title: Long-term results of combination therapy using anti-VEGF agents and dexamethasone intravitreal implant for retinal vein occlusion: an investigational case series.
abstract: BACKGROUND
  One limitation of anti-VEGF therapy is the need for monthly retreatment to maintain efficacy. The purpose of this study was to determine the duration of effect in eyes with macular edema (ME) secondary to branch or central retinal vein occlusion (BRVO or CRVO) treated with anti-VEGF therapy plus sustained-release dexamethasone (DEX implant; Ozurdex).
  
  
  METHODS
  This open-label, interventional case series included 62 eyes with ME due to RVO, central foveal thickness (CFT) >300 μm, and best-corrected visual acuity (BCVA) of 20/40 or worse. Each treatment cycle included an anti-VEGF injection followed 2 weeks later with DEX implant. Patients were eligible for retreatment if CFT increased to >290 μm or increased by >50 μm from the lowest measurement, or if BCVA decreased by six or more Snellen letters. Efficacy and safety were evaluated 2 and 4-6 weeks after the beginning of each treatment cycle and every 4 weeks thereafter until retreatment criteria were met. The primary outcome measure was time to retreatment. Secondary outcome measures included BCVA, CFT, and safety parameters.
  
  
  RESULTS
  The mean reinjection interval for all patients was 135.5±36.4 days. There was no statistically significant difference in mean intertreatment interval for up to six cycles of treatment or between eyes with BRVO or CRVO (P≥0.058). Mean peak change in BCVA was 13.8 letters, and 47.6% of eyes gained three or more lines of BCVA. The mean peak decrease in CFT across all treatment cycles was 200.9 μm for eyes with BRVO and 219.2 μm for eyes with CRVO. The percentage of patients with CFT ≤300 μm at any time during a given treatment cycle ranged from 78% to 94% among eyes with BRVO and from 85% to 100% among eyes with CRVO. Intraocular pressure increased in 19 of 62 eyes, and 26 of 44 phakic eyes underwent cataract surgery.
  
  
  CONCLUSIONS
  In eyes with ME due to RVO, treatment with an anti-VEGF agent plus DEX implant provided a predictable duration of effect, as well as significant improvements in BCVA and CFT.
authors.affiliation: Medical Center Ophthalmology Associates.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Singer
authors.affiliation: University of Texas Health and Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Jansen
authors.affiliation: University of Texas Health and Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Lyndon
authors.initials: L
authors.lastname: Tyler
authors.affiliation: Medical Center Ophthalmology Associates.
authors.forename: Paul
authors.initials: P
authors.lastname: Woods
authors.affiliation: University of Texas Health and Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Faisal
authors.initials: F
authors.lastname: Ansari
authors.affiliation: University of Texas Health and Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Udit
authors.initials: U
authors.lastname: Jain
authors.affiliation: Medical Center Ophthalmology Associates.
authors.forename: Joshua
authors.initials: J
authors.lastname: Singer
authors.affiliation: Medical Center Ophthalmology Associates.
authors.forename: Darren
authors.initials: D
authors.lastname: Bell
authors.affiliation: Medical Center Ophthalmology Associates.
authors.forename: Chelsey
authors.initials: C
authors.lastname: Krambeer
keywords: dexamethasone; intravitreal; macular edema; retinal vein occlusion