Intravitreal corticosteroid MWS 2012 Han.ppt (Read-Only)

12/12/11
Glaucoma in perspective:
sustained therapy
Tube vs Trabeculectomy (TVT)
Study (3 year outcomes)
Agent Topical control Surgery
IVTA 20-35% 1% at 2 years
(DRCR.net)
Dexamethasone implant .7 mg 24% 0.7% at 6 months
Retisert fluocinolone implant 70% 37% at 3 years
Iluvien fluocinolone implant 0, 29% (.2 vs .5 mcg/d) 5% at 1 year
Ranibizumab 9% 0.2% at 2 years
(DRCR.net)
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Ø In POAG patients, compared to
trabeculectomy, aqueous shunts had
Lower failure rate (15 vs 31%)
Lower endophthalmitis rate (1 vs 3%,
N.S.)
Ø Ranibizumab for DME
endophthalmitis rate 1% over 2 yrs
Ø 22% of tube patients lost ≥2 lines VA
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Implications of the Tube vs
Trabeculectomy (TVT) Study
Ø “if intravitreal corticosteroid therapy
is deemed appropriate, the physician
should proceed with the knowledge
that its risks are manageable and
that visual outcome, not IOP, should
be the final arbiter in the decisionmaking
process.”
Evidence-­‐based data on intravitreal
corcosteroids: mulcenter clinical
trials
Ø Diabec macular edema
Ø Renal vein occlusion
Han DP and Heuer DK. Intravitreal corticosteroid therapy: putting the problem of
glaucoma in perspective. Arch Ophth, in press
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