Dexamethasone: intravitreal implant

Macular oedema is one of the complications of retinal vein occlusion. About half of the patients recover spontaneously within 3 to 6 months. There is currently no drug that improves outcome. An intravitreal implant delivering 0.7 mg of dexamethasone has been authorised for the treatment of macular oedema in this setting. Clinical assessment is based on two double-blind randomised trials including a total of 1267 patients, comparing treatment with intravitreal implants delivering about 0.7 mg or 0.35 mg of dexamethasone, versus a sham procedure. Despite a more rapid initial improvement with dexamethasone, the number of patients whose reading ability improved at 6 months did not significantly differ between the groups. A retrospective subgroup analysis raised the possibility that dexamethasone implants may be beneficial in patients with central retinal vein occlusion. The adverse effects of dexamethasone intravitreal implants are the same as those of intraocular steroid injections, including elevated intraocular pressure (25% of patients), cataracts (27%), conjunctival haemorrhage (20%), and ocular pain. In practice, dexamethasone intravitreal implants do not have a positive harm-benefit balance in most patients with macular oedema following retinal vein occlusion. More rapid recovery after central vein occlusion remains to be confirmed. Pending such studies, it is better to avoid using dexamethasone implants. Patients should instead receive ophthalmologic monitoring to detect and manage possible complications, and any risk factors should be treated.