THE OMAR STUDY: Comparison of Ozurdex and Triamcinolone Acetonide for Refractory Cystoid Macular Edema in Retinal Vein Occlusion.

PURPOSE: To compare the risks and benefits of adding either intravitreal dexamethasone implant (DEX) or preservative-free triamcinolone acetonide (TA) to bevacizumab monotherapy in refractory cystoid macular edema due to retinal vein occlusion. METHODS: This is a multicenter, comparative, interventional, retrospective study that included 74 patients who were initially treated with intravitreal bevacizumab and later received either DEX or TA for the treatment of recalcitrant cystoid macular edema due to retinal vein occlusion. Main outcomes were best-corrected visual acuity, central macular thickness, cost of therapy, frequency of intravitreal injections, and side effects. RESULTS: Thirty-nine patients received TA and 35 patients received DEX injections. Groups were similar in age and gender distribution. Although the mean central macular thickness improved significantly for all groups (P < 0.0001), logMAR best-corrected visual acuity did not change significantly after steroid introduction (P = 0.06). Frequency of any intravitreal injection decreased significantly from 0.66 ± 0.18 to 0.26 ± 0.08 injections per month after initiation of steroids (P < 0.0001). This effect was greater in the DEX groups (P < 0.0001). Monthly cost decreased with TA but increased with DEX. CONCLUSION: Adding steroids improved anatomical outcome but did not affect final vision. Injection frequency decreased significantly after adding steroids, more so with DEX. There was no difference between TA and DEX regarding anatomical or functional outcomes or the incidence of side effects.

Use of 25% sulfur hexafluoride gas mixture may minimize short-term postoperative hypotony in sutureless 25-gauge pars plana vitrectomy surgery.

BACKGROUND: The purpose of this study was to compare postoperative intraocular pressures and percentage of vitreous cavity gas fill one day following 25-gauge pars plana vitrectomy with 20% versus 25% sulfur hexafluoride (SF6) gas fill. METHODS: This was a retrospective review of 187 consecutive cases of 25-gauge pars plana vitrectomy with complete fluid/gas exchange. The main outcome measures included percentage of gas fill of the vitreous cavity and intraocular pressure on postoperative day one. RESULTS: Fifty eyes underwent 25-gauge pars plana vitrectomy with 20% SF6 tamponade and 137 with 25% SF6 tamponade. On postoperative day one in the 20% SF6 group, there were five (10%) patients with hypotony (intraocular pressure ≤ 5 mmHg) and none in the 25% SF6 group. Mean intraocular pressure was 9 ± 2.5 mmHg and 16.8 ± 2.4 mmHg for the 20% SF6 and 25% SF6 groups, respectively (P < 0.01). None of the patients had postoperative intraocular pressure > 23 mmHg. Mean vitreous cavity gas fill on postoperative day one was 70.7% ± 10% in the 20% SF6 group and 89.5% ± 2.2% in the 25% SF6 group (P < 0.01). There was no difference in the number of phakic patients needing cataract surgery between the groups. CONCLUSION: A slightly expansile concentration of 25% SF6 gas can be safely and beneficially used in 25-gauge vitrectomy surgery to increase the amount of gas fill in the vitreous cavity and prevent postoperative hypotony.