One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion

Tae Hoon Kim; Chang Ki Yoon; Ji Eun Lee; Joo Eun Lee; In Young Chung; Min Sagong; Kun Hyung Kim; Hyun Woong Kim

doi:10.3341/jkos.2016.57.12.1918

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Kim, Yoon, Lee, Lee, Chung, Sagong, Kim, and Kim: One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2016;57(12):1918-1925.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.12.1918

One-year Outcome of Intravitreal Dexamethasone Implant for Macular Edema Secondary to Central Retinal Vein Occlusion

Tae Hoon Kim, MD¹, Chang Ki Yoon, MD¹, Ji Eun Lee, MD, PhD², Joo Eun Lee, MD, PhD³, In Young Chung, MD, PhD⁴, Min Sagong, MD, PhD⁵, Kun Hyung Kim, MD⁶, Hyun Woong Kim, MD, PhD¹

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea

³Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

⁴Department of Ophthalmology, Gyeongsang National University School of Medicine, Jinju, Korea

⁵Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

⁶Institute of Environmental and Occupational Medicine, Department of Occupational and Environmental Medicine, Inje University College of Medicine, Busan, Korea

Address reprint requests to Hyun Woong Kim, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea Tel: 82-51-890-6015, Fax: 82-51-890-6329, E-mail: maekbak@hanmail.net

Received 7 July 2016 Revised 21 September 2016 Accepted 15 November 2016

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

In the present study, 1-year outcome of intravitreal dexamethasone implant in macular edema secondary to central retinal vein occlusion (CRVO) was evaluated.

Methods

The medical records of 22 patients (22 eyes) with macular edema secondary to CRVO were reviewed retrospectively. All patients were treated with intravitreal dexamethasone implant more than twice a year and followed up at least for 1 year from the first dexamethasone implant injection. The best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were measured every 2 months after the first injection. Adverse effects, including cataract formation and elevation of IOP, were analyzed.

Results

The mean patient age was 64.3 ± 9.5 years and 10 patients (45.5%) were male. The average number of injections was 2.4 ± 0.6 and the interval between the first and second injection was 22.0 ± 6.4 weeks. The mean BCVA (log MAR) was 0.82 ±0.50 and 0.72 ± 0.62 at baseline and after 1 year, respectively. Vision was significantly improved for 8 months after the first injection (p < 0.05). However, vision was not different from baseline after 1 year. The CMT was significantly decreased compared to baseline (p < 0.001). Subgroup analysis revealed that BCVA was improved and CMT decreased significantly when intravitreal dexamethasone concentration was presumed sufficient. Moreover, CMT decreased significantly in hypertensive and ischemic groups compared with normotensive and non-ischemic groups, respectively (p < 0.001). Elevated IOP was observed in 6 eyes (27.3%), but all 6 eyes became normal after topical agent was applied. Cataract formation was observed in 3 eyes (13.6%).

Conclusions

Intravitreal dexamethasone implant resulted in visual acuity stabilization and macular edema reduction in patients having macular edema secondary to CRVO without significant adverse events.

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Keywords: Central retinal vein occlusion, Dexamethasone implant, Macular edema, Ozurdex

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Figure 1.

Best corrected visual acuity (BCVA) and central macular thickness (CMT) results. (A) BCVA was significantly increased at 2, 4, 6, 8 months after first injection. (B) CMT was significantly decreased at 2, 6, 8, 12 months after first injection. * p<0.05, against baseline by paired t-test; ^** p<0.01, against baseline by paired t-test.

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Figure 2.

Univariate analysis (by generalized estimating equation [GEE]) for best corrected visual acuity (BCVA) and central macular thickness (CMT) change from baseline. (A) Hypertension (HTN) group showed no significant difference in BCVA but significantly large decrease in CMT compared tonon-HTN group. (B) Ischemic group neither showed significant difference in BCVA but presented significantly large decrease in CMT compared tonon-HTN group.

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Table 1.

Baseline characteristics of enrolled patients

Baseline characteristics	Data (N = 22)
Sex (male) (n, %)	10 (45.5)
Age (years)	64.3 ± 9.5
HTN (n, %)	15 (68.2)
DM (n, %)	8 (36.4)
Lens status (phakic/pseudophakic) (n, %)	14/6 (63.6/27.3)
Ischemic type (n, %)	6 (27.3)
Prior treatment for CRVO (n, %)	12 (54.5)
BCVA (log MAR)	0.82 ± 0.50
CMT (μ m)	627.3 ± 149.7
IOP (mm Hg)	15.4 ± 3.1

Values are presented as mean ± SD unless otherwise indicated. HTN = hypertension; DM = diabetes mellitus; CRVO = central retinal vein occlusion; BCVA = best corrected visual acuity; CMT = central macular thickness; IOP = intraocular pressure.

Table 2.

Adverse effects of ozurdex injection and results about injection number or interval in follow-up period

Statistics	Data (N=22)
Number of ozurdex injection	2.4 ± 0.6
Duration between 1st and 2nd injection (weeks)	22.0 ± 6.4
IOP elevation (n, %)	6 (27.3)
Cataract progression (n, %)	3 (13.6)
Avastin injection (n, %)	9 (40.9)
Triamcinolone injection (n, %)	2 (9.1)

Values are presented as mean ± SD or n (%). IOP = intraocular pressure.

Table 3.

Multivariate analysis (by GEE) for BCVA change from baseline

Estimate	B	S.E.	95% CI		p-value
Estimate	B	S.E.	Lower	Upper	p-value
DM vs. No DM	–0.092	0.1204	–0.328	0.144	0.447
HTN vs. No HTN	–0.090	0.0764	–0.240	0.060	0.239
Ischemic CRVO vs. Non-ischemic CRVO	–0.013	0.1327	–0.247	0.010	0.922
Age	–0.007	0.0062	–0.019	0.006	0.290
‘High’ concentration section	–0.380	0.0793	–0.536	–0.225	0.000^*
‘Slope’ concentration section	–0.417	0.0781	–0.570	–0.264	0.000^*
‘Low’ concentration section	–0.313	0.0635	–0.437	–0.188	0.000^*
Prior Tx. vs. Naive	0.036	0.0924	–0.145	0.218	0.693

GEE = generalized estimating equation; BCVA = best corrected visual acuity; S.E. = spherical equivalent; CI = confidence interval; DM = diabetes mellitus; HTN = hypertension; CRVO = central retinal vein occlusion; Tx. = treatment.

^* Indicates multivariate GEE.

Table 4.

Multivariate analysis (by GEE) for CMT change from baseline

Estimate	B	S.E.	95% CI		p-value
Estimate	B	S.E.	Lower	Upper	p-value
DM vs. No DM	86.657	53.1710	–17.556	190.870	0.103
HTN vs. No HTN	–103.496	37.6942	–177.375	–29.616	0.006^*
Ischemic CRVO vs. Non-ischemic CRVO	–101.271	47.1429	–193.669	–8.873	0.032^*
‘High’ concentration section	–349.848	48.5683	–445.040	–254.655	0.000^*
‘Slope’ concentration section	–345.252	32.5841	–409.116	–281.389	0.000^*
‘Low’ concentration section	–105.684	38.1145	–180.387	–30.981	0.006^*
Prior Tx. vs. Naive	–49.371	53.7578	–154.735	55.992	0.358

GEE = generalized estimating equation; CMT = central macular thickness; S.E. = spherical equivalent; CI = confidence interval; DM = diabetes mellitus; HTN = hypertension; CRVO = central retinal vein occlusion; Tx. = treatment.

^* Indicates multivariate GEE.

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