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Bunjo LJ, Bacchi S, Pietris J, Chan WO. Current management options for the treatment of refractory postoperative cystoid macular edema: A systematic review. Surv Ophthalmol 2024; 69:606-621. [PMID: 38490455 DOI: 10.1016/j.survophthal.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
Post-operative cystoid macular edema (PCME) is an important complication following intraocular surgery that often resolves spontaneously without treatment. In some cases, PCME may persist despite initial medical therapy, which can adversely impact visual outcomes. Various topical, intraocular and systemic treatments exist for the prevention and management of cystoid macular edema; however, there is no consensus on treatment of refractory cases in the postoperative setting. In accordance with the PRISMA guidelines, we systematically reviewed 68 articles describing management options and their outcomes for treatment-resistant cases of PCME. The most commonly reported treatments included steroid (39 studies) and biological-based (17 studies) therapies. We provide an overview of the treatment options for refractory PCME.
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Affiliation(s)
- Layla J Bunjo
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Stephen Bacchi
- Lyell McEwin Hospital, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - James Pietris
- University of Queensland, Herston, Queensland, Australia
| | - Weng Onn Chan
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, South Australia, Australia
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Karasu B, Kesim E, Celebi ARC. The efficacy of different anti-vascular endothelial growth factor agents, and dexamethasone implant therapy in patients with serous retinal detachment caused by Irvine-Gass syndrome. Eur J Ophthalmol 2024; 34:510-523. [PMID: 37408434 DOI: 10.1177/11206721231185909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
PURPOSE The aim of this study is to compare the efficacy of intravitreal aflibercept (IVA), bevacizumab (IVB), ranibizumab (IVR), and dexamethasone implant (IVDI) in the treatment of serous retinal detachment (SRD) caused by Irvine-Gass syndrome (IGS). DESIGN Retrospective cohort, comparative study. METHODS AND MATERIALS The medical records of 128 eyes with no previous history of intravitreal agents in 128 IGS patients with SRD that received IVA, IVB, IVR, and IVDI monotherapy were retrospectively reviewed. The patients were divided into 4 groups, according to treatment. Patients with recurrence and/or were unresponsive following a course of topical steroids and non-steroidal anti-inflammatory drugs (NSAIDs) were included in the study. Best corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and SRD were compared between the 4 treatment groups at baseline, at follow-up months 1, 3, 6, and 12, and at the final follow-up visit. RESULTS Serous retinal detachment completely resolved in 74%, 45.7%, 66.4%, and 40.8% of the eyes at month 1 (P = 0.042), 87%, 50.9%, 75.8%, and 80.9% at month 3 (p = 0.031), 88.9%, 50.4%, 75.7%, 80.2% at month 6 (p = 0.028), 81.7%, 72.8%, 68.7%, 80.1% at month 12 (p = 0.580), and 100%, 66.4%, 87.9%, 93.2% (p = 0.478) at final follow-up visit in the IVA, IVB, IVR, and IVDI groups, respectively. BCVA was significantly better in the IVA group at all follow-up time points (month 1: p < 0.001; month 3: p < 0.001; month 6: p = 0.002; month 12: p = 0.009, final follow-up visit: p < 0.001). CMT was significantly lower in the IVA group at months 3 (p = 0.008), 6 (p = 0.011), and 12 (p = 0.010), and at the final follow-up visit (p < 0.001). Recurrence was observed after a longer period of time and fewer injections were needed in the IVDI and IVA groups (p < 0.05). Resolution of CME was most rapid in the IVA group (p = 0.032). CONCLUSION All intravitreal agents were effective in terms of visual results in the SRD patients; however, eyes treated with IVA and IVDI required fewer injections, as compared to the eyes treated with IVB and IVR. Furthermore, SRD entirely resolved in all eyes in the IVA group at the final follow-up visit.
