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Chung, Lee, and Sagong: Intravitreal Dexamethasone Implant for Macular Edema in Branch Retinal Vein Occlusion According to Previous Responses to Bevacizumab
Original Article

J Korean Ophthalmol Soc 2016;57(12):1910-1917.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1910

Intravitreal Dexamethasone Implant for Macular Edema in Branch Retinal Vein Occlusion According to Previous Responses to Bevacizumab

Hyunuk Chung, MD, Junyeop Lee, MD, PhD, Min Sagong, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Min Sagong, MD, PhD Department of Ophthalmology, Yeungnam University Hospital, #170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: 82-53-620-3443, Fax: 82-53-626-5936 E-mail: msagong@ynu.ac.kr

Received 14 July 2016       Revised 1 October 2016       Accepted 15 November 2016

Copyright © 2016 Korean Ophthalmological Society

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 compare the efficacy of intravitreal dexamethasone implant according to previous responses to Bevacizumab treatment in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO).

Methods

Sixty eyes of 60 patients who received an intravitreal dexamethasone implant for ME secondary to BRVO and followed up for at least 6 months were retrospectively reviewed. Of these, 31 patients were treatment naïve and 29 patients had previously received intravitreal injection of anti-vascular endothelial growth factor (VEGF). Out of these previously-treated patients, 17 patients were categorized as a refractory group who did not respond to previous injection and 12 patients were categorized as a responder group who showed recurrent ME despite a good response to previous anti-VEGF treatment. The best corrected visual acuity (BCVA), central macular thickness (CMT) and recurrence of ME were assessed monthly for 6 months.

Results

At each 3-month follow-up, the BCVA improved significantly from baseline in the naïve group, while the refractory group and the responder group showed significant improvement for only 2 months. At each 3-month follow-up, the CMT showed significant decreases in every group. However, the mean change in CMT from baseline showed significant differences between the 3 groups at month 3 (p < 0.001). During follow-up, 18 eyes in the naïve group (58.1%), 16 eyes in the refractory group (94.1%), and 6 eyes in the responder group (50.0%) received retreatment for the recurrence of ME, and there was a significant difference in the retreatment rate between the three groups (p = 0.016).

Conclusions

Intravitreal dexamethasone implant showed early good functional and anatomical improvements irrespective of the response to the previous treatment in patients with ME secondary to BRVO. However, when treating the refractory group, more careful observation and intensive retreatment are required, considering the short duration of its efficacy.

Keywords: Branch retinal vein occlusion, Intravitreal dexamethasone implant, Macular edema

References

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Figure 1.
Mean change in BCVA. (A) Mean BCVA during the follow-up period. (B) Mean change in BCVA from baseline during the follow-up period. At each visit of 6-month follow-up, the BCVA improved significantly from baseline in the naïve group, while the refractory group and the responder group showed significant improvement for only 2 months.
jkos-57-1910f1.tif
Figure 2.
Mean change in CMT. (A) Mean CMT during the follow-up period. (B) Mean change in CMT from baseline during the follow-up period. The CMT showed significant decrease at each visit in the naïve group and the responder group, and the refractory group showed decrease in CMT for only 3 months. There were significant differences between the groups at month 3, 4, 5 and 6 (p < 0.001 at month 3, 4 and 5, p = 0.013 at month 6).
jkos-57-1910f2.tif
Table 1.
Demographic and baseline characteristics of patients
  Naïve Previously-treated p-value Previously-treated
 p-value
Refractory Responder
Number of eyes 31 29   17 12  
Gender            
  Male 12 8 0.361* 5 3 0.793*
  Female 19 21 0.361 12 9 0.793
OD/OS 18/13 19/10 0.553* 12/5 7/5 0.494*
Age 64.77 ± 10.55 62.59 ± 7.73 0.366† 63.35 ± 7.27 61.50 ± 8.53 0.328†
Diabetes mellitus (n, %) 4 (12.9) 3 (10.3) 0.538‡ 3 (17.6) 0 (0.0) 0.246‡
Hypertension (n, %) 14 (45.2) 8 (27.6) 0.158* 4 (23.5) 4 (33.3) 0.683‡
Lens status (phakic/pseudophakic) 25/6 27/2 0.257‡ 15/2 12/0 0.498‡
Occlusion site (major branch/macular b branch) 20/11 21/8 0.511* 12/5 9/3 0.793*
Macular ischemia (n, %) 13 (41.9) 14 (48.3) 0.622* 11 (64.7) 3 (25.0) 0.035*
Peripheral ischemia (n, %) 12 (38.7) 19 (65.5) 0.038* 14 (82.4) 5 (41.7) 0.023*
Baseline BCVA (log MAR) 0.76 ± 0.33 0.68 ± 0.40 0.430† 0.69 ± 0.44 0.59 ± 0.37 0.446†
Baseline CMT (μ m) 583.61 ± 169.71 509.14 ± 112.38 0.051†5 509.82 ± 104.53 508.17 ± 127.48 0.879†

Values are presented as mean ± SD unless otherwise indicated. BCVA = best corrected visual acuity; log MAR = logarithm of the minimal angle of resolution; CMT = central macular thickness.

* Pearson's chi-squared test

† Independent t-test

‡ Fisher's exact test.

Table 2.
Number of patients of retreatment in each group
  Naïve Previously-treated
 p-value*
Refractory Responder
Retreatment 18 (58.1) 16 (94.1) 6 (50.0) 0.016
No retreatment 13 (41.9) 1 (5.9) 6 (50.0)  
Total 31 (100.0) 17 (100.0) 12 (100.0)  

Values are presented as n (%) unless otherwise indicated.

* Pearson's chi-squared test.

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