: In the present study, 1-year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO) was evaluated. METHODS: The medical records of 22 patients (22 eyes) with macular edema secondary to CRVO were reviewed retrospectively. All patients were treated with intravitreal dexamethasone implant more than twice a year and followed up at least for 1 year from the first dexamethasone implant injection. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured every 2 months after the first injection. Adverse effects, including cataract formation and elevation of IOP, were analyzed. RESULTS: The mean patient age was 64.3 ± 9.5 years and 10 patients (45.5%) were male. The average number of injections was 2.4 ± 0.6 and the interval between the first and second injection was 22.0 ± 6.4 weeks. The mean BCVA (log MAR) was 0.82 ± 0.50 and 0.72 ± 0.62 at baseline and after 1 year, respectively. Vision was significantly improved for 8 months after the first injection (p < 0.05). However, vision was not different from baseline after 1 year. The CMT was significantly decreased compared to baseline (p < 0.001). Subgroup analysis revealed that BCVA was improved and CMT decreased significantly when intravitreal dexamethasone concentration was presumed sufficient. Moreover, CMT decreased significantly in hypertensive and ischemic groups compared with normotensive and non-ischemic groups, respectively (p < 0.001). Elevated IOP was observed in 6 eyes (27.3%), but all 6 eyes became normal after topical agent was applied. Cataract formation was observed in 3 eyes (13.6%). CONCLUSIONS: Intravitreal dexamethasone implant resulted in visual acuity stabilization and macular edema reduction in patients having macular edema secondary to CRVO without significant adverse events.

A Case of Anterior Migration of Fragmented Dexamethasone Intravitreal Implant

PURPOSE: To report a case of fragmentation and anterior migration occurred after dexamethasone intravitreal implant (Ozurdex®, Allergan, Irvine, CA, USA) injection in a branch retinal vein occlusion patient. CASE SUMMARY: A 66-year-old male was referred for blurred vision. He received cataract surgery in 1986 and was diagnosed with central retinal vein obstruction in 2011 in the right eye. For treatment of macular edema, dexamethasone intravitreal implant was performed in the right eye. One week after implantation, a fragment of the dexamethasone implant migrated to the anterior chamber with corneal edema and surgical removal was performed immediately. One day after removal, the remaining fragmented implant migrated to the anterior chamber and corneal edema still existed. The fragmented implant was removed with anterior chamber irrigation. After removal, corneal edema improved and visual acuity was recovered. CONCLUSIONS: Anterior migrated dexamethasone implant could induce corneal complications, such as corneal edema and corneal decompensation and might lower the corneal endothelial cell even if immediately removed. We report a case of corneal edema, which was induced by anterior migration of a fragmented dexamethasone implant and recovered with immediate surgical removal.

Spectral domain optical coherence tomography changes following intravitreal dexamethasone implant, Ozurdex® in patients with uveitic cystoid macular edema.

Purpose: To correlate the structural and functional changes following intravitreal injection of dexamethasone 0.7 mg (Ozurdex®) implant in patients with recalcitrant uveitic cystoid macular edema (CME). Materials and Methods: In a prospective, interventional, nonrandomized study, 30 eyes (27 patients) with uveitic CME received Ozurdex® implant and were followed‑up for 24 weeks at periodic intervals to monitor structural alterations seen on spectral domain optical coherence tomography (SD-OCT). The outcome measures included change in central macular thickness (CMT) and best‑corrected visual acuity (BCVA) as well as structural alterations seen on OCT such as change in the height of cystoid spaces (CSs) and sub‑foveal serous retinal detachment (SSRD). The integrity of external limiting membrane and inner‑outer segment junction was assessed at baseline and follow‑up visits. Results: Mean age of the patients was 46.09 ± 15.66 years. The mean CMT decreased by 96 μm at 1‑day, 231.64 μm at 1‑week, 254.21 μm at 4 weeks and 249.14 μm at 12 weeks (P < 0.001) compared with baseline. BCVA improved from a baseline mean of 0.62 LogMAR units to 0.49 on day 1 to 0.31 at 24 weeks (P < 0.001). A decrease in the mean height of CS, that is, 133.28 μm from a baseline of 317.71 μm was noted on the 1st day (P < 0.001). 4 eyes demonstrated the presence of CS at 4 weeks, 1 eye at 6 weeks and 3 eyes at 12 weeks. At baseline, 16 eyes (53.33%) demonstrated the presence of SSRD. Among these, 11 eyes showed resolution of SSRD on day 1. SSRD resolved in all patients at 4 weeks and was maintained up to 24 weeks. Conclusions: Ozurdex® implant improves the visual outcome of patients with recalcitrant uveitic CME. Reversibility of retinal changes may be possible following treatment with dexamethasone implant. Thus final visual outcome may be independent of pretreatment CMT, the height of CS or SSRD.

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

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.

Inadvertent Intralenticular Dexamethasone Implant for Diabetic Macular Edema Unresponsive to Bevacizumab

PURPOSE: To report a case of inadvertent intralenticular slow-release dexamthasone implant (Ozurdex(R), Allergan Inc., Irvine, CA, USA) for diabetic macular edema unresponsive to bevacizumab. CASE SUMMARY: A 71-year-old woman presented with proliferative diabetic retinopathy. During follow-up, diabetic macular edema developed in both eyes and did not improve with intravitreal bevacizumab injections. For refractory diabetic macular edema, slow-release dexamthasone implant (Ozurdex(R)) was to be injected at the vitreous cavity of her left eye, but it was inadvertently injected into the crystalline lens. The patient was followed closely for 10 months. Diabetic macular edema completely resolved 1 month after the injection and did not recur during follow-up. There were no severe complications except mild cataract formation. Best-corrected visual acuity for the left eye improved from 0.1 to 0.2. The Ozurdex(R) implant slightly decreased after 10 months, but was still observed in the crystalline lens. CONCLUSIONS: The inadvertent intralenticular dexamthasone implant was a rare complication but effective for diabetic macular edema.