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Affiliation(s)
- Buğra Karasu
- Tuzla Public Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Enes Kesim
- Tuzla Public Hospital, Department of Ophthalmology, Istanbul, Turkey
- Okan University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
| | - Ali Rıza Cenk Celebi
- Acibadem University, School of Medicine, Department of Ophthalmology, Istanbul, Turkey
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[Pseudophakic cystoid macular edema : Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022]. DIE OPHTHALMOLOGIE 2023; 120:276-284. [PMID: 36692849 DOI: 10.1007/s00347-022-01771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 01/25/2023]
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[Pseudophakic Cystoid Macular Edema - Statement of the German Society of Ophthalmology, the German Retina Society and the German Professional Association of Ophthalmologists. Status 22 October 2022]. Klin Monbl Augenheilkd 2023; 240:316-326. [PMID: 36977428 DOI: 10.1055/a-2019-9748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
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Topical NSAIDs and Oral Acetazolamide for Macular Edema after Uncomplicated Phacoemulsification: Outcome and Predictors of Non-Response. J Clin Med 2022; 11:jcm11195537. [PMID: 36233408 PMCID: PMC9572828 DOI: 10.3390/jcm11195537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose: To investigate the effectiveness of nonsteroidal anti-inflammatory eye drops (NSAIDs) combined with oral acetazolamide for postoperative macular edema (PME) after uncomplicated phacoemulsification (PE) and identify predictors of non-response. Methods: We analyzed data of uncomplicated PE and identified eyes with PME. First-line therapy included topical NSAIDs combined with oral acetazolamide. In the case of non-response, triamcinolone was administered subtenonally. Outcome measures included best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: 94 eyes out of 9750 uncomplicated PE developed PME, of which 60 eyes were included. Follow-ups occurred 6.4 ± 1.8, 12.5 ± 3.7 and 18.6 ± 6.0 weeks after diagnosis. BCVA and CMT improved significantly in all follow-ups. In total, 40 eyes showed a response to first-line therapy at the first follow-up (G1). The remaining 20 eyes showed no response and required subtenon triamcinolone (G2), of which 11 eyes showed complete regression at the second follow-up and 4 eyes at third follow-up. A further 5 eyes showed no response and required intravitreal injection. Multivariate linear regression model showed that Diabetes mellitus (DM) and increased cumulative dissipated energy (CDE) are predictors of non-response. Conclusion: Topical NSAIDs with acetazolamide resulted in complete regression of PME in 67% of all cases. DM and increased CDE might be considered as predictors of non-response to this treatment.
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Friesacher A, Varde MA, Valmaggia C, Todorova M. An Off-Label Application of Anti-VEGF in Refractory Posttraumatic Irvine-Gass Syndrome: A Case Report. Klin Monbl Augenheilkd 2022; 239:534-536. [PMID: 35472800 DOI: 10.1055/a-1785-5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anna Friesacher
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Meghana Anika Varde
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Christophe Valmaggia
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Margarita Todorova
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,Department of Ophthalmology, University of Zürich, Zürich, Switzerland
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Obis J, Arias L, Lorenzo D, Padron-Perez N, Garcia-Bru P, Cobos E, Morwani R, Caminal J. Topical NSAIDs, intravitreal dexamethasone and peribulbar triamcinolone for pseudophakic macular edema. BMC Ophthalmol 2021; 21:387. [PMID: 34740334 PMCID: PMC8570006 DOI: 10.1186/s12886-021-02132-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of this study is to assess the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (intravitreal dexamethasone and peribulbar triamcinolone) in treating pseudophakic macular edema (PME). Methods Retrospective study of 33 eyes. Variables included best corrected visual acuity (BCVA; logMAR scale) and central retinal thickness (CRT) and central choroidal thickness (CCT) assessed with swept-source OCT. All patients were initially prescribed topical NSAIDs and reevaluated after 2 months. If improvement in BCVA or CRT was noted, topical NSAIDs were continued until resolution. If no improvement was observed at 2 months or subsequent visits, intravitreal dexamethasone implant was performed. Patients who refused intravitreal treatment were offered peribulbar triamcinolone. Results After treatment with topical NSAIDs for a median of 2 months, BCVA increased significantly from 0.5 to 0.3 while CRT decreased significantly from 435 to 316 μm. PME resolved in 19 of the 33 eyes (57.6%). Of the 14 recalcitrant cases, 13 were treated with corticosteroids. Of these 13 cases, 9 (69.2%) resolved. BCVA increased non-significantly from 0.7 to 0.4. CRT and CCT decreased significantly from 492 to 317 μm and from 204 to 182 μm respectively. Conclusions The overall success rate of the treatment algorithm was greater than 80%, a remarkable finding considering that no randomized study has yet been conducted to determine the optimal therapeutic protocol for PME. This is the first study to evaluate choroidal thickness in PME using SS-OCT, which could play a key role in its pathophysiology and provide useful information to improve the management of PME.
