Mr Venki Sundaram
Consultant Ophthalmic Surgeon
MD FRCOphth MRCOphth BMBCh BSc

Steroid therapy

In some of the common retinal conditions such as Diabetic Macular Oedema and Retinal Vein Occlusion, there is a significant amount in inflammation that can occur in the retina, which can exacerbate the problem of damaged blood vessels and cause further leakage of fluid into the retina. Steroids act by having an anti-inflammatory effect and can therefore help to control damaged blood vessels and reduce macular oedema (swelling).

Ozurdex

Ozurdex is a steroid implant that is injected into the vitreous jelly of the eye. It is licensed for the treatment of macular oedema in patients with either Central or Branch Retinal Vein Occlusion. The implant can last up to 6 months and may need to be given again.

How is Ozurdex given?

  • The therapy is given as an outpatient procedure.
  • Patients lie down comfortably on a couch and the eye is numbed with anaesthetic eye drops.
  • The skin area around the eye is cleaned, with a sterile drape is placed around the eye and a small clip (speculum) used to keep the eyelids open.
  • The steroid implant is injected into the eye using a special applicator. This is usually not painful as plenty of anaesthetic drops are given.
  • Antibiotic drops are applied and patients continue these for a few days at home.
  • The whole process takes around 5 minutes, with the actual time taken to give the injection being less than 20 seconds.
  • Patients are generally free to return to their normal activities once an injection is given.

What are the risks of Ozurdex?

Although Ozurdex is effective in improving vision, the 2 most common side effects include:

  • Raised eye pressure – this can normally be controlled with topical anti-pressure drops, but occasionally patients may require surgery to reduce the eye pressure if it remains high.
  • Cataract formation – this may require cataract surgery if the cataract impairs the vision.

Other rare complications include:

  • Serious infection in the eye.
  • Detached retina
  • Bleeding in the eye
  • Inflammation in the eye

Iluvien

Iluvien is a steroid implant that is injected into the vitreous jelly of the eye (see Image 1). It is licensed for the treatment of Diabetic Macular Oedema that has not responded to other therapies, and in patients who have had previous cataract surgery. It can last up to 3 years and a repeat treatment can be given.

It is given in a similar way to the Ozurdex implant, except that a different applicator is used.

Similarly, there is a risk of raised eye pressure when using this therapy and patients will need to have their eye pressure monitored on a regular basis.

Lens implant

Image 1 – an illustration of an Iluvien implant in the eye