What is the role of dexamethasone therapy in the treatment of central retinal vein occlusion (CRVO)?

Updated: Apr 18, 2019
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Answer

Dexamethasone intravitreal implant

Dexamethasone is a potent, water-soluble corticosteroid that can be delivered to the vitreous cavity by the dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan; Irvine, Calif). A dexamethasone implant is composed of a biodegradable copolymer of lactic acid and glycolic acid containing micronized dexamethasone. The drug-copolymer complex gradually releases the total dose of dexamethasone over a series of months after insertion into the eye through a small pars plana puncture using a customized applicator system.

A 6-month study evaluated the safety and efficacy of dexamethasone implant 0.35 mg and 0.7 mg compared with a sham procedure in eyes with vision loss due to macular edema associated with BRVO and CRVO. [30] In conclusion, the results of the study demonstrated that the dexamethasone implant reduced the risk of further vision loss and increased the chance of improvement in visual acuity in eyes with CRVO.

The percentage of eyes with a greater than or equal to 15-letter improvement in BCVA was significantly higher in both dexamethasone implant groups compared with sham at days 30 to 90 (P< .001). The results of this study further demonstrate that when these eyes were left untreated, a significant percentage will either fail to improve or will experience further loss of visual acuity. The dexamethasone implant was well tolerated, producing generally transient, moderate, and readily managed increases in IOP in less than 16% of eyes. Overall, this study suggests that the DEX implant could be a valuable treatment option for eyes with visual loss due to CRVO.


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