Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
Josh Wallsh, Behnam Sharareh, Ron GallemoreRetina Macula Institute, Torrance, CA, USAPurpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.M...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2016-05-01
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| Series: | Clinical Ophthalmology |
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| Online Access: | https://www.dovepress.com/therapeutic-effect-of-dexamethasone-implant-in-retinal-vein-occlusions-peer-reviewed-article-OPTH |
| _version_ | 1818854103017586688 |
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| author | Wallsh J Sharareh B Gallemore R |
| author_facet | Wallsh J Sharareh B Gallemore R |
| author_sort | Wallsh J |
| collection | DOAJ |
| description | Josh Wallsh, Behnam Sharareh, Ron GallemoreRetina Macula Institute, Torrance, CA, USAPurpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.Methods: A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points.Results: All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P<0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P<0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 µm at 4 months (P<0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P<0.05) in this patient population and partially limited analysis of other end points.Conclusion: DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.Keywords: retinal vein occlusion, intravitreal dexamethasone implant, multifocal electroretinography, anti-VEGF, cataract progression |
| first_indexed | 2024-12-19T07:47:23Z |
| format | Article |
| id | doaj.art-31dc4928569d4401a65cbf276975d2d6 |
| institution | Directory Open Access Journal |
| issn | 1177-5483 |
| language | English |
| last_indexed | 2024-12-19T07:47:23Z |
| publishDate | 2016-05-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Clinical Ophthalmology |
| spelling | doaj.art-31dc4928569d4401a65cbf276975d2d62022-12-21T20:30:16ZengDove Medical PressClinical Ophthalmology1177-54832016-05-012016Issue 194795427103Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapyWallsh JSharareh BGallemore RJosh Wallsh, Behnam Sharareh, Ron GallemoreRetina Macula Institute, Torrance, CA, USAPurpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.Methods: A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points.Results: All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P<0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P<0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 µm at 4 months (P<0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P<0.05) in this patient population and partially limited analysis of other end points.Conclusion: DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.Keywords: retinal vein occlusion, intravitreal dexamethasone implant, multifocal electroretinography, anti-VEGF, cataract progressionhttps://www.dovepress.com/therapeutic-effect-of-dexamethasone-implant-in-retinal-vein-occlusions-peer-reviewed-article-OPTHRetinal vein occlusionintravitreal dexamethasone implantmultifocal electroretinography |
| spellingShingle | Wallsh J Sharareh B Gallemore R Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy Clinical Ophthalmology Retinal vein occlusion intravitreal dexamethasone implant multifocal electroretinography |
| title | Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy |
| title_full | Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy |
| title_fullStr | Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy |
| title_full_unstemmed | Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy |
| title_short | Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy |
| title_sort | therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti vegf therapy |
| topic | Retinal vein occlusion intravitreal dexamethasone implant multifocal electroretinography |
| url | https://www.dovepress.com/therapeutic-effect-of-dexamethasone-implant-in-retinal-vein-occlusions-peer-reviewed-article-OPTH |
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