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Affiliation(s)
- Javier Obis
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain.
| | - Luis Arias
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Lorenzo
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Noel Padron-Perez
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Pere Garcia-Bru
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Estefania Cobos
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Rahul Morwani
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
| | - Jose Caminal
- Ophthalmology department, Bellvitge University Hospital, Carrer de la Feixa Llarga, s/n, 08907. Hospitalet de Llobregat, Barcelona, Spain
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Current Management Options in Irvine-Gass Syndrome: A Systemized Review. J Clin Med 2021; 10:jcm10194375. [PMID: 34640393 PMCID: PMC8509495 DOI: 10.3390/jcm10194375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/09/2021] [Accepted: 09/18/2021] [Indexed: 01/11/2023] Open
Abstract
Irvine-Gass syndrome (IGS) remains one of the most common complications following uneventful cataract surgery. In most cases, macular edema (ME) in IGS is benign, self-limiting, and resolves spontaneously without visual impairment; however, persistent edema and refractory cases may occur and potentially deteriorate visual function. Despite the relatively high prevalence of IGS, no solid management guidelines exist. We searched the PUBMED database for randomized clinical trials (RCT) or case series of at least 10 cases published since 2000 evaluating different treatment strategies in patients with cystoid macular edema (CME). The search revealed 28 papers that fulfilled the inclusion criteria with only seven RCTs. The scarceness of material makes it impossible to formulate strong recommendations for the treatment of IGS. Clinical practice and theoretical background support topical non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line therapy. Invasive procedures, such as periocular steroids, intravitreal corticosteroids, and anti-vascular endothelial growth factor (anti-VEGF), are usually applied in prolonged or refractory cases. Results of novel applications of subthreshold micropulse laser (SML) are also promising and should be studied carefully in terms of the safety profile and cost effectiveness. Early initiation of invasive treatment for providing better functional results must be examined in further research.
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BILATERAL INTRAVITREAL 0.19-MG FLUOCINOLONE ACETONIDE IMPLANT FOR PERSISTENT NONDIABETIC CYSTOID MACULAR EDEMA AFTER VITRECTOMY. Retin Cases Brief Rep 2021; 15:261-265. [PMID: 30015770 DOI: 10.1097/icb.0000000000000779] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Iluvien (Alimera Science, Alpharetta, GA) is an injectable, nonbiodegradable, sustained-release 0.19-mg fluocinolone acetonide intravitreal implant. Although currently approved by the Food and Drug Administration only for diabetic macular edema previously treated with a course of corticosteroids without a clinically significant intraocular pressure response, the 0.19-mg fluocinolone acetonide implant could theoretically be used to treat other noninfectious inflammatory conditions including persistent cystoid macular edema because of nondiabetic etiologies. METHODS Interventional case report. A 79-year-old man had persistent cystoid macular edema after pars plana vitrectomy in both eyes that was refractory to topical treatments and intravitreal anti-vascular endothelial growth factor. His cystoid macular edema was responsive to preservative-free intravitreal triamcinolone acetonide after which he developed noninfectious endophthalmitis or pseudoendophthalmitis in both eyes precluding further intravitreal triamcinolone acetonide injections. He was subsequently treated with bilateral intravitreal 0.19-mg fluocinolone acetonide implants. RESULTS At the most recent post-treatment follow-up (11 months for the right eye and 13 months for the left eye), the patient demonstrated an improvement in visual acuity, 20/126 to 20/50 in the right eye and 20/80 to 20/40 in the left eye, and in central subfield thickness, 592 μm to 288 μm in the right eye and 565 μm to 287 μm in the left eye, without intraocular pressure elevation. CONCLUSION The intravitreal 0.19-mg fluocinolone acetonide implant is an effective and potentially safe off-label therapeutic option for persistent nondiabetic cystoid macular edema after vitrectomy.
