What is the recommended dosage for intravitreal dexamethasone (Ozurdex implant)?

Intravitreal Dexamethasone Dosage

The FDA-approved dose for intravitreal dexamethasone (Ozurdex) is 0.7 mg as a single intravitreal implant. 1

Standard Dosing

• Each Ozurdex implant contains dexamethasone 0.7 mg in the NOVADUR solid polymer drug delivery system 1
• This is the only available dose formulation for the intravitreal dexamethasone implant 1
• The implant is administered as a single intravitreal injection per treatment session 1

FDA-Approved Indications

The 0.7 mg dose is approved for:

• Macular edema following branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) 1
• Non-infectious uveitis affecting the posterior segment 1
• Diabetic macular edema 1

Retreatment Intervals

• Retreatment is administered on an "as-needed" basis when macular edema recurs 2, 3
• The GENEVA study evaluated both 0.35 mg and 0.7 mg doses, but only the 0.7 mg dose received FDA approval in 2009 for retinal vein occlusion 4
• Real-world data shows patients typically receive 2.3-2.5 injections per year with intervals of 4.7-5.2 months between treatments 2, 5
• The COBALT study demonstrated that retreatment as often as every 4 months can achieve significant visual gains 4

Important Clinical Considerations

Each applicator is single-use only - if treating both eyes, a completely new sterile setup (applicator, gloves, drapes, speculum) must be used for the contralateral eye 1

Monitoring Requirements After Injection:

• Check optic nerve head perfusion immediately post-injection 1
• Tonometry within 30 minutes to assess for IOP elevation 1
• Biomicroscopy between 2-7 days to monitor for endophthalmitis 1

Common Adverse Effects:

• IOP elevation occurs in 18-20% of patients and is typically manageable with topical anti-glaucoma monotherapy 4, 2, 6
• Cataract formation/progression occurs in 10-16% at one year 4, 7, 3
• Peak IOP elevation is seen at 1 week to 3 months post-injection 6

Efficacy Timeline

• Peak visual acuity improvement occurs at 1-2 months (approximately 60-90 days) after injection 4, 2
• Therapeutic effect diminishes between 3-6 months, with many patients experiencing recurrence by 4-5 months 2, 6, 5
• The GENEVA study showed significant visual gains at 90 days that were lost by 6 months in retinal vein occlusion patients 4

Contraindications to the 0.7 mg Dose

The standard 0.7 mg Ozurdex implant is contraindicated in:

• Active or suspected ocular/periocular infections including herpes simplex keratitis 1
• Glaucoma patients with cup-to-disc ratio >0.8 1
• Torn or ruptured posterior lens capsule (risk of anterior chamber migration) 1
• Known hypersensitivity to any component 1