Dexamethasone Implant Improves Visual Acuity in Macular Edema

The subset of patients who receive intravitreal dexamethasone implants (IDIs) to treat macular edema (ME) who have phakic eyes are likely to experience visual acuity improvements, but may be at increased risk for a rise in intraocular pressure (IOP), according to findings presented at the American Academy of Ophthalmology (AAO) 2022 annual meeting. The conference was held September 30 through October 3, 2022, in Chicago, Illinois.

Investigators at the University of Arkansas for Medical Sciences (UAMS) Health sourced data for this study from 16 centers in the United Kingdom. Patients (N=1550) who received an IDI for ME from retinal vein occlusion or branch retinal vein occlusion were evaluated for clinical and visual outcomes. Elevated IOP was defined as higher than 21 mm Hg, or the need for IOP-lowering medications.

Eyes had ME from branch retinal vein occlusion (55.6%) or central retinal vein occlusion (44.4%), 80.6% were treatment naïve, and 28% had elevated IOP.

Following the first IDI treatment, mean visual acuity improved from 0.80 (standard deviation [SD], 0.48) logMAR at baseline to 0.27 (SD, 0.45) logMAR. Stratified by phakic status, phakic eyes were more likely to have an increase in IOP of 10 mm Hg or greater (14.2% vs 5.4%; P =.004) compared with pseudophakic eyes, respectively.

Few eyes (0.7%) require IOP-filtering surgery and the probability of cataract surgery at 24 months was 15%.

This study was limited by its retrospective design and as with any study of patient records, these data may have included missing or miss-coded information.

The study authors concluded that following IDI for ME from retinal vein occlusion or branch retinal vein occlusion, overall, visual acuity improved significantly from baseline. Clinicians should be aware that some phakic eyes may be at increased risk for IOP rise following IDI.