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Choi EY, Lee CH, Kang HG, Han JY, Byeon SH, Kim SS, Koh HJ, Kim M. Long-term surgical outcomes of primary retropupillary iris claw intraocular lens implantation for the treatment of intraocular lens dislocation. Sci Rep 2021; 11:726. [PMID: 33436860 PMCID: PMC7804091 DOI: 10.1038/s41598-020-80292-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate the efficacy and safety of primary retropupillary iris claw intraocular lens (R-IOL) implantation in patients with complete intraocular lens (IOL) dislocation. In this single-center retrospective case series, we reviewed the medical records of patients who underwent R-IOL implantation surgery with pars plana vitrectomy for the treatment of IOL dislocation between September 2014 and July 2019. The primary outcome was change in visual acuity (VA) up to 24 months postoperatively. The secondary outcomes included changes in intraocular pressure (IOP), refractive errors, and endothelial cell count (ECC) over the same period. Data of 103 eyes (98 patients) were analyzed. The mean uncorrected VA was significantly improved at one month postoperatively (− 0.69 logMAR, P < 0.001), compared to the preoperative value. IOP (− 2.3 mmHg, P = 0.008) and ECC (− 333.4 cells/mm2, P = 0.027) significantly decreased one month post-surgery and remained stable thereafter. Postoperative mean spherical equivalents were similar to the prediction error throughout the follow-up period. IOP elevation (n = 8, 7.8%), cystoid macular edema (n = 4, 3.9%), and dislocation of the R-IOL (n = 10, 9.7%) were managed successfully. Overall, primary R-IOL implantation with pars plana vitrectomy is effective and safe for correcting IOL dislocation due to various causes.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Chul Hee Lee
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Hyun Goo Kang
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Jae Yong Han
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Sung Soo Kim
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Hyoung Jun Koh
- Department of Ophthalmology, Institute of Vision Research, Severance Eye Hospital, Yonsei University College of Medicine, 50-1, Yonseiro, Seodaemun-gu, Seoul, 03722, Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonjuro, Gangnam-gu, Seoul, 06273, Korea.
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Cheng CK, Mei F, Kao TY. Simultaneous existence of three intraocular lens inside one eye. Taiwan J Ophthalmol 2021; 12:209-212. [PMID: 35813795 PMCID: PMC9262020 DOI: 10.4103/tjo.tjo_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
The purpose of the study was to report an unusual case of recurrent pseudophakic cystoid macular edema (PCME) in an eye with three simultaneous intraocular lenses (IOLs) inside. A 57-year-old female with diabetes mellitus (DM) and a history of complicated cataract surgery was diagnosed with cystoid macular edema (CME). Upon examination, an anterior chamber intraocular lens (ACIOL) with vitreous strand in her right eye was noted. The fluorescence angiography revealed CME of the right eye and microaneurysms in both eyes. Pars plana vitrectomy was performed to release the vitreous prolapse and traction around the ACIOL. During the surgery, two sunken posterior chamber IOLs in the vitreous were incidentally found and removed. The vitreous traction strand around the inappropriately placed anterior chamber ACIOL was also released. It was rarely reported that two dislocated IOL and ACIOL simultaneously existed in the same eye. Chronic recurrent PCME in this patient was possibly associated with posteriorly dislocated IOL, DM, and vitreous traction.
