Article Date: 4/1/2013

Ozurdex/Grid Laser Combination Therapy for CRVO

Case 1. Ozurdex/Grid Laser Combination Therapy for CRVO

A 49-year-old female reporting one day of vision loss OD presented to our retina service on 1/14/2011 seeking treatment and a second opinion. The day before, at a different institution, she had been diagnosed with CRVO and advised that one month of observation was the best course of action.

Fundus photography and fluorescein angiography showed CRVO OD with no neovascularization (Figure 1). OCT was unable to accurately measure retinal thickness due to severe thickening. Thickness was approximately 1,200 microns (Figure 2). Visual acuity was 20/400. Because of the patient’s young age, we ordered a hypercoagulability work-up, which was positive for Protein S deficiency.

On the day the patient presented, we inserted dexamethasone intravitreal implant 0.7 mg (Ozurdex) OD. Three weeks later, vision improved to 20/30 and we performed grid laser OD (Figure 3). For the next 3 months, the patient did not require additional treatment. Three months after Ozurdex implantation and grid laser treatment (Figures 4 and 5), her visual acuity was 20/30 and her IOP was 15 mmHg. One year follow-up revealed that no further treatments were necessary and her vision was stable at 20/30.

— Case provided by Seenu M. Hariprasad, MD

Case 2. Anti-VEGF/Ozurdex Combination Therapy for BRVO

We first treated this 93-year-old female patient for BRVO in June 2009. Throughout the course of her treatment, rebound macular edema has been problematic. After she was initially treated with four anti-VEGF injections, we implanted Ozurdex. Since November 2009, she received numerous anti-VEGF injections and a total of five Ozurdex implants. Each implant allowed her to go without additional treatment for 3 to 6 months. She was able to switch to a Lucentis/Ozurdex combination in October 2010 and stayed dry until insurance issues prevented her from receiving combination therapy. She now requires monthly Avastin injections.

Figures 1 through 6 illustrate her SD-OCT results at select times. At the last of her visits shown here, August 2012, 3 years and 2 months after her first treatment, her visual acuity was 20/80 and she received an anti-VEGF injection. We have continued to follow and treat her as needed.

— Case provided by Michael M. Singer, MD

Case 3. Anti-VEGF/Ozurdex Combination Therapy for BRVO

We diagnosed BRVO in this 82-year-old female patient in June 2009. We treated her with three Avastin injections. Two weeks after the third injection, her visual acuity was 20/30-2 and her macular center point thickness according to SD-OCT was 318 microns and we implanted Ozurdex. Three months later, in January 2010, we gave an anti-VEGF injection in an attempt to prolong her response to treatment. When her macular edema recurred 2 months after the injection, we gave another anti-VEGF injection and followed it in 2 weeks with a second Ozurdex implant. With the second steroid implant in place, the patient did not require additional treatment for the next 15 months. Figures 1 through 6 show her SD-OCT image results throughout this timeframe in her treatment.

— Case provided by Michael M. Singer, MD

Retinal Physician, Issue: April 2013