Intravitreal Dexamethasone Implant Versus Anti-VEGF Injection for Treatment-naïve Patients with Retinal Vein Occlusion and Macular Edema: a 12-month Follow-up Study

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2015 Feb 13

PMID 25673251

Citations 15

Authors

C Chiquet

C Dupuy

A M Bron

F Aptel

M Straub

R Isaico

J P Romanet

C Creuzot-Garcher

Affiliations

Soon will be listed here.

Abstract

Purpose: The objective of his study was to compare the visual and anatomical outcomes in treatment-naïve patients with macular edema secondary to retinal vein occlusion after intravitreal injections of dexamethasone implants (DEX) and anti-VEGF.

Methods: One hundred two patients (64 in the anti-VEGF group, 38 in the DEX group) without previous treatment were included in this multi-center retrospective study and evaluated at baseline and 1, 3, 6, and 12 months after the onset of treatment. Patients were defined as "good responders" if central macular thickness (CMT) was less than or equal to 250 μm in TD-OCT or 300 μm in SD-OCT after the injections.

Results: At month 3 (n = 102), BCVA had increased significantly, by 0.1 ± 0.3 logMAR in the anti-VEGF group (p = 0.04) and 0.4 ± 0.4 logMAR in the DEX group (p < 0.001); the difference between the two groups was statistically significant (p = 0.007). CMT decreased significantly, by 138 ± 201 μm (-19 %, p < 0.001) in the anti-VEGF group and 163 ± 243 μm (-21 %, p < 0.001) in the DEX group. After 3 months, five patients (13 %) in the DEX group and 20 (31 %) in the anti-VEGF group (p < 0.001) changed treatment. Among the 77 patients who did not switch from their initial treatment, no significant functional or anatomical difference between the two groups was observed at months 6 and 12. Elevation of intraocular pressure > 21 mmHg was more frequent in the DEX group (21 %) than in the anti-VEGF group (3 %, p = 0.008).

Conclusions: Visual acuity recovery was better in the DEX group than in the anti-VEGF group at month 3, but with no difference in CMT. In patients who did not change treatment, the long-term anatomical and visual outcome was similar between the DEX and anti-VEGF groups.

Citing Articles

Long term efficacy and safety profile of dexamethasone intravitreal implant in retinal vein occlusions: a systematic review.

Carnevali A, Bacherini D, Metrangolo C, Chiosi F, Viggiano P, Astarita C Front Med (Lausanne). 2024; 11:1454591.

PMID: 39678032 PMC: 11641122. DOI: 10.3389/fmed.2024.1454591.

Intravitreal Dexamethasone Implant Switch after Anti-VEGF Treatment in Patients Affected by Retinal Vein Occlusion: A Review of the Literature.

Vitiello L, Lixi F, Coppola A, Abbinante G, Gagliardi V, Salerno G J Clin Med. 2024; 13(17).

PMID: 39274219 PMC: 11395781. DOI: 10.3390/jcm13175006.

Prospective evaluation of the effectiveness of combined treatment of macular edema secondary to retinal vein occlusion with intravitreal bevacizumab and dexamethasone implants.

Moreno-Lopez M, de-Arriba-Palomero P, de-Arriba-Palomero F, Ituruburu F, Dompablo E, Negrete F Arq Bras Oftalmol. 2022; 86(3):255-262.

PMID: 35319651 PMC: 11826545. DOI: 10.5935/0004-2749.20230040.

Clinical Use of Dexamethasone Implants in Resistant Macular Edema Secondary to Branch Retinal Vascular Occlusion Compared with Intravitreal Anti-Vascular Endothelial Growth Factor.

Eris E, Perente I, Erdogan G, Seymen Z, Sucu M, Ozkaya A Beyoglu Eye J. 2022; 4(1):11-16.

PMID: 35187425 PMC: 8842035. DOI: 10.14744/bej.2019.63835.

Anti-vascular endothelial growth factor for macular oedema secondary to branch retinal vein occlusion.

Shalchi Z, Mahroo O, Bunce C, Mitry D Cochrane Database Syst Rev. 2020; 7:CD009510.

PMID: 32633861 PMC: 7388176. DOI: 10.1002/14651858.CD009510.pub3.

References

Brown D, Campochiaro P, Singh R, Li Z, Gray S, Saroj N . Ranibizumab for macular edema following central retinal vein occlusion: six-month primary end point results of a phase III study. Ophthalmology. 2010; 117(6):1124-1133.e1. DOI: 10.1016/j.ophtha.2010.02.022. View

Chakravarthy U, Harding S, Rogers C, Downes S, Lotery A, Wordsworth S . Ranibizumab versus bevacizumab to treat neovascular age-related macular degeneration: one-year findings from the IVAN randomized trial. Ophthalmology. 2012; 119(7):1399-411. DOI: 10.1016/j.ophtha.2012.04.015. View

Holladay J . Proper method for calculating average visual acuity. J Refract Surg. 1997; 13(4):388-91. DOI: 10.3928/1081-597X-19970701-16. View

