"Mr. Ozurdex" is Seeing Well

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"Mr. Ozurdex" is Seeing Well

Ozurdex has been approved for the treatment of macular swelling caused by retinal vascular problems. In my own practice, Ozurdex is becoming more useful. It signifies the beginning of a new era!

Ozurdex is a new injectable drug delivery system for the eye.  Over the past few months we’ve talked about new technology and the emergence of several sustained release drug delivery systems.

About 2 weeks ago, I injected the left eye of one of my patients with Ozurdex™.  Ozurdex will release a steroid, dexamethasone, for up to 6 months.  The FDA approved Ozurdex for the treatment of retinal vein occlusions (not diabetic retinopathy and not macular degeneration).

My patient sustained a branch retinal vein occlusion to his left eye a few months ago.  The “gold standard” of treatment used to be laser treatment, but there was too much intraretinal hemorrhage to permit laser.

I told my patient about Ozurdex.  I told him that the major risk of injections is the possibility of blinding infection (endophthalmitis) which is estimated to be about 1/2000 (the same as cataract surgery).  He understood and agreed to treatment.  We gave him antibiotic drops to use prior to his return for the injection.

On injection day, in the office, his eye was cleansed with the same povidone/iodine disinfectant used in the operating room.  His eye was numbed with a Q-tip soaked in numbing solution.  This was followed by a small injection of numbing medicine.

I use a wire contraption, called a speculum, to keep the eye open.  The Ozurdex comes pre-packaged with a sharp needle for insertion.  Carefully choosing a spot at the bottom of the eye, I injected the sustained release system.  It is as big as a grain of rice.

The needle and applicator were removed.  The hole is quite small (22 gauge) and is self sealing, that is, the eye doesn’t leak when the needle is withdrawn and no stitches are needed.  He did not require a patch and was given instructions to use antibiotic drops for a few days.

He felt nothing.

Mr. Ozurdex returned this AM telling us that the vision improved in just a few days.  Today was actually 2 weeks since his injection.  The vision improved from 20/200 to 20/40.  He went from legally blind to able to read!

There is still room for improvement, but the immediate results are quite exciting.  He is very excited…and so are we!

What Does This Mean? Ozurdex is one of four sustained release systems for eye treatment.  Ozurdex is the only product FDA approved, albeit for retinal vein occlusions.  The significance of “Mr. Ozurdex” is to highlight that a new age of technology and treatment as arrived.  The product became available only a few months ago.  The treatment went smoothly.  The concept of administering injections in an office setting is “old hat.”

In the very near future, other systems will come closer to FDA approval.  Some of these systems will be releasing drugs for diabetic retinopathy and, eventually, wet macular degeneration.  Iluvien (pSivida/Alimera) is hopefully going to be approved for the treatment of diabetic macular edema.  Suromodics’ anticipates a product delivering Lucentis for sustained release treatment of wet macular degeneration.  Icon Bioscience is the latest to enter the market, now testing a system to help with healing after cataract surgery, but they too, have plans for products to treat the retina.

9 Comments

  1. Dick Marquis says:

    In the case of Iluvien (pSivida/Alimera) for wet AMD, would its use result in a healing/curing effect (thus improved vision) or merely to retard or even prevent further deterioration?

  2. Andrew Fabricant says:

    your example is of a patient which BRVO. what about CRVO? Have you had any experience or know of someone like myself, sho has bi-lateral CRVO. What are likely to be the results of a person like myself.
    Thankyou

  3. Paul Campbell says:

    I received an Ozurdex injection on 6/2/2011, had a follow up visit on 6/28/2011, the swelling of retina reduced dramatically, pressure was normal. I am not a doctor, but viewing the photo the retina looked normal. Beginning 11/4/2011 thru 4/29/2011, I received an Avastin injection every 5 weeks without any improvement to the swelling. I was astonished with the Ozurdex and am hopeful the vision will improve. My next visit is 8/10/2011. I wonder if Avastin would help improve the vision after the retina swelling was reduced?

    • Dear Paul,

      Glad to hear you are doing well…but why did you get an injection to begin with? RVO?

      I have seen several things happen with Ozurdex and Avastin. They often, though not always, work well together, that is, it may be possible to have periodic injections of Avastin to keep down swelling controlled with Ozurdex.

      Randy

  4. […] treatment of a retinal disease.  The first drug, Ozurdex, was approved by the FDA for treatment of retinal vascular occlusions (e.g. CRVO, BRVO).  Ozurdex received FDA approval in […]

  5. divyapriyan says:

    removal of ozurdex injection is the correct thing to reduce pressure

    • Dear divyapriyan,

      Use of Ozurdex in indicated for patients with retinal vein occlusions and in some cases of diabetic retinopathy.

      Causes of raised intraocular pressure therefore;

      1. Neovascular glaucoma from diabetes or retinal vein occlusion
      2. Steroid response

      Thus, if the eye pressure is in fact due to the steroid (Ozurdex), removal may be appropriate. Just need to realize there can be multiple reasons for increased eye pressure when Ozurdex is used.

      Randy

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