The Clinical Effect Of Dexamethasone Intravitreal Implant On Macular Edema Secondary To Retinal Vein Occlusion

Objective:To observe the efficacy and safety of intravitreal dexamethasone implant(Ozurdex)for the treatment of macular edema(ME)secondary to retinal vein occlusion(RVO),and explore the prognostic factors of RVO patients.Methods:A retrospective Study.A total of 35 patients with RVO secondary to ME diagnosed in the affiliated Hospital of Qingdao University from June 2018 to January 2020 were selected as the research subjects for the study.According to whether they were ischemic,the patients were divided into the non-ischemic group(22 eyes)and the ischemic group(13 eyes);according to the baseline central macular thickness(CMT),the patients were divided into the CMT≤600μm group(18 eyes)and the CMT>600μm group(17 eyes);according to the existence of serous retinal detachment(SRD),the patients were divided into the non-SRD group(20 eyes)and the SRD group(15 eyes).All patients were intravitreously injected with Ozurdex.The best corrected visual acuity(BCVA),CMT,intraocular pressure(IOP),recurrence rate and adverse reactions were observed and compared at each time point(before implantation,14 d,1,2,3,4,5 and 6mo after implantation).To explore the prognostic factors of patients with RVO,BCVA,CMT and the recurrence rate of patients were compared between different characteristics groups at the same time.Results:1.Changes of BCVA,CMT and safety results after treatment(1)From 14 d to 6mo after treatment,compared with pre-treatment the difference of BCVA was statistically significant(all P < 0.001),BCVA of patients from 14 d to 6mo after treatment was better than that before treatment.(2)From 14 d to 6mo after treatment,compared with pre-treatment the difference of CMT was statistically significant(all P < 0.001),CMT of patients from 14 d to 6mo after treatment was lower than that before treatment.(3)From 14 d to 3mo after treatment,compared with pre-treatment the difference of IOP was statistically significant(all P < 0.05),IOP of patients from 14 d to 3mo after treatment was higher than that before treatment.A total of 16 eyes(45.71%)of ME recurred during the 6mo follow-up after treatment,with an average recurrence time of 4.31±0.97 months.After re-implantation the BCVA was still improved in relapsed patients.No serious complications such as cataract progression,vitreous hemorrhage,endophthalmitis occurred in all patients after treatment.2.Comparison between the non-ischemic group and the ischemic group(1)The BCVA of the non-ischemic group from 14 days to 6 months after implantation was higher than that before implantation(all P < 0.05).The BCVA of the ischemic group from 14 days to 5 months after implantation was higher than that before implantation(all P < 0.05).From 14 days to 6 months after implantation,BCVA in the non-ischemic group was better than that in the ischemic group(all P < 0.05).(2)After 14 days to 6 months of implantation,the CMT of the non-ischemic group was lower than that before implantation(all P < 0.05).After 14 days to 5 months of implantation,CMT in the ischemic group was lower than that before implantation(all P <0.05).After 4 to 6 months of implantation,CMT in the non-ischemic group was lower than that in the ischemic group(all P < 0.05).(3)The recurrence rate of ME in the non-ischemic group was lower than the ischemic group(P < 0.05).3.Comparison between the CMT≤600μm group and the CMT > 600μm group(1)From 14 days to 6 months after implantation,BCVA in the CMT≤600μm group and the CMT > 600μm group both increased compared with before implantation(all P <0.05).Compare the main effects: BCVA in the CMT≤600μm group was better than the CMT > 600μm group(P < 0.05).(2)From 14 days to 6 months after implantation,CMT in the CMT≤600μm group and the CMT > 600μm group both decreased compared with before implantation(all P <0.05).The CMT of the CMT≤600μm group was lower than that of the CMT > 600μm group at 14 days,5 months and 6 months after implantation(all P < 0.05).(3)The recurrence rate of ME in the CMT≤600μm group was lower than that in the CMT > 600μm group(P < 0.05).4.Comparison between the non-SRD group and the SRD group(1)From 14 days to 6 months after implantation,BCVA in the non-SRD group was higher than that before implantation(all P < 0.05).From 14 days to 4 months after implantation,BCVA in the SRD group was higher than that before implantation(all P <0.05).At 4,5 and 6 months after implantation,BCVA in the non-SRD group was better than that in the SRD group(all P < 0.05).(2)From 14 days to 6 months after treatment,CMT in the non-SRD group and the SRD group both decreased compared with before treatment(all P < 0.05).At 4,5 and 6months after treatment,CMT in the non-SRD group was lower than that in the SRD group(all P < 0.05).(3)The recurrence rate of ME in the non-SRD group was lower than that in the SRD group(P < 0.05).5.Analysis of influencing factors for prognosis of patients with RVOMultiple linear regression analysis showed that ischemic,baseline CMT > 600μm and SRD were independent prognostic factors for BCVA in RVO patients(all P<0.05).conclusion:1.Ozurdex can improve BCVA and reduce CMT in patients with ME secondary to RVO.2.In some RVO patients,ME will relapse after Ozurdex implantation.Patients with non-ischemic,baseline CMT≤600μm and without SRD had a lower recurrence rate and a better prognosis than patients with ischemic,baseline CMT > 600μm and with SRD.3.The most important complication after Ozurdex implantation is the increase of IOP in patients,which requires close attention to the IOP changes of patients after implantation.