Aim To assess the effectiveness of intravitreal dexamethasone implants for treating postsurgical macular oedema (PSMO) including Irvine–Gass syndrome and determining the predictive factors of treatment response.
Methods Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. One hundred patients were included between April 2011 and June 2014, with a minimum of 1-year follow-up. Patients received dexamethasone implant 0.7 mg at baseline. Clinical characteristics, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and intraocular pressure were measured at each visit. The main outcome measure was the change in BCVA (Early Treatment of Diabetic Retinopathy Study (ETDRS) letters: L). An analysis of predictive factors of treatment response is also provided.
Results Mean improvement in BCVA was 9.6 (±10.6) L at month 6 and 10.3 (±10.7) L at month 12 (p<0.001). The proportion of eyes with gains in BCVA of 15 or more letters was 32.5% and 37.5% at months 6 and 12, respectively. The mean reduction in CSMT was 135.2 and 160.9 µm at months 6 and 12, respectively (p<0.001). Thirty-seven per cent of patients did not need a second injection after the first injection during follow-up. The presence of at least one PSMO risk factor decreases the probability of a gain in visual acuity (VA) ≥10 L (p=0.006). Initial VA ≤50 L at baseline and non-naïve status decrease the probability of having only one injection during follow-up (p=0.044).
Conclusions The significant gain in BCVA from baseline achieved at month 6 was maintained at month 12 after intravitreal injection of dexamethasone implant. Naïve status seems to be a good predictive factor of treatment response.
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Contributors DB and LK were the principal investigators who conceived and designed the study. NV was the trial statistician and undertook the analyses. DB, LK, VP-K, FM, CB, CD, JA, SM, SB, VS, BW, CS, AM and MW participated to patients’ recruitment. This manuscript was drafted by DB, revised by LK and approved by all living authors.
Competing interests VP-K––has sat on advisory boards and received lecture fees from Allergan, Bayer and Novartis; FM––investigator for trials sponsored by Novartis, Bayer and Alcon; has sat on advisory boards for Allergan and Bayer; received lecture fees from Allergan, Bayer and Novartis; CD––reports personal fees from Allergan, Alcon, Bayer and Novartis, outside the submitted work; JA––co-investigator for the trial sponsored by Novartis; has sat on advisory boards for Allergan and Bayer; received lecture fees from Allergan, Bayer and Novartis; SM––investigator for trials sponsored by Bayer and Novartis; received lecture fees from Alcon, Allergan, Bayer, Essilor and Novartis; SB––sat on advisory boards for Novartis, Bayer and Allergan; BW––sat on advisory boards for Novartis; MW––has sat on advisory boards for Alcon, Alimera, Allergan, Bayer, FCI, Novartis and Théa; received lecture fees from Alcon, Alimera, Allergan, Bayer, Novartis and Théa; LK––principal investigator for trials sponsored by Novartis, Bausch&Lomb, Théa and Alcon; has sat on advisory boards for Alcon, Alimera, Allergan, Bayer, Bausch&Lomb, Novartis and Théa; received lecture fees from Alcon, Alimera, Allergan, Bayer, Bausch&Lomb, Novartis and Théa.
Provenance and peer review Not commissioned; externally peer reviewed.