Safety and Efficacy of Dexamethasone Intravitreal Implant (Ozurdex) for the Treatment of Persistent Macular Edema Secondary to Retinal Vein Occlusion in Eyes Previously Treated with Anti-Vascular Endothelial Growth Factors

Abstract

Provided the complexity of molecular mechanisms involved in ΜΕ development and the effect of corticosteroids on many of these mechanisms, in our case series, Ozurdex appeared to be a safe and beneficial treatment option for persistent ME due to RVO, in patients with poor or complete lack of response after at least 3 consecutive monthly intravitreal anti-VEGF injections. The complication rate of cataract reported in our study is relatively high compared to previous reports. This might be attributed to the multiple injections, as the incidence of cataract increases with time. Regarding IOP elevation, there is no consensus among published clinical trials on the percentage of patients requiring IOP-lowering medications. Further studies with a greater patient population as well as a control group are required in order to confirm our findings.

Evaluation of Peripapillary Nerve Fiber Layer after Dexamethasone Implantation (Ozurdex) in Branch Retinal Vein Occlusions

“…Previous studies have shown the steroid-induced IOP increases after the intravitreal injection of Ozurdex implant in the treatment of RVO related ME [8, 9, 11]. In addition, some studies have found an association between the secondary glaucoma and Ozurdex implant [10, 17].…”

“…Ozurdex implant lowers the levels of many mediators that cause deterioration of blood-retina barrier, especially VEGF, and decreases the vascular permeability [7]. However, it has been shown to be associated with intraocular pressure (IOP) elevation [8–11]. …”

“…In glaucoma, peripapillary RNFL is affected before the other glaucoma signs such as optic disc excavation and visual field defects occur [14]. Although Ozurdex implant has been found to cause IOP elevation [8–11], to the best of our knowledge, there is no study investigating the effect of this IOP elevation on peripapillary RNFL thickness. Therefore, in the present study, we aimed to evaluate the peripapillary RNFL thicknesses of patients treated with intravitreal Ozurdex implant due to RVO related ME.…”

An ultra-low-molecular-weight heparin, fondaparinux, to treat retinal vein occlusion

“…Large amounts of VEGF are released in ischemic vein occlusions (10). This creates macular edema and anti-VEGF agents can be used to treat that edema (6,7). However, studies in primates have indicated that VEGF induces capillary endothelial cell proliferation within blood vessels, and particularly in veins, leading to intussusceptions and endothelial cell wall bridging within venules in some areas and vascular closure and non-perfusion in others (11).…”

“…These injections can resolve severe macular edema and temporarily improve VA while waiting for the venous blockage to spontaneously resolve through recanalization or collateral vessel formation. These injections are not known to help remove or resolve a thrombus (6,7).…”