Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration

Soo Hyun Kwon; Jae Pil Shin; In Taek Kim; Dong Ho Park

doi:10.3341/jkos.2015.56.8.1208

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Kwon, Shin, Kim, and Park: Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration

Original Article

J Korean Ophthalmol Soc 2015;56(8):1208-1214.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1208

Efficacy of Intravitreal Dexamethasone Implant for Macular Edema Due to Branch Retinal Vein Occlusion According to Symptom Duration

Soo Hyun Kwon, M.D., Jae Pil Shin, M.D., PhD, In Taek Kim, M.D., PhD, Dong Ho Park, M.D., PhD

Department of Ophthalmology, Kyungpook National University School of Medicine, Daegu, Korea

Address reprint requests to Dong Ho Park, MD, PhD Department of Ophthalmology, Kyungpook National University Hospital, #130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea Tel: 82-53-200-5813, Fax: 82-53-426-6552 E-mail: sarasate2222@gmail.com

∗ This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (NRF-2014R1A1A2055007), and by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (A111345).

Received 6 February 201520 March 2015 Accepted 19 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of intravitreal dexamethasone implants for the treatment of macular edema (ME) due to branch retinal vein occlusion (BRVO) according to the duration of symptoms.

Methods

Thirty-one patients who received an intravitreal dexamethasone implant for ME due to BRVO were included in this ret-rospective study. The patients were divided into 2 groups. Group A included eyes with symptom duration less than 12 weeks and Group B included eyes with symptom duration of 12 weeks or longer. The main efficacy outcomes such as best-corrected visual acui-ty (BCVA) and central macular thickness (CMT) were measured at baseline and every 4 weeks over 24 weeks. Retreatment criteria included an increased CMT of 150 µm or reduction of logarithm of the minimal angle of resolution (log MAR) scores of at least 0.2.

Results

The CMT and BCVA improved significantly at each follow-up compared with the baseline ( p < 0.001, p < 0.05, re-spectively). At 4 and 8 weeks after the first injection, CMT in Group A (285.3 ± 19.9, 276.1 ± 23.1 μ m, respectively) was less than in Group B (310.3 ± 37.5, 318.1 ± 39.6 μ m; p = 0.033, p = 0.001, respectively). At 4 weeks, the BCVA in Group A was better than in Group B ( p = 0.009). Rate and timing of recurrence were not different between the 2 groups ( p > 0.05). At 24 weeks, Group A showed less CMT and better BCVA compared with Group B ( p = 0.043, p = 0.041, respectively).

Conclusions

The intravitreal dexamethasone implant significantly reduced the CMT and improved BCVA in patients with ME due to BRVO. Patients with shorter symptom duration showed better anatomical and functional outcomes over 24 weeks. Early treatment with the intravitreal dexamethasone implant could produce better clinical results.

Keywords: Branch retinal vein occlusion, Dexamethasone, Macular edema, Recurrence

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Figure 1.

Central macular thickness (CMT) changes after in-travitreal dexamethasone implant. CMT changes was sig-nificantly different from the baseline at all follow-up visits. ^* p < 0.001.

Figure 2.

(A) Comparison of central macular thickness (CMT) and (B) best-corrected visual acuity (BCVA) in patients with macular edema due to retinal vein occlusion after first in-jection of intravitreal dexamethasone according to symptom duration. (A) There was a significant difference at 4 ( p = 0.033), 8 ( p = 0.001) and 24 ( p = 0.043) weeks in CMT between two groups. (B) There was a significant difference at 4 ( p = 0.009) and 24 ( p = 0.041) weeks in the BCVA. Vertical bars are standard deviation of the Group A (symptom duration <12 weeks) and Group B (symptom duration ≥12 weeks). ^* p < 0.05.

Table 1.

Clinical characteristics of the patients

	Group A^∗ (16 eyes)	Group B^†(15 eyes)	p-value
Age (years)	59.7 ± 8.9	65.3 ± 8.1	0.08^‡
Male gender (n, %)	30 (55.5)	25 (49.0)	0.20^§
Symptom duration (weeks)	7.7 ± 3.0	32.1 ± 19.4	<0.001^‡
Mean follow up (weeks)	25.7 ± 1.7	25.1 ± 1.1	0.32^‡
Hypertension (n, %)	6 (37.5)	5 (33.3)	0.81^§

Values are presented as mean ± SD unless otherwise indicated.

^∗ Symptom duration <12 weeks;

^† Symptom duration ≥12 weeks;

^‡ Mann-Whitney U-test;

^§ Chi-square test.

Table 2.

Changes of central macular thickness and best-corrected visual acuity of total patients

	Baseline	Month 1	Months 2	Months 3	Months 4	Months 5	Months 6
CMT (μ m)	599.2 ± 85.3	297.4 ± 31.9	296.4 ± 38.1	403.7 ± 96.2	435.6 ± 140.9	411.7 ± 99.6	406.5 ± 109.8
		p < 0.001	p < 0.001	p < 0.001	p < 0.001	p < 0.001	p < 0.001
BCVA (log MAR)	0.70 ± 0.35	0.34 ± 0.18	0.44 ± 0.13	0.53 ± 0.23	0.56 ± 0.33	0.58 ± 0.38	0.54 ± 0.22
		p < 0.001	p = 0.001	p = 0.018	p = 0.017	p = 0.043	p = 0.001

Values are presented as mean ± SD unless otherwise indicated. p-value was evaluated by paired t-test and repeated measures analysis of variance.

CMT = central macular thickness; BCVA = best-corrected visual acuity; log MAR = logarithm of the minimal angle of resolution.

Table 3.

Comparison of clinical outcomes according to symptom duration

	Group A^∗ (16 eyes)	Group B^† (16 eyes)	p-value
Recurrence rate (%)	56.2	60.0	0.80^‡
Timing of recurrence (weeks)	14.7 ± 2.8	13.3 ± 2.0	0.34^§
Symptom duration (weeks)	7.7 ± 3.0	32.1 ± 19.4	<0.001^§
Final CMT (μ m)	364.8 ± 112.5	450.9 ± 90.6	0.043^§
Final BCVA (log MAR)	0.49 ± 0.25	0.61 ± 0.17	0.041^§

Values are presented as mean ± SD unless otherwise indicated.

CMT = central macular thickness; BCVA = best-corrected visual acuity; log MAR = logarithm of the minimal angle of resolution.

^∗ Symptom duration <12 weeks;

^† Symptom duration ≥12 weeks;

^‡ Chi-square test;

^§ Mann-Whitney U-test.

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