Intravitreal dexamethasone implant for central retinal vein occlusion without macular edema

Abstract

Background To evaluate the efficacy of an intravitreal dexamethasone (IVD) implant (Ozurdex®) for the treatment of central retinal vein occlusion (CRVO) without macular edema (ME). Methods A retrospective cohort study was designed, and 20 eyes of 20 patients diagnosed with non-ischemic CRVO without ME were included. A total of 10 CRVO eyes were observed without treatment, and another 10 CRVO eyes received a single IVD injection at baseline. Mean changes in pathomorphologic parameters of fundus and optical coherence tomography parameters were measured at baseline and at 1, 3, 6, and 12 months. Results The decreases in venous tortuosity ( p = 0.014 for superior; 0.036 for inferior arcades) and width ( p = 0.024 for superior; 0.003 for inferior arcades) from baseline to 12 months after injection were significantly greater in the treated group than the observed group. The improvements in RNFL swelling ( p = 0.010) and retinal hemorrhage ( p = 0.006) were also significantly greater in the treated group. Visual symptom improvement was significantly faster in the treated group ( p = 0.001). In two cases, IVD injection resulted in complete resolution of cilioretinal artery occlusion associated with the CRVO, leading to complete visual recovery in 1 week. None of the treated eyes showed signs of ME development, ischemia progression, or neovascularization. Conclusions IVD implant was significantly effective in improving venous engorgement, retinal hemorrhage, RNFL swelling, and visual symptoms by presumed alleviation of disc swelling and venous outflow. This treatment may be a considerable treatment option in CRVO patients with no ME.

Review: The Development of Risk Factors and Cytokines in Retinal Vein Occlusion

“…3) Local inflammation: Vascular stasis and exudation stimulates the secretion of inflammatory factors, causing focal phlebitis and optic nerve head swelling (ONH) in a significant number of patients ( 3 ). Decreasing inflammatory factors and VEGF could relieve the disc edema and recover damaged visual acuity (VA) ( 8 ). Ischemia and hypoxia increased the oxidative stress response of the body and stimulated the secretion of inflammatory markers as well as caspase-9 ( 9 , 10 ).…”

Central retinal artery occlusion and central retinal vein occlusion in contralateral eye

“…(14) Ozurdex® was chosen in this case since it seems to have significant beneficial effects in improving venous engorgement, retinal hemorrhage and disc swelling. (9,15) Considering most negative ancillary tests and presence of bilateral atheroma in carotid arteries, we believe the bilateral ocular findings of our patient were probably a consequence of non-controlled comorbidities, such as hypertension and dyslipidemia. Also, it is important to emphasize the patient is also at risk for ischemic events after treatment, largely because atherosclerotic disease is the primary underlying diagnosis of his condition.…”

“…(6) The prognosis is related to the occurrence of vision loss due to macular edema, intraretinal hemorrhage, and ischemia, leading to neovascularization. (9) The control of factors associated with arterial occlusion may be crucial, preventing the onset of cerebral ischemic disease or ischemic cardiomyopathy, (2,5,10) which may appear in the first and second week, when upon examination. (8) Thus, rapid and accurate diagnosis of the condition involved is important to prevent mortality.…”

“…(11) Central retinal vein occlusion can be classified according to tissue perfusion status by fluorescein angiography (FA) as ischemic or non-ischemic. (6,7,9) Moreover, it is well known that over 75% of CRVOs are non-ischemic, and 34% of those cases converted to ischemic form during follow-up. Furthermore, up to 60% of eyes with ischemic CRVO developed neovascularization, with neovascular glaucoma developing in some cases.…”

“…Furthermore, up to 60% of eyes with ischemic CRVO developed neovascularization, with neovascular glaucoma developing in some cases. (9) Systemic findings found in CRAO combined with CRVO include diabetes, hypertension, dyslipidemia, as well as inflammatory, coagulation and tumoral disorders. (12,13) Recently, high factor VIII indices have been associated with venous thromboembolism in cases of combined venous and arterial In 6-month follow-up of the condition in RE, there was a complete vascular recanalization, with no glaucoma associated, but atrophy of the retinal inner layers on OCT (Figure 5).…”