Título

INTRAVITREAL DEXAMETHASONE IMPLANT IN REFRACTORY ISCHEMIC MACULAR EDEMA: A CASE REPORT

Introdução / Purpose

Present a case of Intravitreal dexamethasone use as intravitreal therapy for refractory cystoid macular edema in a patient diagnosed with superior branch retinal vein occlusion(BRVO) and discuss about Ozurdex® safety and efficacy.

Material e Método / Methods

A case of a patient with ischemic macular edema due to branch retinal vein occlusion in the left eye followed up. Submitted in the period to anti vascular endothelial growth factor the patient evolved to refractory cystoid macular edema (CME) after the last 5th injection and was efficiently treated with intravitreal Ozurdex® without the observation of any complications.

Resultados / Results

Cystoid macular edema a main cause of decreased visual acuity following branch retinal vein occlusions, and can be a source of significant patient morbidity. It isn’t well defined if the stromal leakage occurs due to hydrodynamic changes from the obstruction or to chemical mediators however its known that increased vascular permeability associated with high levels of vascular endothelial growth factor (VEGF), combined with inflammatory factors release such as IL-6, IL-8 and Prostaglandins plays a significant role in its physiopathology.
Ozurdex® is a biodegradable intravitreal drug delivery implant providing sustained release of 0.7mg of corticosteroid, modulating the mediators acting on formation of cystoid macular edema.

Discussão e Conclusões / Discussion

In several studies, anti-VEGF agents are considered the preferred initial therapy for treatment of macular edema related to retinal occlusions, being shown to be both safe and effective in treating the edema as well as in limiting the neovascularization associated with BRVO.
Considering its physiopathology corticosteroids should be considered an excellent choice when there is a failure to respond or an inadequate response, especially in pseudophakic patient without history of ocular hypertension. Ozurdex® might even be helpful for an immediate benefit and may also improve the ability to deliver a complete and proper laser treatment when necessary.

Palavras Chave

Branch Retinal Vein Occlusion ; Macular Edema ; Refractory