SD-OCT Pattern of Retinal Venous Occlusion with Cystoid Macular Edema Treated with Ozurdex®

Abstract

Purpose

To report our experience with sustained-release dexamethasone 0.7 mg intravitreal implant (Ozurdex®; Allergan, Inc., Irvine, CA) in retinal vein occlusion with macular edema.

Methods

A prospective study of a series of 9 patients with recent retinal vein occlusion with macular edema treated with sustained-release dexamethasone 0.7 mg intravitreal implant was performed. Complete ophthalmic examination including visual acuity, fundus biomicroscopy, fundus photography, fluorescein angiography, and spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) was performed at baseline and follow-up (1 week, 1 month, and 3 months), and tolerability of the implant was assessed.

Results

Nine eyes of 9 consecutive patients treated with a total of 9 sustained-release dexamethasone 0.7 mg intravitreal implants for macular edema associated with retinal vein occlusion were included. Five patients had central retinal vein occlusion and 4 patients had branch retinal vein occlusion. Accentuated ischemia was associated in 2/5 patients with central retinal vein occlusion. All eyes showed SD-OCT evidence of decreased edema following implant placement (mean decrease in central retinal thickness 320 μm). All eyes showed decrease of serous detachment of the neurosensory retina (not present in 7/9 cases at 1 month). Intraretinal central cyst resolved in 7/9 cases; small peripheral cysts were persistent in only 2/9 cases. Spectral domain optical coherence tomography demonstrated the presence and the integrity of external limiting membrane and inner and outer segments (IS/OS) of the photoreceptors in 6/9 cases at month 3. Forty percent of patients gained ≥10 letters of best-corrected visual acuity at 3 months. The safety profile was consistent with the results of a previous phase III trial of Ozurdex®, and no serious ocular or systemic adverse events were observed during the follow-up period.

Conclusions

In patients with macular edema in retinal vein occlusion, sustained-release dexamethasone 0.7 mg intravitreal implant may be an effective treatment option to control macular edema. At the final visit, foveal thickness was decreased to physiologic levels in all eyes. In parallel with resolution of the macular edema, visual acuity was significantly improved at the final visit. However, final visual acuity in eyes with still interrupted or thickened IS/OS interface was significantly poorer than that in eyes with a normal IS/OS line.

Keywords

Cystoid macular edema Dexamethasone implant Ischemia Ozurdex®Retinal vein occlusion Spectral domain optical coherence tomography

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