United Kingdom Database Study of Intravitreal Dexamethasone Implant (Ozurdex) for Macular Edema Related to Retinal Vein Occlusion

Abstract

To study the treatment patterns, visual outcomes and safety profile of intravitreal dexamethasone implant (IDI) used for the treatment of macular edema secondary to retinal vein occlusion.Methods: Up to 2 years of routinely collected anonymized data within electronic medical record systems were remotely extracted from 16 centers. The outcome measures include visual outcome, number of injections, and safety measures, including the rate of intraocular pressure (IOP) rise, frequency of IOP-lowering medication usage, and cataract surgery rates.Results: The study included 688 eyes (44.4%) with central retinal vein occlusion and 862 eyes (55.6%) with branch retinal vein occlusion; 1,250 eyes (80.6%) were treatment naive and 28% (275/989) had high IOP or were on IOP-lowering medications before IDI use. It was found that 31% (476) of eyes received two injections, and 11.7% (182) and 3.7% (58) of eyes received three and four injections, respectively. The mean baseline Snellen visual acuity improved from 20/125 to 20/40 after the first injection. The probability of cataract surgery was 15% at 24 months. The proportion of eyes with $10 mmHg change from baseline was higher in phakic (14.2%) compared with pseudophakic eyes (5.4%, P = 0.004). Three eyes required IOP filtering surgery (0.2%). Conclusion:The visual results of IDI in eyes with macular edema secondary to retinal vein occlusion in the real world are comparable to those of clinical trial setting. Increased IOP in eyes with preexisting ocular hypertension or glaucoma can be controlled with additional medical treatment. Intraocular pressure rise with IDI may be more frequent in phakic than in pseudophakic eyes.RETINA 43:679-687, 2023D examethasone implant (Ozurdex, Allergan, Dublin, Ireland) treatment for macular edema (ME) in retinal vein occlusion (RVO) has been shown in clinical trials to be effective. [1][2][3] The pivotal clinical trial, GENEVA, demonstrated that a single 0.7-mg implant was well tolerated and improved both functional and anatomical outcomes in eyes with branch RVO (BRVO) and central RVO (CRVO) with 30% of treated eyes gaining $3 lines of vision. 1 This gain was maintained during the open-label extension of the study for a further 12 months. 2 Intravitreal dexamethasone implant (IDI) for the treatment of ME caused by RVO was approved for use in routine clinical care in the United Kingdom in July 2011. 3

Increased intraocular inflammation in retinal vein occlusion is independent of circulating immune mediators and is involved in retinal oedema

“…RVO causes retinal hemorrhage, ischemia, macular oedema, and neovascularization leading to visual impairment ( Jung et al, 2014 ; Zeng et al, 2019 ). The mainstream therapies of RVO include intraocular injection of vascular endothelial cell growth factor (VEGF) inhibitors or dexamethasone, laser photocoagulation, and surgery ( Soliman et al, 2022 ). Despite the successful outcomes of intraocular injection of anti-VEGF agents, up to 77.5% of RVO patients continue to suffer from refractory or recurring edema ( Karagiannis et al, 2011 ).…”