Cauterization of Ozurdex wound for the prevention of scleral leakage in vitrectomized eyes

A Comparison of Ocular Complications after 0.7 mg Dexamethasone Implant versus 2 mg of Intravitreal Triamcinolone in Vitrectomized Eyes

OBJECTIVE

To compare the rates of complications in eyes that received a dexamethasone (DEX) implant (0.7 mg) or intravitreal triamcinolone (IVT) (2 mg) to treat postvitrectomy macular edema (ME).

DESIGN

Retrospective, comparative, case series.

SUBJECTS

A total of 148 eyes (147 patients); 75 eyes (75 patients) in the DEX group and 73 eyes (72 patients) in the IVT group.

METHODS

The medical records of patients who received an intravitreal DEX 0.7 mg (Ozurdex) or triamcinolone (2 mg) (Triesence) for postvitrectomy ME between July 2014 and December 2021 with a minimum follow-up of 3 months were reviewed. Ocular hypotony and ocular hypertension were defined as intraocular pressure of < 6 mmHg and > 24 mmHg, respectively.

MAIN OUTCOME MEASURES

The rates of complications.

RESULTS

The follow-up duration was 2.5 ± 1.6 years, with no significant difference between the groups (P = 0.398). The rate of transient ocular hypotony per eye and per injection was significantly higher in the DEX group (10 eyes [13%], 30 of 443 injections [7%]) compared with the IVT group (2 eyes [3%], 2 of 262 injections [0.8%]) (P = 0.039 and < 0.001, respectively). Mean visual acuity significantly decreased at the time of ocular hypotony (P = 0.031), but returned to preinjection level after resolution of the hypotony after a median of 12 days. The incidence of ocular hypertension was higher in the DEX group (23 eyes [31%]) than the IVT group (16 eyes [22%]), but this was not statistically significant (P = 0.307). Ocular hypertension was controlled with observation or topical medication. There were no between-group differences in the incidence of vitreous hemorrhage (DEX, 3 eyes [4%]; IVT, 1 eye [1%]; P = 0.632) or rhegmatogenous retinal detachment (DEX, 3 eyes [4%]; IVT, 0 eyes [0%]; P = 0.253). Four eyes (5%) experienced migration of the DEX implant into the anterior chamber. No eye developed endophthalmitis.

CONCLUSION

The incidence of ocular hypotony, which causes transient visual impairment, was significantly higher in vitrectomized eyes treated with DEX compared with eyes treated with IVT. Injections other than the inferotemporal quadrant or rotating injection sites may be recommended.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found after the references.

Safety of nurse-led intravitreal injection of dexamethasone (Ozurdex) implant service. Audit of first 1000 cases

PURPOSE

To assess the safety of nurse-led services of intravitreal injection of dexamethasone implant.

METHODS

An audit of intravitreal injection of dexamethasone implant service in our unit revealed a significant delay in the delivery of injection from the time a clinical decision was made. The limiting factors were an inadequate number of injectors and limited capacity. The constraint in capacity was addressed by moving the service from the theatre to the cleanroom in the outpatients setting. Two senior nurse practitioners in the existing pool of injectors, experienced in intravitreal anti-VEGF injection, were trained to deliver the intravitreal dexamethasone implant service. A safety audit was carried out after they had completed 1000 cases.

RESULTS

The nurse practitioners administered 1006 injections from February 2017 to October 2019. There was no case of endophthalmitis (0%) or other visually significant complications like retinal detachment, vitreous haemorrhage, hypotony or iatrogenic cataract. One patient had incomplete scleral penetration of the implant, but this resolved without any sequelae. The waiting time to inject the implant nearly halved from 29.5 to 15 days in the nurse-led service. A patient satisfaction survey was overwhelmingly positive, with the majority advocating for the continuation of the nurse-led service.

CONCLUSION

The current cohort of experienced nurses providing anti-VEGF injections can be trained under supervision to inject the intravitreal dexamethasone implant (Ozurdex). This is safe, additionally effective in streamlining the service and reducing the waiting time for delivery of the steroid implant.