Kreutzer T, Alge C, Wolf A, Kook D, Burger J, Strauss R . Intravitreal bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol. 2008; 92(3):351-5. DOI: 10.1136/bjo.2007.123513. View

McIntosh R, Rogers S, Lim L, Cheung N, Wang J, Mitchell P . Natural history of central retinal vein occlusion: an evidence-based systematic review. Ophthalmology. 2010; 117(6):1113-1123.e15. DOI: 10.1016/j.ophtha.2010.01.060. View

Brown D, Campochiaro P, Bhisitkul R, Ho A, Gray S, Saroj N . Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion: 12-month outcomes of a phase III study. Ophthalmology. 2011; 118(8):1594-602. DOI: 10.1016/j.ophtha.2011.02.022. View

Haller J, Bandello F, Belfort Jr R, Blumenkranz M, Gillies M, Heier J . Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology. 2010; 117(6):1134-1146.e3. DOI: 10.1016/j.ophtha.2010.03.032. View

Haller J, Bandello F, Belfort Jr R, Blumenkranz M, Gillies M, Heier J . Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology. 2011; 118(12):2453-60. DOI: 10.1016/j.ophtha.2011.05.014. View

Campochiaro P, Brown D, Awh C, Lee S, Gray S, Saroj N . Sustained benefits from ranibizumab for macular edema following central retinal vein occlusion: twelve-month outcomes of a phase III study. Ophthalmology. 2011; 118(10):2041-9. DOI: 10.1016/j.ophtha.2011.02.038. View

10.

Krebs I, Schmetterer L, Boltz A, Told R, Vecsei-Marlovits V, Egger S . A randomised double-masked trial comparing the visual outcome after treatment with ranibizumab or bevacizumab in patients with neovascular age-related macular degeneration. Br J Ophthalmol. 2013; 97(3):266-71. DOI: 10.1136/bjophthalmol-2012-302391. View

11.

Kriechbaum K, Michels S, Prager F, Georgopoulos M, Funk M, Geitzenauer W . Intravitreal Avastin for macular oedema secondary to retinal vein occlusion: a prospective study. Br J Ophthalmol. 2008; 92(4):518-22. DOI: 10.1136/bjo.2007.127282. View

12.

Hansen L, Danisevskis P, Arntz H, Hovener G, Wiederholt M . A randomised prospective study on treatment of central retinal vein occlusion by isovolaemic haemodilution and photocoagulation. Br J Ophthalmol. 1985; 69(2):108-16. PMC: 1040535. DOI: 10.1136/bjo.69.2.108. View

13.

Bhisitkul R, Campochiaro P, Shapiro H, Rubio R . Predictive value in retinal vein occlusions of early versus late or incomplete ranibizumab response defined by optical coherence tomography. Ophthalmology. 2013; 120(5):1057-63. DOI: 10.1016/j.ophtha.2012.11.011. View

14.

Conrath J, Giorgi R, Raccah D, Ridings B . Foveal avascular zone in diabetic retinopathy: quantitative vs qualitative assessment. Eye (Lond). 2004; 19(3):322-6. DOI: 10.1038/sj.eye.6701456. View

15.

Battaglia Parodi M, Iacono P, De Benedetto U, Cascavilla M, Bandello F . Rebound effect after intravitreal dexamethasone implant for the treatment of macular edema secondary to central retinal vein occlusion. J Ocul Pharmacol Ther. 2012; 28(6):566-8. DOI: 10.1089/jop.2012.0016. View

16.

Campochiaro P, Hafiz G, Channa R, Shah S, Nguyen Q, Ying H . Antagonism of vascular endothelial growth factor for macular edema caused by retinal vein occlusions: two-year outcomes. Ophthalmology. 2010; 117(12):2387-2394.e1-5. DOI: 10.1016/j.ophtha.2010.03.060. View

17.

Risard S, Pieramici D, Rabena M, Basefsky J, Avery R, Castellarin A . Intravitreal ranibizumab for macular edema secondary to central retinal vein occlusion. Retina. 2011; 31(6):1060-7. DOI: 10.1097/IAE.0b013e3181fbce76. View

18.

Mayer W, Remy M, Wolf A, Kook D, Kampik A, Ulbig M . Comparison of intravitreal bevacizumab upload followed by a dexamethasone implant versus dexamethasone implant monotherapy for retinal vein occlusion with macular edema. Ophthalmologica. 2012; 228(2):110-6. DOI: 10.1159/000338732. View

19.

Stahl A, Agostini H, Hansen L, Feltgen N . Bevacizumab in retinal vein occlusion-results of a prospective case series. Graefes Arch Clin Exp Ophthalmol. 2007; 245(10):1429-36. DOI: 10.1007/s00417-007-0569-6. View

20.

Kodjikian L, Souied E, Mimoun G, Mauget-Faysse M, Behar-Cohen F, Decullier E . Ranibizumab versus Bevacizumab for Neovascular Age-related Macular Degeneration: Results from the GEFAL Noninferiority Randomized Trial. Ophthalmology. 2013; 120(11):2300-9. DOI: 10.1016/j.ophtha.2013.06.020. View