Outcome of Intravitreal Dexamethasone Implant Use in Uveitic Eyes Undergoing Pars Plana Vitrectomy Surgery

Figures & data

Table 1. Baseline characteristics of eyes with noninfectious uveitis receiving intravitreal dexamethasone at the time of pars plana vitrectomy

No.	Age	Sex	Eye	Uveitis Category	Etiology	Lens Status	CME	Surgery Indication	Systemic therapy	Previous ocular treatments
1	55	F	OS	Panuveitis	Postoperative	Pseudophakic	Yes	VO, CME	No	Anti-VEGF, PRP
2	25	F	OD	Intermediate	Idiopathic	Phakic	Yes	VO	Mycophenolate	OFI
3	77	F	OD	Panuveitis	Idiopathic	Pseudophakic	Yes	ERM, VO	No	OFI, IVTA, DEX
4	52	M	OS	Panuveitis	Idiopathic	Pseudophakic	Yes	ERM, VO	MTX, Adalimumab	DEX
5	54	F	OS	Posterior	Postoperative	Pseudophakic	Yes	CME, ERM	No	OFI
6	87	F	OS	Posterior	Postoperative	Pseudophakic	Yes	Vitreous prolapse, lens exchange, ERM	No	Anti-VEGF
7	67	F	OS	Posterior	Sarcoidosis	Pseudophakic	Yes	ERM, VO	Steroids, MTX	OFI, IVTA
8	84	F	OD	Panuveitis	Idiopathic	Pseudophakic	Yes	ERM	Steroids	No
9	79	F	OD	Intermediate	Idiopathic	Pseudophakic	Yes	ERM	No	OFI, DEX
10	56	M	OD	Posterior	Trauma	Pseudophakic	Yes	ERM, VO	No	OFI
11	62	M	OD	Posterior	Postoperative	Pseudophakic	Yes	CME, ERM	No	OFI, IVTA, DEX
12	68	M	OD	Anterior	Postoperative	Pseudophakic	Yes	Oil Removal	No	PPV
13	50	F	OS	Intermediate	Idiopathic	Pseudophakic	Yes	ERM, VO	No	No
14	51	F	OS	Panuveitis	Idiopathic	Phakic	No	ERM, VO	No	No

Abbreviations: CME, cystoid macular edema; ERM, epiretinal membrane; VO, vitreous opacities; MTX, methotrexate; VEGF, vascular endothelial growth factor; PRP, panretinal photocoagulation; OFI, orbital floor injection; IVTA, intravitreal triamcinolone acetate; DEX, intravitreal dexamethasone implant; PPV, pars plana vitrectomy.

Table 2. Treatments before and after intravitreal dexamethasone implant in uveitic eyes undergoing pars plana vitrectomy

Treatment*	Preoperative treatments No. eyes (%)	Postoperative treatments No. eyes (%)
Any treatment or procedure	11/14 (78.6)	6/14 (42.9)
Any intraocular/periocular injection, n (%)	10/14 (71.4)	6/14 (42.9)
Periorbital steroid injections	6/14 (42.9)	1/14 (7.1)
IVTA	3/14 (21.4)	0/14 (0.0)
DEX implant	4/14 (28.6)	2/14 (14.3)
Fluocinolone acetonide implant (0.19 mg or 0.59 mg)	0/14 (0.0)	3/14 (21.4)
PPV, n (%)	1/14 (7.1)	1/14 (7.1)^†
Systemic medication	4/14 (28.6)	2/14 (14.3)
Prednisone	2/14 (14.3)	1/14 (7.1)
Single IMT	2/14 (14.3)	1/14 (7.1)
Dual IMT	1/14 (7.1)	1/14 (10.5)

Abbreviations: PPV, pars plana vitrectomy; DEX, dexamethasone (ozurdex) implant; VEGF, vascular endothelial growth factor; IVTA, intravitreal triamcinolone acetate; IMT, immunomodulatory treatment.

*Patients could receive multiple or repeated treatments before and after PPV + DEX.

^†Repeat PPV to remove adherent DEX implant from macula.

Table 3. Clinical outcomes including visual acuity, vitreous haze score and central macular thickness after intravitreal dexamethasone implant in uveitic eyes undergoing pars plana vitrectomy

Outcome measure	Baseline	2 weeks	1 month	3 months	6 months	9 months	12 months
VA, LogMAR Mean ± SD	0.84 ± 0.64	0.74 ± 0.54	0.65 ± 0.55	0.46 ± 0.38	0.42 ± 0.36	0.32 ± 0.19	0.56 ± 0.72
IOP, mmHg Mean ± SD	16.1 ± 4.4	14.8 ± 5.8	20 ± 7.5	17.5 ± 5.3	11.5 ± 4.7	15.8 ± 5.1	13.4 ± 3.3
VHS, n (%)
0	6 (42.9)	12 (92.3)	12 (100)	12 (92.3)	9 (81.8)	9 (90)	6 (85.7)
+0.5	4 (28.6)	0	0	1 (7.7)	1 (9.1)	1 (10)	1 (14.3)
+1	2 (14.3)	0	0	0	1 (9.1)	0	0
+2	1 (7.1)	0	0	0	0	0	0
+3	0	0	0	0	0	0	0
+4	0	1*	0	0	0	0	0
CST, µm Mean ± SD	469 ± 182	389 ± 104	380 ± 183	338 ± 112	320 ± 60	369 ± 178	295 ± 46
Total, n	n = 14	n = 13	n = 11	n = 13	n = 11	n = 10	n = 7

Abbreviations: CST, central subfield thickness; IOP, intraocular pressure; VA, visual acuity; VHS, vitreous haze score.

*Single patient with postoperative fibrin syndrome.

Figure 1. Probability of clinically improved macular edema after intravitreal dexamethasone implant treatment in uveitic eyes undergoing pars plana vitrectomy (defined as ≥20% reduction in central subfield thickness). Dotted lines represent the 95% confidence interval.

Figure 2. Probability of visual acuity increase defined as ≥0.3 logMAR improvement after intravitreal dexamethasone implant treatment in uveitic eyes undergoing pars plana vitrectomy. Dotted lines represent the 95% confidence interval.

Table 4. Adverse effects after intravitreal dexamethasone implant in uveitic eyes undergoing pars plana vitrectomy

Safety parameter	Proportion of eyes (%)
Hypotony	1/14 (7.1)
Inadvertent retinal trauma	1/14 (7.1)
Postoperative fibrin syndrome	1/14 (7.1)
Glaucoma surgery	0/14 (0)
Initiation of IOP-lowering meds due to steroid response	6/14 (42.9)
IOP elevation
≥10 mmHg increase from baseline at any visit	7/14 (50.0)
≥20 mmHg at any visit	0/14 (0)
IOP elevation at final visit
≥10 mmHg increase from baseline at final visit	1/14 (7.1)
≥20 mmHg at final visit	0/14 (0)

Abbreviations: IOP, intraocular pressure.

Figure 3. Probability of intraocular pressure increase ≥5 mmHg and ≥10 mmHg from baseline after intravitreal treatment in uveitic eyes undergoing pars plana vitrectomy.

Figure 4. Probability of repeat treatment with steroid implants, including dexamethasone implant or fluocinolone acetonide (Retisert), after intravitreal dexamethasone implant treatment in uveitic eyes undergoing pars plana vitrectomy. Dotted lines represent the 95% confidence interval.