Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy

Josh Wallsh, Behnam Sharareh, Ron GallemoreRetina Macula Institute, Torrance, CA, USAPurpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.M...

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Autores principales:	Wallsh J, Sharareh B, Gallemore R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Retinal vein occlusion intravitreal dexamethasone implant multifocal electroretinography Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/31dc4928569d4401a65cbf276975d2d6
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spelling	oai:doaj.org-article:31dc4928569d4401a65cbf276975d2d62021-12-02T06:09:04ZTherapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy1177-5483https://doaj.org/article/31dc4928569d4401a65cbf276975d2d62016-05-01T00:00:00Zhttps://www.dovepress.com/therapeutic-effect-of-dexamethasone-implant-in-retinal-vein-occlusions-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Josh Wallsh, Behnam Sharareh, Ron GallemoreRetina Macula Institute, Torrance, CA, USAPurpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.Methods: A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points.Results: All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P<0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P<0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 µm at 4 months (P<0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P<0.05) in this patient population and partially limited analysis of other end points.Conclusion: DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.Keywords: retinal vein occlusion, intravitreal dexamethasone implant, multifocal electroretinography, anti-VEGF, cataract progressionWallsh JSharareh BGallemore RDove Medical PressarticleRetinal vein occlusionintravitreal dexamethasone implantmultifocal electroretinographyOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2016, Iss Issue 1, Pp 947-954 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Retinal vein occlusion intravitreal dexamethasone implant multifocal electroretinography Ophthalmology RE1-994
spellingShingle	Retinal vein occlusion intravitreal dexamethasone implant multifocal electroretinography Ophthalmology RE1-994 Wallsh J Sharareh B Gallemore R Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
description	Josh Wallsh, Behnam Sharareh, Ron GallemoreRetina Macula Institute, Torrance, CA, USAPurpose: To test the efficacy of the intravitreal dexamethasone (DEX) implant in patients with retinal vein occlusions (RVOs) who have failed multiple anti-vascular endothelial growth factor (anti-VEGF) treatments.Methods: A randomized exploratory study of ten patients with branch RVO or central RVO who received at least two previous anti-VEGF treatments and had persistent or unresponsive cystoid macular edema. Treatment with the DEX implant was either every 4 months or pro re nata (PRN) depending on their group assignment for 1 year. Multifocal electroretinography and microperimetry were the primary end points, with high-resolution optical coherence tomography and best-corrected visual acuity as the secondary end points.Results: All patients in both the every 4 month and PRN cohorts who completed the study received the three maximal injections of DEX; therefore, the data from both cohorts were combined and reported as a case series. On average, the multifocal electroretinography amplitude increased significantly from 5.11±0.66 to 24.19±5.30 nV/deg2 at 12 months (P<0.005), mean macular sensitivity increased from 7.67±2.10 to 8.01±1.98 dB at 4 months (P=0.32), best-corrected visual acuity increased significantly from 51.0±5.1 to 55.4±5.1 early treatment of diabetic retinopathy study letters at 2 months (P<0.05), and central retinal thickness decreased from 427.6±39.5 to 367.1±37.8 µm at 4 months (P<0.05). Intraocular pressure increased significantly in one patient, with that patient requiring an additional glaucoma medication for management. Additionally, cataract progression increased significantly (P<0.05) in this patient population and partially limited analysis of other end points.Conclusion: DEX should be considered as a treatment option in patients with RVOs who have failed anti-VEGF therapy, as the results of this study demonstrated an improvement in retinal morphology and macular function. Cataract progression did occur following multiple consecutive injections; however, steroid-induced glaucoma was not a limiting factor.Keywords: retinal vein occlusion, intravitreal dexamethasone implant, multifocal electroretinography, anti-VEGF, cataract progression
format	article
author	Wallsh J Sharareh B Gallemore R
author_facet	Wallsh J Sharareh B Gallemore R
author_sort	Wallsh J
title	Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
title_short	Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
title_full	Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
title_fullStr	Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
title_full_unstemmed	Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy
title_sort	therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-vegf therapy
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/31dc4928569d4401a65cbf276975d2d6
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Therapeutic effect of dexamethasone implant in retinal vein occlusions resistant to anti-VEGF therapy

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