Anterior migration of dexamethasone implant in a pseudophakic patient with intact posterior capsule.

Intravitreal application of Ozurdex® (Allergan, Inc., Irvine, CA, USA) which is a biodegradable, sustained‑release dexamethasone implant has been reported to be effective in the treatment of macular edema. Migration of such implant into the anterior chamber has been recently described in cases without perfect zonular or the posterior capsular integrity. Herein, we report the first case with anterior migration of Ozurdex® implant that mislocated just behind the intraocular lens (IOL) in an intact capsular bag. It is thought that such implant migrated anteriorly towards into the posterior chamber through weak zonules as the present case had a medical history of uneventful phacoemulsification surgery with the implantation of posterior chamber IOL. However, the migrated implant was well tolerated since there was no sign of the corneal complication, rise in intraocular pressure, and anterior chamber reaction. Close follow‑up was scheduled to find out any signs of anterior segment pathology. Meanwhile dexamethasone implant completely degraded at the 4th month of postoperative follow‑up.

Implante intravítreo de Dexametasona en uveítis no infecciosa. Resultados clínicos en un grupo de pacientes de la ciudad de Medellín / Dexamethasone intravitreal implant for noninfectious uveitis. Clinical results in a patients group in Medellín

Objetivos: describir los resultados clínicos del uso del implante de dexametasona intravítrea en un grupo pacientes con uveítis no infecciosa de la ciudad de Medellín. Diseño del estudio: estudio descriptivo, retrospectivo y observacional. Métodos: se revisaron las historias clínicas de 19 pacientes con uveítis no infecciosa a los que se les realizó el implante de dexametasona. Se compararon variables clínicas antes de la aplicación, al lograr una mejoría de los parámetros inflamatorios y en la última valoración que tuvieran los pacientes. Se realizaron cálculos de medias y rangos y se aplicó la t de Student pareada para la diferencia de medias de las variables clínicas descritas antes del procedimiento y al lograr la mejoría clínica, y antes del procedimiento y en la última valoración. Resultados: se realizaron 24 implantes de dexametasona en los 19 pacientes. La mayoría de los pacientes tuvieron uveítis intermedia idiopática (42.1%) o panuveitis (42.1%). Se encontró una mejoría de los parámetros inflamatorios en un promedio de 8.39 semanas (rango 4-16 semanas) con una diferencia significativa antes de la aplicación y en el momento de la mejoría, en las variables de agudeza visual (p=0,025), celularidad en cámara anterior (p=0,000), celularidad en vítreo (p=0,000) y opacidad vítrea (p=0,000). Con respecto a la última valoración hubo una mejoría estadísticamente significativa de los parámetros inflamatorios, excepto de la agudeza visual (p=0,331). Conclusión: el implante intravítreo de dexametasona es una alternativa para pacientes con uveítis no infecciosas que no mejoren con tratamiento estándar. A las 8 semanas se observa una mejoría estadísticamente significativa de todos los parámetros inflamatorios, que pueden persistir hasta las 34 semanas, a pesar de que hay pacientes que requieren reaplicaciones y/o continuidad de la terapia sistémica o tópica.

Purpose: to describe the clinical results of intravitreal dexamethasone implants in a group of patients with noninfectious uveitis. Methods: a retrospective analysis of the records of 19 patients with noninfectious uveitis who underwent intravitreal dexamethasone implants was performed to compare clinical measures before the application, during the improvement phase of infl ammatory parameters and in the last visit. Paired t student was used to assess differences of clinical parameters before and after the clinical procedure. Results: nineteen patients were treated with 24 dexamethasone implants. Most of the patients had idiopathic intermediate uveitis (42.1%) or panuveitis (42.1%). Improvement was found in 8.39 weeks (R= 4-16 weeks) in the inflammatory parameters with a significant improvement in visual acuity (p=0,025), anterior chamber cells (p=0,000), vitreous cells (p=0,000) and vitreous haze (p=0,000). Average follow up to the last visit was 39.4 weeks (8-104 weeks) with improvement on these clinical variables with exception of visual acuity (p=0,331). Conclusions: The intravitreal dexamethasone implant is a good alternative for patients with non infectious uveitis who don't get better with the standard treatment or have contraindications for it. Significant improvement in the parameters were observed as early as week 8 and were maintained over 34 weeks, despite there were patients who required reapplications and/or topic or systemic or therapy.

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.

A Case of Dexamethasone Intravitreal Implant Fragmentation During the Injection Procedure in Central Retinal Vein Occlusion

PURPOSE: We report a case of dexamethasone intravitreal implant (Ozurdex(R); Allergan, Inc.) fragmentation during the injection procedure in macular edema due to central retinal vein occlusion. CASE SUMMARY: A 57-year-old man visited our hospital for visual disturbance in his right eye. The patient's best-corrected visual acuity was 0.02 in the right eye and 1.2 in the left eye. After fundus examination, the patient was diagnosed with central retinal vein occlusion with macular edema, thus bevacizumab was injected in the right eye. However, the macular edema did not improve, and a dexamethasone intravitreal implant was injected in the right eye. Immediately after the dexamethasone intravitreal implant injection, on fundus exam, the drug was observed to be fragmented into 3 pieces without any additional treatment. After 2 months, the patient's best-corrected visual acuity was 0.4 in the right eye and 1.2 in the left eye. Macular edema decreased according to optical coherence tomography. CONCLUSIONS: A case of dexamethasone intravitreal implant fragmentation during an injection procedure has not been previously reported in Korea. Although the drug fragmented, the treatment was effective without complications.