Susceptibility to a Dexamethasone Intraocular Implant with and Without Concomitant Oral Steroid Intake: A Case Report

Abstract

Introduction: This case report addresses the possible and controversial influence of a concomitant oral steroid intake on the efficacy of a dexamethasone intravitreal implant (Ozurdex) in treating macular edema (ME), mostly when related to inflammatory ocular diseases. Case Presentation: A 34-year-old Caucasian male with Behçet's disease (BD) presented with central retinal vein occlusion (CRVO), first in one eye and then in the other. The eye affected first showed a favorable course. The eye next affected, instead, developed chronic ME poorly responsive to systemic and local treatments. In this eye, two Ozurdex implants were finally performed with a 6-month interval. During the uneventful follow up to the first injection, an episode of central serous chorioretinopathy occurred in the fellow non-implanted eye. This caused the end of the long-lasting oral steroidal regimen, due to the well known negative effect of steroids on central serous chorioretinopathy. The interruption was then maintained during the whole follow up to the second injection. After both treatments, a complete resolution of ME quickly occurred, followed by a partial rebound at the end of the implant's activity (6-month). Conclusion: In this peculiar case with an internal control, macular reaction to Ozurdex was similar in effectiveness and duration with or without concomitant oral steroid intake.