gms | German Medical Science

Objective: To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular edema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO).

Methods: The charts of 102 patients with CME secondary to BRVO (n=54) or CRVO (n=48) treated with Ozurdex at 8 centers were retrospectively reviewed. The patients were monthly examined over a 6 months period. With progression of the disease (loss of 1 line associated by an increased central retinal thickness (CRT) of 150 um), a reinjection of Ozurdex or anti-VEGF was offered.

Results: In the BRVO group the median BCVA was 0.6 logMAR at baseline and improved to 0.4 logMAR of 0.40 after 4 weeks, 0.3 logMAR after 8 weeks, 0.4 logMAR after 12 weeks, 0.5 logMAR after 16 weeks, 0.4 logMAR after 20 weeks and 0.45 logMAR after 24 weeks. The mean CRT was 559 + (SD) 209 µm at baseline and it decreased to 335 + 148 µm after 4 weeks, 316 + 137 µm after 8 weeks, 369 + 126 µm after 12 weeks, 407 + 161 µm after 16 weeks, 399 + 191 µm after 20 weeks, 419 + 196 µm after 24 weeks. In the CRVO group the median BCVA was 0.7 logMAR at baseline and improved to 0.4 logMAR after 4 weeks, 0.4 logMAR after 8 weeks, 0.6 logMAR after 12 weeks, 0.6 logMAR after 16 weeks, 0.5 logMAR after 20 weeks and 0.52 logMAR after 24 weeks. The mean CRT at baseline was 740 + 351µm and it decreased to 419 + 315 µm after 4 weeks, 352 + 261 µm after 8 weeks, 455 + 251 µm after 12 weeks, 497 + 280 µm after 16 weeks, 468 + 301 µm after 20 weeks and 395 + 234 µm after 24 weeks. The BCVA improvement was statistically significant better (p<0.05) compared to baseline in both groups at every follow-up visit. The mean CRT maintained significant better compared to baseline in both groups at all follow-up visits. Early re-injection was indicated in BRVO in 40.7 % after 17.5 + 4.2 weeks and in CRVO in 50 % after 17.68 + 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 + 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 + 7.0 weeks.

Conclusions: Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early re-treatment after 4 months instead of 6 months, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.