Initial Ten Years of Experience with the Intravitreal Dexamethasone Implant: A Retrospective Chart Review

Figures & data

Table 1 Patient Demographics

	BRVO	CRVO	Uveitis	DME	Total
Patients	79	58	128	43	270
Eyes	90	59	154	62	315
Age (years)
Mean ± SEM	69.5 ± 1.0	70.1 ± 2.0	67.4 ± 1.2	68.3 ± 1.6	68.7 ± 0.7
Gender
Male: Female	46: 33	36: 22	65: 63	23: 20	145: 125
Lens Status
Phakic: Pseudophakic	36: 54	34: 25	30: 124	18: 44	107: 208
Previously Treated Eyes*
Amount (%)	77 (85.5%)	54 (91.5%)	118 (76.6%)	57 (91.%)	261 (82.5%)
Intravitreal anti-VEGF	74 (82.2%)	53 (89.8%)	89 (57.7%)	57 (91.%)	229 (72.4%)
Subtenon Kenalog	3 (3.3%)	2 (3.38%)	50 (32.4%)	4 (6.4%)	58 (18.3%)
Intravitreal Steroid	15 (16.6%)	9 (15.2%)	45 (29.2%)	19 (30.%)	77 (24.3%)
Focal Laser Photocoagulation	28 (31.1%)	11 (18.6%)	14 (9.0%)	31 (50%)	64 (20.2%)
Panretinal Photocoagulation	26 (28.8%)	14 (23.7%)	14 (9.0%)	31 (50%)	63 (19.9%)
Concurrent Anti-VEGF Treatment
Amount (%)	45 (50.0%)	33 (55.9%)	54 (35.1%)	32 (51.6%)	145 (46.0%)
Length of Treatment (days)
Mean ± SEM	300.1 ± 49.1	442.7 ± 78.4	565.4 ± 52.5	247.4 ± 35.30	447.4 ± 32.3
Total DEX Injections	247	206	744	153	1216

Note: *Treatments included intravitreal anti-VEGF injections, steroid injections, focal and panretinal photocoagulation.

Abbreviations: SEM, standard error of means; DEX, intravitreal dexamethasone implants; BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema.

Figure 1 Comparison of best-corrected visual acuity from baseline to final visit for each cohort and all studied eyes. *Statistically significant (p < 0.05).

Abbreviations: BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema.

Figure 2 Comparison of central macular thickness on optical coherence tomography (OCT) from baseline to final visit for each cohort and all studied eyes. * Statistically significant (p < 0.05).

Abbreviations: BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema.

Figure 3 Change in BCVA compared to baseline following each DEX injection. Each graphed line includes only those patients who received at least the amount of DEX injections noted in the legend. Decreasing values signify improvement in BCVA. The BCVA values were recorded preferentially at the follow-up visit closest to six weeks after DEX injection and at least four weeks after treatment date. (A) All studied eyes, (B) BRVO, (C) CRVO, (D) DME, and (E) uveitis.

Abbreviations: BCVA, best-corrected visual acuity; BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema.

Figure 4 Comparison of baseline and final visit BCVA and CMT results for DME cohort based on lens status (pseudophakic throughout, phakic throughout, or underwent cataract surgery during study). Those eyes that underwent cataract surgery did so after an average of 1.6±0.2 DEX implants. The average change in BCVA and CMT was compared across each subgroup utilizing a Student’s t-test. Based on BCVA the following p-values were calculated: pseudophakic vs phakic –0.60, pseudophakic vs cataract surgery –0.83, and phakic vs cataract surgery –0.62. For CMT data the following p-values were calculated: pseudophakic vs phakic –0.09, pseudophakic vs cataract surgery –0.04, phakic vs cataract surgery 0.62.

Abbreviations: BCVA, best-corrected visual acuity; CMT, central macular thickness; DEX, intravitreal dexamethasone implant.

