Macular oedema in eyes with retinal vein occlusion

Steroids are uniquely positioned to address the cascade of events leading to macular oedema in eyes with retinal vein occlusion (RVO), said Baruch D Kuppermann MD, PhD, University of California, USA, at the 15th EURETINA Congress in Nice.

“Steroids block a multitude of actions in eyes with RVO. These include the inhibition of cytokines, prostaglandins and leukotrienes, decreased vascular permeability and increased tight junction integrity,” he said, speaking during the main session on RVO.

“We have to remember that 30 per cent of RVO patient eyes with macular oedema have VEGF levels within normal limits, so anti-VEGF might not be able to help these eyes,” said Dr Kuppermann. “Indeed, the cytokine IL-6 appears to be a better discriminator of disease than VEGF, which makes steroid treatment particularly efficacious.”

Dr Kuppermann was particularly interested in the advantages of Kenalog® as compared to other steroid formulations. “Kenalog® has longer vitreous durability in animal models,” he said.

Dr Kuppermann has had significant experience with Ozurdex® because it is readily covered by health insurance in the USA. He pointed out that many patients in the GENEVA study were included more than three months after the onset of macular oedema, leading to lower efficacy than if Ozurdex® treatment had been initiated earlier.

“Each month delay in treatment with Ozurdex® results in 11 per cent less likelihood of achieving 15-letter BCVA improvement, so the ‘wait and see’ philosophy is obsolete. Early treatment of macular oedema in RVO unequivocally results in better outcomes,” he concluded.