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Intravitreal dexamethasone implant versus triamcinolone acetonide for macular
oedema of central retinal vein occlusion: quantifying efficacy and safety
#MMPMID29632703
Mishra SK
; Gupta A
; Patyal S
; Kumar S
; Raji K
; Singh A
; Sharma V
Int J Retina Vitreous
2018[]; 4
(?): 13
PMID29632703
show ga
PURPOSE: Among the retinal vascular diseases, burden of retinal vein occlusion is
most common immediately after diabetic retinopathy. Intravitreal corticosteroids
are gaining popularity in managing macular edema (ME) of RVO. Our study compares
efficacy and safety of intravitreal triamcinolone (IVTA) and dexamethasone
implant (IVD) over 6 months. METHODS: This comparative, prospective, randomized
study on 40 patients of non-ischemic central RVO with significant ME (>?330 ?m)
of 3 months duration. Study was done at Army Research Hospital between Sep-2012
and May-2014 in accordance to Helsinki Declaration. IVD group (n?=?20) received
Ozurdex(®) while IVTA group (n?=?20) received triamcinolone-acetonide
(4 mg/0.1 ml), followed up at day-1 and weeks 4, 8, 12, 24. RESULTS: At 6 months,
mean improvement in best corrected visual acuity and retinal thickness (CMT) in
the IVD group was 0.43 logmar and 323 ?m and in IVTA group was 0.49 logmar and
322 ?m respectively. Proportion of patients achieving ??15 letters was about 40%
in both groups. IOP rise was significantly higher in IVTA group at 12 and
24 weeks. In IVTA group ??10 mmHg IOP rise was seen in 60% of patients, 41.6%
among them had >?35 mmHg and 66% needed combination treatment and failed to reach
baseline line IOP at 6 months. In IVD group, 5 pts had IOP rise with all being
26 mmHg and were easily managed with single agent with IOP reaching baseline by
6th month in all pts. Relative risk of IOP rise with IVTA is 2.4 times higher
compared to IVD. Cataract progression and cataract surgeries were required at
significantly higher rates in IVTA group. In IVTA group, cataract progression was
seen in 35% patients, with 71.5% requiring cataract surgery at 6 months. IVD
group, 10% patients had cataract progression while none required surgery at
6 months. Relative risk of cataract progression with IVTA is 3.5 times higher
compared to IVD. CONCLUSION: Intravitreal steroids are effective in managing
macular edema of retinal vein occlusion, while newer formulation of sustained
release dexamethasone implant is significantly safer than IVTA.