Dexamethasone Intravitreal Implant Rescue Treatment for Bevacizumab Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion
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Purpose: To evaluate the prognostic factors and outcomes of dexamethasone intravitreal implant (DEX implant)for intravitreal bevacizumab refractory macular edema secondary to branch retinal vein occlusion (BRVO). Methods: This was a retrospective, interventional case series. Medical records were reviewed, and a total of38 eyes that were treated with DEX implant for macular edema secondary to BRVO that did not respond toat least two consecutive intravitreal bevacizumab injections (IBIs) were included. Best-corrected visual acuity(BCVA), central subfield macular thickness, and central subfoveal choroidal thickness were evaluated at baseline,2 months, and 6 months after DEX implantation. Results: Patients had undergone an average of 6.32 ± 4.66 prior IBI treatments. The average BCVA improvedfrom 0.53 ± 0.26 to 0.41 ± 0.25 and 0.44 ± 0.23 logarithm of the minimal angle of resolution (logMAR) at 2 and6 months, respectively (p < 0.001). The average central subfield macular thickness was 504.00 ± 121.54 μmat baseline and changed to 293.21 ± 74.17 μm and 427.28 ± 119.57 μm at 2 and 6 months, respectively (p <0.001 and p = 0.002). Average central subfoveal choroidal thickness was 237.46 ± 92.21 μm at baseline andchanged to 204.75 ± 74.74 μm and 226.86 ± 90.77 μm at 2 and 6 months, respectively (p < 0.001 and p = 0.455). Twenty-two eyes (58%) gained ≥0.1 logMAR at 2 months, while 16 eyes showed no improvement. Low BCVAat symptom presentation, low baseline BCVA, and shorter duration of macular edema were correlated withincreased BCVA after treatment. Conclusions: The DEX implant improves functional and anatomical outcomes for up to 6 months in about halfof the patients treated with IBI refractory macular edema secondary to BRVO, particularly in patients with lowinitial and baseline BCVA.
Abstract
Purpose: To evaluate the prognostic factors and outcomes of dexamethasone intravitreal implant (DEX implant)for intravitreal bevacizumab refractory macular edema secondary to branch retinal vein occlusion (BRVO). Methods: This was a retrospective, interventional case series. Medical records were reviewed, and a total of38 eyes that were treated with DEX implant for macular edema secondary to BRVO that did not respond toat least two consecutive intravitreal bevacizumab injections (IBIs) were included. Best-corrected visual acuity(BCVA), central subfield macular thickness, and central subfoveal choroidal thickness were evaluated at baseline,2 months, and 6 months after DEX implantation. Results: Patients had undergone an average of 6.32 ± 4.66 prior IBI treatments. The average BCVA improvedfrom 0.53 ± 0.26 to 0.41 ± 0.25 and 0.44 ± 0.23 logarithm of the minimal angle of resolution (logMAR) at 2 and6 months, respectively (p < 0.001). The average central subfield macular thickness was 504.00 ± 121.54 μmat baseline and changed to 293.21 ± 74.17 μm and 427.28 ± 119.57 μm at 2 and 6 months, respectively (p <0.001 and p = 0.002). Average central subfoveal choroidal thickness was 237.46 ± 92.21 μm at baseline andchanged to 204.75 ± 74.74 μm and 226.86 ± 90.77 μm at 2 and 6 months, respectively (p < 0.001 and p = 0.455). Twenty-two eyes (58%) gained ≥0.1 logMAR at 2 months, while 16 eyes showed no improvement. Low BCVAat symptom presentation, low baseline BCVA, and shorter duration of macular edema were correlated withincreased BCVA after treatment. Conclusions: The DEX implant improves functional and anatomical outcomes for up to 6 months in about halfof the patients treated with IBI refractory macular edema secondary to BRVO, particularly in patients with lowinitial and baseline BCVA.
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