Table 2 Uveitis Cohort Supplemental Information

Etiology	Eyes (Percent)
Idiopathic	135 (87.6%)
Birdshot	7 (4.5%)
Retinitis Pigmentosa	7 (4.5%)
HLA-B27	2 (1.2%)
Vogt-Koyanagi-Harada	2 (1.2%)
Psoriasis	1 (0.6%)
Concurrent Oral Steroid Therapy	Eyes (Percent)
Yes	8 (5.1%)
No	146 (94.8%)
Concurrent Immunomodulatory Therapy	Eyes (Percent)
Yes	12 (7.7%)
No	142 (92.2%)
Eyes with >1 Year of Follow-up After Completing DEX Treatment (n=95)
Intravitreal or Periocular Injection During Follow-up	Eyes (Percent)
Yes	58 (61.0%)
No	37 (38.9%)
Eyes without Additional Injections (n=39)	Mean ± SEM
Length of Follow-up (years)	4.6 ± 0.3
BCVA at DEX Treatment Completion	0.47 ± 0.08
BCVA at Most Recent Follow-up	0.59 ± 0.11*

Note: *Compared to DEX Treatment Completion (p < 0.05).

Abbreviations: DEX, intravitreal dexamethasone implant; BCVA, best-corrected visual acuity.

Figure 5 Uveitis cohort subgroup analysis with evaluation of the change in BCVA for various patient characteristics. Improvement in BCVA noted for the vitrectomized eyes, eyes without glaucoma diagnosis, age less than 60 years old, CMT greater than or equal to 400 µm and baseline visual acuity greater than or equal to 20/60. * Statistically significant (p < 0.05).

Abbreviations: BCVA, best-corrected visual acuity; CMT, central macular thickness.

Figure 6 Best-corrected visual acuity in eyes undergoing cataract surgery compared from baseline (prior to initiation of intravitreal dexamethasone implant treatment) to the final visit. *Statistically significant (p < 0.05).

Abbreviations: BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema.

Table 3 Complications

Intraocular Pressure	BRVO	CRVO	Uveitis	DME	Total
Baseline (mmHg)
Mean ± SEM	14.4 ± 0.5	15.0 ± 0.5	14.7 ± 0.3	15.1 ± 0.7	14.7 ± 0.2
Final Visit (mmHg)
Mean ± SEM	16.0 ± 0.4	16.0 ± 0.8	15.3 ± 0.4	16.3 ± 0.6	15.8 ± 0.2
Lens Change in Phakic Patients	BRVO	CRVO	Uveitis	DME	Total
Cataract Progression
Amount (% of Phakic Patients)	6 (16.6%)	9 (26.4%)	2 (6.6%)	4 (22.2%)	17 (15.8%)
Cataract Surgery
Amount (% of Phakic Patients)	10 (27.7%)	12 (35.2%)	23 (79.3%)	5 (27.7%)	46 (42.9%)
Cataract Surgery or Progression
Amount (% of Phakic Patients)	16 (44.4%)	21 (61.7%)	25 (83.3%)	9 (50%)	63 (58.8%)
Other Complications	BRVO	CRVO	Uveitis	DME	Total
Incisional Glaucoma Surgery
Amount (%)	1 (1.11%)	3 (5.08%)	18 (11.6%)	0 (0%)	22 (6.9%)
Anterior Chamber DEX Migration
Amount (%)	0 (0%)	0 (0%)	2 (1.30%)	0 (0%)	2 (0.6%)
Endophthalmitis
Amount (%)	0 (0%)	0 (0%)	3 (1.96%)	0 (0%)	3 (0.9%)
Vitreous Hemorrhage
Amount (%)	0 (0%)	1 (1.69%)	1 (0.65%)	0 (0%)	2 (0.6%)

Abbreviations: SEM, standard error of means; BRVO, branch retinal vein occlusion; CRVO, central retinal vein occlusion; DME, diabetic macular edema; DEX, intravitreal dexamethasone implant.

Table 4 Maximum Intraocular Pressure

All Eyes
Maximum IOP
Mean ± SEM	19.8 ± 0.3
Number of DEX to Maximum IOP
Mean ± SEM	2.1 ± 0.1
Time to Maximum IOP (days)
Mean ± SEM	224.51 ± 20.9
Eyes with Max IOP >25 mmHg or Change ≥10 mmHg (n = 68)
Number of DEX to Maximum IOP
Mean ± SEM	3.2 ± 0.5
Time to Maximum IOP (days)
Mean ± SEM	347.6 ± 63.5
Maximum IOP After 1 DEX
Amount (% of Eyes)	34 (50.0%)
Maximum IOP After ≤2 DEX
Amount (%)	45 (66.1%)
Maximum IOP After ≤3 DEX
Amount (%)	55 (80.8%)
Maximum IOP After ≤6 Months
Amount (%)	34 (50%)

Abbreviations: SEM, standard error of means; IOP, intraocular pressure; DEX, intravitreal dexamethasone implant.