Sir,
The letter ‘Local safety of repeated intravitreal Ozurdex’ by Hernández-Martinez et al1 highlights the impact of intravitreal Dexamethason-implant (Ozurdex) on lens opacification. They showed in a retrospective review that four out of five (BRVO) or six (CRVO) eyes receiving a second Ozurdex showed a progression of cataract requiring surgery. As the Geneva study has shown,2 Ozurdex is an effective treatment option for macular edema due to RVO. While our study3 confirms these data, it furthermore shows a significant progression in cataract formation after the third intravitreal injection. Therefore, it is mandatory to consider along with age and intraocular pressure the lens status when using intravitreal Ozurdex. In the mentioned retrospective case series by Hernández-Martinez et al, it is not clear whether there is a progression of an existing cataract to a cataract requiring surgery or clear lenses showing a beginning of cataract formation. Furthermore, no objective classification of lens opacification was assessed to show which kind of lens opacification shows a significant progression requiring surgery. It is also necessary to investigate recurrence rates, treatment intervals and the data should be supplemented by a clear follow-up time. We agree that long-term follow-up data are needed to confirm present observations. As the adequate treatment of macular edema due to RVO is still a challenge, treatment possibilities including intravitreal steroids, anti-VEGF substances, laser photocoagulation or combinations are safe and effective options after taking into account the pathogenesis of retinal vein occlusion.
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13 March 2014
This article has been corrected since online publication and a corrigendum is also printed in this issue.
References
Hernández-Martínez P, Gallego-Pinazo R, Martínez-Castillo S, Dolz-Marco R, Díaz-Llopis M . Local safety of repeated intravitreal Ozurdex. Eye 2014; 28 (3): 361–362.
Haller JA, Bandello F, Belfort R Jr, Blumenkranz MS, Gillies M, Heier J et alOZURDEX GENEVA Study Group. Randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion. Ophthalmology 2010; 117 (6): 1134–1146.e3.
Mayer WJ, Wolf A, Kernt M, Kook D, Kampik A, Ulbig M et al. Twelve-month experience with Ozurdex for the treatment of macular edema associated with retinal vein occlusion. Eye 2013; 27 (7): 816–822.
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Mayer, W., Wolf, A., Kernt, M. et al. Response to Hernández-Martínez et al. Eye 28, 362 (2014). https://doi.org/10.1038/eye.2013.261
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DOI: https://doi.org/10.1038/eye.2013.261