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Moon CW, Park DG, Sagong M. Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Akay F, Işık MU, Akmaz B, Güven YZ. Comparison of intravitreal anti-vascular endothelial growth factor agents and treatment results in Irvine-Gass syndrome. Int J Ophthalmol 2020; 13:1586-1591. [PMID: 33078109 DOI: 10.18240/ijo.2020.10.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the efficacy of bevacizumab, ranibizumab, and aflibercept in pseudophakic cystoid macular edema (CME) patients with Irvine-Gass syndrome (IGS). METHODS This study is designed as retrospective consecutive case series. Those who developed postoperative pseudophakic CME that refractory to topical treatment and were treated with anti-vascular endothelial growth factor (VEGF) agents included in the study. Optical coherence tomography (OCT) examination including central macular thickness (CMT), total macular volume (TMV), retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) and choroidal thickness (ChT) measurements at the baseline, 1st, 3rd and 6th month controls were performed. RESULTS Fifty-nine eyes of 59 patients with CME and other healthy eyes of the patients (Control group) were evaluated. There were 22 eyes of 22 patients in the bevacizumab group (group 1), 19 eyes of 19 patients in the ranibizumab group (group 2), and 18 eyes of 18 patients in the aflibercept group (group 3). There was no difference in terms of age, gender, axial length, IOP, and spherical equivalent values. The baseline subfoveal and mean ChT were higher in the IGS group. The difference between the baseline and sixth month values of subfoveal and mean ChT were compared in the CME groups, thinning was observed in all three groups. GCL was thinner in the patient group at the 6th month of treatment. The resolution time of CME was observed faster in group 1. CONCLUSION All three anti-VEGF agents seem to be effective in CME but bevacizumab appears to be slightly more cost-effective than the other two alternatives.
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Affiliation(s)
- Fahrettin Akay
- Department of Ophthalmology, Izmir Katip Çelebi University Atatürk Educating and Research Hospital, Izmir 35620, Turkey
| | - Mehmed Uğur Işık
- Department of Ophthalmology, Kastamonu University Faculty of Medicine, Kastamonu 37100, Turkey
| | - Berkay Akmaz
- Department of Ophthalmology, Izmir Katip Çelebi University Atatürk Educating and Research Hospital, Izmir 35620, Turkey
| | - Yusuf Ziya Güven
- Department of Ophthalmology, Izmir Katip Çelebi University Atatürk Educating and Research Hospital, Izmir 35620, Turkey
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Aaronson A, Achiron A, Tuuminen R. Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac. J Clin Med 2020; 9:jcm9093034. [PMID: 32967137 PMCID: PMC7563612 DOI: 10.3390/jcm9093034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Department of Ophthalmology, Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, 58100 Holon, Israel;
- Department of Ophthalmology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotkantie 41, FI-48210 Kotka, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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Sakalova ED. [Modern approaches to treatment of postsurgical macular edema]. Vestn Oftalmol 2020; 136:289-295. [PMID: 32880153 DOI: 10.17116/oftalma2020136042289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Postsurgical macular edema, known as Irvine-Gass syndrome, is one of the possible causes of reduced visual acuity in ophthalmic surgery. The article reviews and summarizes data on the main approaches to the treatment of this pathology, discusses the main groups of drugs used to manage postoperative macular edema.
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Affiliation(s)
- E D Sakalova
- Research Institute of Eye Diseases, Moscow, Russia
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Pham BH, Hien DL, Matsumiya W, Tuong Ngoc TT, Doan HL, Akhavanrezayat A, Yaşar Ç, Nguyen HV, Halim MS, Nguyen QD. Anti-interleukin-6 receptor therapy with tocilizumab for refractory pseudophakic cystoid macular edema. Am J Ophthalmol Case Rep 2020; 20:100881. [PMID: 32875161 PMCID: PMC7452126 DOI: 10.1016/j.ajoc.2020.100881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose To describe the clinical course of a patient with refractory pseudophakic cystoid macular edema treated with interleukin-6 receptor antagonist tocilizumab. Observations An 80-year-old Caucasian man with past ocular history significant for glaucoma (right eye) and iritis presented with cystoid macular edema (CME) in the right eye (OD). His ocular surgery history was significant for cataract extraction with posterior chamber intraocular lenses in 1999 and YAG laser capsulotomy in 2014 in both eyes (OU). His medications at time of presentation included latanoprost and dorzolamide-timolol in OD for glaucoma, as well as prednisolone in OD for iritis. Upon examination, his visual acuity was 20/250 in OD and 20/20 in the left eye (OS). Intraocular pressure was 20 mmHg in OD and 10 mmHg in OS. Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed CME and a cup-to-disk ratio of 0.9 in OD and normal findings in OS. Initial spectral domain optical coherence tomography (SD-OCT) demonstrated intraretinal fluid in both outer and inner layers as well as mild subretinal fluid with an intact ellipsoid zone in OD. Fluorescein angiography revealed perifoveal leakage in OD. Laboratory evaluations, including infectious work-up, were unremarkable. While the patient's CME initially improved after initiation of therapy with topical prednisolone and oral acetazolamide, the CME later recurred after systemic acetazolamide was stopped due to intolerable side effects. Despite multiple therapeutic approaches, including topical and systemic corticosteroids (both oral and intravenous) and topical interferon α2b over the course of more than one year, the patient's visual acuity continued to worsen with increasing intra- and subretinal fluid in the macula. Due to the refractory CME, the patient was started on monthly infusions of anti-interleukin (IL)-6 receptor tocilizumab (8 mg/kg) with three days of methylprednisolone infusions (500 mg/day). After nine cycles of treatment, SD-OCT demonstrated restoration of normal foveal contour with complete resolution of CME. Conclusions and Importance IL-6 inhibition with tocilizumab may be a safe and effective treatment for refractory CME. Further studies are needed to elucidate the nature and extent of therapeutic IL-6 inhibition in CME.
