Acta Ophthalmologica 2014

Seddon JM, Sharma S & Adelman RA (2006): Evaluation of the clinical age-related maculopathy staging system. Ophthalmology 113: 260–266.

Correspondence: Dr. Jorge Sa a Unidad de Investigaci on Fundaci on Hospital de Jove Avda. Eduardo Castro s/n 33290 Gij on, Spain Tel: +34 985320050 Ext. 84216 Fax: +34 985315710 Email: [email protected]

Dexamethasone intravitreal implants for retinal vein occlusion in a clinical setting Valerie Krivosic, 1 Anishta Bheekee, 2,3 Sylvain Michee, 1 Marie Noelle Delyfer, 2,3 Ramin Tadayoni 1 and Jean Francßois Korobelnik 2,3 1

Department of Ophthalmology, H^ opital Lariboisiere, AP-HP, Universite Paris 7, Paris, France; 2Department of Ophthalmology, CHU de Bordeaux, Universite Bordeaux Selagen, Bordeaux, France; 3INSERM, ISPED, U897, Epidemiologie Biostatistique, Bordeaux, France doi: 10.1111/aos.12395

Editor, tandard treatments of macular oedema (ME) due to retinal vein occlusion (RVO) include macular laser photocoagulation (The Branch Vein Occlusion Study Group 1986), intravitreal injections of antivascular endothelial growth factor agents (Brown et al. 2010; Boyer et al. 2012) and intravitreal corticosteroid injection. Recently, a sustained-release biodegradable dexamethasone intravitreal implant (DEX implant; Ozurdexâ; Allergan, Inc., Irvine, Calif.) has been shown to reduce ME and improve visual acuity (VA) in patients with RVO (Haller et al. 2010, 2011). The aim of our study was to report the results and safety of DEX implant in clinical settings. The charts of 55 consecutive patients were reviewed. As a general rule, DEX

implant was not used for patients requiring more than one medication to control their intraocular pressure (IOP), having undergone filtering surgery or with a history of steroidinduced IOP. During the treatment period, patients attended consultations every 2 months. At each visit, a complete eye examination was performed with best corrected visual acuity (BCVA) measurement using the ETDRS chart and OCT assessment of central macular thickness (CMT) (SDOCT, Spectralisâ, HRA Heidelberg, Heidelberg, Germany and Cirrus OCT, Carl Zeiss, Dublin, CA, USA). Reinjections were done from the 4th month of follow-up, when the retinal thickness was greater than 250 lm and a 2-line BCVA loss was observed. Changes in BCVA and CMT from baseline were analysed using a paired student’s t-test with significance level at ≤0.05. The main safety parameter measured was the IOP changes. Increased IOP was defined when intraocular pressure (IOP) rose above 24 mmHg or IOP increased by 10 mmHg. Patients’ mean age was 66  12 years. Proportions of central and branch RVO among studied eyes were 54% and 46%, respectively. The mean BCVA (LogMar) was 0.69  35 at baseline, increased significantly to 0.54  0.42 at 2 months (p < 0.001) and then decreased to 0.57  0.42 at 6 months and 0.64  0.53 at 12 months. A 15-letter gain in BCVA from baseline

was achieved by 32% and 22% of eyes at 2 and 12 months, respectively. At 2 months, the mean CMT significantly decreased from 589  178 lm at baseline to 300  103 lm (range: 184–787) (p < 0.001), with a mean reduction of 289  75 lm. At 6 and 12 months, the mean CMT was of 386  192 lm (range: 181–962) (p < 0.001) and 293  111 lm (range: 216–575) (p < 0.001), respectively. Reinjections were needed in 43%, 58% and 56% of patients at 4, 6 and 12 months, respectively. After 4, 6 and 12 months of follow-up, 58%, 42% and 11% of patients had only one injection, respectively. We observed a mean interval of 5 months between the first and second injection and 5 months between the second and third injection. Two months after DEX implant injection, the IOP was elevated in 28% of patients. These patients were successfully managed with topical IOP-lowering medication. None required laser or surgical intervention. These IOP results were similar to those of the GENEVA study, where IOP-lowering medication was needed in 26% of cases (Haller et al. 2011). Our results were also in accordance with the GENEVA study in terms of efficacy on VA and ME (Haller et al. 2010, 2011), but differed in terms of duration of DEX implant efficacy and frequency of reinjections. Indeed, differently from the Geneva study where no control visit was done between the

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(A)

(B)

(C) Fig. 1. Case of a patient with macular oedema due to central retinal vein occlusion on his left eye. (A) Optical coherence tomography (OCT) scan before treatment showing a cystoid macular oedema. Visual acuity was of 20/40. (B) OCT scan 2 months after one dexamethasone intravitreal injection. The macular oedema disappeared and the visual acuity increased to 20/32. (C) OCT scan 4 months after the injection. The macular oedema relapsed and the visual acuity was of 20/50.

