Bilateral intravitreal injection of antivascular endothelial growth factor therapy.

PURPOSE: The purpose of this study was to review adverse events and patient preference after bilateral intravitreal injection of antibodies to vascular endothelial growth factor. METHODS: A retrospective case-control study. Patients with exudative age-related macular degeneration who received intravitreal antivascular endothelial growth factor agent injections in both eyes (bilateral group) on the same day over a 23-month period were compared with patients who received injections in only 1 eye. The occurrence of endophthalmitis, cerebrovascular accident, myocardial infarction, death, patient discomfort, and patient preference was compared between the two groups. RESULTS: One hundred and two patients received an average of 4.43 bilateral injections (range 1-13). A case-control group of 102 patients received an average of 10.2 unilateral injections, (range 2-28). Bevacizumab was injected 45.5%, ranibizumab 45.5%, and a combination of bevacizumab and ranibizumab 9% of the time for bilateral injections. Bevacizumab was used 50.3% and ranubizumab 49.7% of the time in unilateral injections. The follow-up of both groups averaged 18.4 months (range 4.7-36.5 months). There were no cases of endophthalmitis or cerebrovascular accident in either group. There was a single case of myocardial infarction in each group. There were two deaths in the bilateral group and three deaths in the unilateral group. More than 90% strongly preferred bilateral injections to unilateral injections. CONCLUSION: Bilateral injections of antivascular endothelial growth factor agents on the same day did not increase the rate of adverse events and was preferred by the majority of patients.

Resolution of refractory macular edema because of branch retinal vein occlusion after ozurdex implantation.

PURPOSE: To report a case of a woman with a branch vein occlusion and macular edema refractory to grid laser, intravitreal bevacizumab, pars plana vitrectomy with sheathotomy of the arteriovenous branch site, and intravitreal triamcinolone, who had complete resolution of fluid after injection of a dexamethasone intravitreal implant (DEX implant, Ozurdex; Allergan, Inc, Irvine, CA). METHODS: A 75-year-old woman with a branch vein occlusion and macular edema was treated with grid laser, intravitreal bevacizumab, pars plana vitrectomy with sheathotomy, and intravitreal triamcinolone. Neither edema nor vision improved. She was treated with an Ozurdex intravitreal implant. RESULTS: One month after Ozurdex intravitreal implantation, the patient's visual acuity and edema had improved dramatically. The macula remained flat until 5 months after injection when the edema returned and a second Ozurdex was injected. One month later, the macular edema was significantly less and visual acuity had improved to 20/50 with pinhole. CONCLUSION: Ozurdex may be effective in reducing macular edema because of a branch retinal vein occlusion in eyes refractory to multiple other treatments.