Pro-Permeability Factors After Dexamethasone Implant in Retinal Vein Occlusion; the Ozurdex for Retinal Vein Occlusion (ORVO) Study.

Abstract

PURPOSE:

To correlate aqueous vasoactive protein changes with macular edema after dexamethasone implant in retinal vein occlusion (RVO).

DESIGN:

Prospective, interventional case series.

METHODS:

Twenty-three central RVO (CRVO) and 17 branch RVO (BRVO) subjects with edema despite prior anti-vascular endothelial growth factor (VEGF) treatment had aqueous taps at baseline and 4 and 16 weeks after dexamethasone implant. Best-corrected visual acuity (BCVA) and center subfield thickness were measured every 4 weeks. Aqueous vasoactive protein levels were measured by protein array or enzyme-linked immunosorbent assay.

RESULTS:

Thirty-two vasoactive proteins were detected in aqueous in untreated eyes with macular edema due to RVO. Reduction in excess foveal thickness after dexamethasone implant correlated with reduction in persephin and pentraxin 3 (Pearson correlation coefficients = 0.682 and 0.638, P = .014 and P = .003). Other protein changes differed among RVO patients as edema decreased, but ≥50% of patients showed reductions in hepatocyte growth factor, endocrine gland VEGF, insulin-like growth factor binding proteins, or endostatin by ≥30%. Enzyme-linked immunosorbent assay in 18 eyes (12 CRVO, 6 BRVO) showed baseline levels of hepatocyte growth factor and VEGF of 168.2 ± 20.1 pg/mL and 78.7 ± 10.0 pg/mL, and each was reduced in 12 eyes after dexamethasone implant.

CONCLUSIONS:

Dexamethasone implants reduce several pro-permeability proteins providing a multitargeted approach in RVO. No single protein in addition to VEGF can be implicated as a contributor in all patients. Candidates for contribution to chronic edema in subgroups of patients that deserve further study include persephin, hepatocyte growth factor, and endocrine gland VEGF.

• Authors: Peter A Campochiaro, Gulnar Hafiz, Tahreem A Mir, Adrienne W Scott, Raafay Sophie, Syed M Shah, Howard S Ying, Lili Lu, Connie Chen, J Peter Campbell, Saleema Kherani, Ingrid Zimmer-Galler, Adam Wenick, Ian Han, Yannis Paulus, Akrit Sodhi, Guohua Wang, Jiang Qian
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 160 Issue 2 Pg. 313-321.e19 (Aug 2015) ISSN: 1879-1891 [Electronic] United States
• PMID: 25908486 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Drug Implants
• Glucocorticoids
• Dexamethasone

Topics

• Aged
• Aged, 80 and over
• Dexamethasone (administration & dosage, pharmacokinetics)
• Drug Implants
• Enzyme-Linked Immunosorbent Assay
• Female
• Follow-Up Studies
• Glucocorticoids (administration & dosage, pharmacokinetics)
• Humans
• Intravitreal Injections
• Male
• Middle Aged
• Permeability
• Prospective Studies
• Retinal Vein Occlusion (diagnosis, drug therapy, metabolism)
• Tomography, Optical Coherence
• Treatment Outcome
• Visual Acuity