Acta Ophthalmologica 2014

3rd and 6th months, we performed assessments every 2 months to detect recurrences with shorter delay. Our results point out the need for reinjection every 5 months, with good results on CMT and VA in real life (Fig. 1). Financial disclosures outside the subject of this work: Dr Krivosic received honoraria for board membership, consultancy, lectures and received reimbursement of travel and meeting expenses from Allergan, Bayer and Novartis. Dr Bheekee has no financial disclosure. Dr Michee has no financial disclosure. Dr Delyfer has no financial disclosure. Pr Tadayoni received honoraria for board membership, consultancy, lectures and educational presentation, and received reimbursement of travel and meeting expenses from Alcon, Allergan, Alimera, Bausch & Lomb, Bayer, Dorc, FCI, Novartis, Pfizer, Servier and Takeda. Pr Korobelnik received honoraria for board membership, consultancy, lectures and educational presentation, and received reimbursement of travel and meeting expenses from Alcon, Allergan, Bayer, Carl Zeiss Meditec, Novartis, Roche and Thea.

References Boyer D, Heier J, Brown DM et al. (2012): Vascular endothelial growth factor TrapEye for macular edema secondary to central retinal vein occlusion: six-month results of the phase 3 COPERNICUS study. Ophthalmology 119: 1024–1032. Brown DM, Campochiaro PA, Singh RP, Li Z, Saroj N, Rundle AC, Rubio RG, Murahashi WY & CRUISE Investigators (2010): Ranibizumab for macular edema following central retinal vein occlusion sixmonth primary end point results of a phase III study. Ophthalmology 117: 1124–1133. Haller JA, Bandello F, Belfort R Jr et al. (2010): Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 117: 1134– 1146. Haller JA, Bandello F, Belfort R Jret al. (2011): Dexamethasone intravitreal implant in patients with macular edema related to branch or central retinal vein occlusion twelve-month study results. Ophthalmology 118: 2453–2460. The Branch Vein Occlusion Study Group (1986): Argon laser scatter photocoagulation for prevention of neovascularization and vitreous hemorrhage in branch vein

occlusion. A randomized clinical trial. Arch Ophthalmol 104: 34–41.

Correspondence Valerie Krivosic, MD Department of Ophthalmology H^ opital Lariboisiere 2 rue Ambroise Pare 75010 Paris, France Tel: +33149956488 Fax: +33149956483 Email: [email protected]

Comparison of burn size after retinal photocoagulation by conventional and high-power short-duration methods Tomoyasu Shiraya,1 Satoshi Kato,1 Takashi Shigeeda,1 Takuhiro Yamaguchi2 and Tadayoshi Kaiya3 1

Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; 2Division of Biostatistics, Graduate School of Medicine, Tohoku University, Sendai, Japan; 3Kaiya Eye Clinic, Hamamatsu, Japan doi: 10.1111/aos.12393

Editor, ecently, the method of retinal photocoagulation has been advanced through the use of a new tool, the Pattern-scanning laser (PASCALâ; TOPCON Corp, Tokyo, Japan). This new approach results in much smaller burns. According to a report by Maeshima et al. (2004), the laser scars were larger after use of the conventional method (overall, 89.5%; posterior pole, 12.7%; peripheral, 7.0%). Muqit et al. (2010) reported a 35% reduction in burn size with use of the short-duration method. However, the authors evaluated the results of photocoagulation 4 weeks after treatment, and their report lacked any description of burn features. Herein, we compared the medium-term rate of burn expansion after retinal photocoagulation performed using conventional versus highpower short-duration methods.

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Subjects were classified into two groups based on whether they underwent the conventional method or the highpower short-duration method for the treatment of ischemic retina in eyes with a history of branch retinal vein occlusion (BRVO) or pan-retinal photocoagulation in eyes with signs of diabetic retinopathy (DR). The study included 400 photocoagulation spots (20 laser spots per one eye) from 20 eyes (BRVO: nine eyes; DR: 11 eyes) of 20 patients treated with the conventional method of photocoagulation and 140 photocoagulation spots from seven eyes (BRVO: two eyes; DR: seven eyes) of seven patients treated with the high-power short-duration method of photocoagulation. Each procedure was performed by the same operator (K.T.). The conventional method was applied to a size of 200 lm at 100–150 mW (121.4  24.1 mW) for 200 millisecond (using the NOVUS Omniâ; Lumenis, Yokneam, Israel), whereas the high-power short-duration method was applied at 400 mW for 20 millisecond (using the Pascalâ: Topcom) to make barely discernible burn. For the conventional, photocoagulation was performed in the green wavelength with use of the PASCALâ. Preplaced Mainster PRP165 lenses (Ocular Instruments Inc., Bellevue, WA, USA) were used for photocoagulation in both groups. Burn size in the posterior pole area was measured by one physician blinded to group assignment, based on hi assessment of digital fundus photographs, which were taken twice after photocoagulation. The area of the photocoagulation spot was calculated by multiplying the vertical and horizontal diameters of 20 spots on the posterior pole outside the macula vessels in the digitalized photographs (Fig. 1). If the selected 20 spots were not clear in both sets of fundus photographs, the pair was excluded from the trial. The first and second digital fundus photographs were taken after 64.9  17.6 days and 211.1  43.0 days in the conventional photocoagulation group and after 50.3  39.7 days and 215.6  57.8 days in the high-power short-duration photocoagulation group, respectively. There were no significant differences in the interval between measurements between the groups. We applied linear-regression analysis to estimate the slope of the expansion rate. The generalized estimating equations (GEE) approach was used to

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Dexamethasone intravitreal implants for retinal vein occlusion in a clinical setting.

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