title: EFFICACY OF DEXAMETHASONE INTRAVITREAL IMPLANT FOR REFRACTORY MACULAR EDEMA CAUSED BY RETINAL VEIN OCCLUSION.
abstract: OBJECTIVE
  To investigate efficacy of dexamethasone intravitreal (DEX) implant in treating refractory macular edema caused by retinal vein occlusion.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  Twenty-two eyes with refractory macular edema caused by retinal vein occlusion were treated with a mean of 2.2 DEX over 12 months. Patient had previously received a mean of 7 treatments (laser, bevacizumab, and/or triamcinolone) for macular edema present for at least 4 months duration (mean 20.8 ± 17.6 months, range 4-72 months) before starting DEX. Mean baseline visual acuity was 20/91, and mean central subfield thickness was 506 μm. DEX improved mean best-corrected visual acuity to 20/75 and 20/66 at 7 weeks and 6 months follow-up, although it worsened to 20/132 at 12 months. Mean central subfield thickness improved to 292, 352, and 356 μm at 7 weeks, 6 months, and 12 months follow-up, respectively. There was a statistically significant association between number of DEX treatments and central subfield thickness (P = 3.28 × 10). There was a statistically significant association between number of days followed and best-corrected visual acuity (P = 0.006). Six of 12 (50%) phakic patients developed visually significant cataract requiring surgery. Five of 22 (23%) patients developed ocular hypertension (intraocular pressure > 30) and consequently did not undergo further treatment with DEX.
  
  
  CONCLUSIONS
  DEX resulted in sustained anatomical reduction of retinal vein occlusion-associated refractory macular edema, although this did not translate into long-term best-corrected visual acuity improvement in either phakic or pseudophakic patients, possibly related to chronic structural alterations in the retina despite reduction of edema.
authors.affiliation: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Rehan M
authors.initials: RM
authors.lastname: Hussain
authors.affiliation: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN.|Retina Service, Midwest Eye Institute, Indianapolis, IN.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Ciulla
authors.affiliation: Retina Service, Midwest Eye Institute, Indianapolis, IN.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Ciulla
authors.affiliation: Retina Service, Midwest Eye Institute, Indianapolis, IN.
authors.forename: Bethany
authors.initials: B
authors.lastname: Sink
authors.affiliation: Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Alon
authors.initials: A
authors.lastname: Harris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage*; D004343:Drug Implants; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D008269:Macular Edema / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012170:Retinal Vein Occlusion / Q000150:complications*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000893:Anti-Inflammatory Agents; D004343:Drug Implants; D005938:Glucocorticoids; D003907:Dexamethasone