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Affiliation(s)
| | - Doan Luong Hien
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | | | - Than Trong Tuong Ngoc
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Pham Ngoc Thach University of Medicine, Saigon, Viet Nam
| | - Huy Luong Doan
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | - Çigdem Yaşar
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Huy Vu Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Corresponding author. Spencer Center for Vision Research Byers Eye Institute at Stanford University 2452 Watson Court Suite 200 Palo Alto, CA 94303, USA.
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17
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Sharma A, Bandello F, Loewenstein A, Kuppermann BD, Lanzetta P, Zur D, Hilely A, Iglicki M, Veritti D, Wang A, Miassi F, Bellocq D, Zacharias LC, Makam D, Kumar N, Parachuri N, Barriera AK, Sharma R, Faridi H, Mathis T, Kodjikian L. Current role of intravitreal injections in Irvine Gass syndrome-CRIIG study. Int Ophthalmol 2020; 40:3067-3075. [PMID: 32613461 DOI: 10.1007/s10792-020-01491-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the role of intravitreal anti-vascular endothelial growth factor (anti-VEGF) or steroid injection for the management of Irvine Gass syndrome. METHODS It is an interventional, retrospective, multicenter study. One hundred and thirty-two injections were given in 79 eyes of 72 patients with Irvine Gass syndrome. Patients were treated with at least one intravitreal injection of either anti-VEGF or steroid. Outcomes were measured at 12 months (± 1 week). [Ranibizumab (Lucentis; Genentech, South San Francisco, CA) (Razumab; Intas Pharmaceutical Ltd, Ahmedabad, India) Bevacizumab (Avastin; Genentech, South San Francisco, CA) or Aflibercept (Eylea; Regeneron, Tarrytown, NY)] or steroids [Dexamethasone implant (Ozurdex, Allergan Inc, Irvine, CA) or intravitreal triamcinolone)]. RESULTS Intravitreal injections were initiated in (67.6%) of eyes within 14 weeks of diagnosis. Intravitreal dexamethasone implant was used as the initial intravitreal therapy in (73.4%) of eyes. More than fifty percent (54.5%) of the patients were switched from anti-VEGF to Intravitreal dexamethasone implant. Reduction in the mean CMT was 336.7 ± 191.7 and 160.1 ± 153.1 microns in eyes treated within four weeks and more than 14 weeks from diagnosis (p = 0.005). Mean ETDRS letter gain was 16.7 ± 12.9 and 5.2 ± 9.2 in eyes treated within 4 weeks and more than 14 weeks from diagnosis (p = 0.004). Three eyes injected with intravitreal dexamethasone implant reported an intraocular pressure spike of > 25 mmHg which was controlled with topical medications. No other ocular or systemic adverse events were observed. CONCLUSION Study results suggest that physicians tend to introduce intravitreal therapy within 14 weeks of diagnosis. The most common therapy at initiation and for the switch is intravitreal dexamethasone implant. Patients treated early (within 4 weeks) respond better in terms of structure and function.
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Affiliation(s)
- Ashish Sharma
- Lotus Eye Hospital and Institute, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India.
| | | | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Paolo Lanzetta
- Department of Ophthalmology, University of Udine, Udine, Italy
| | - Dinah Zur
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Hilely
- Division of Ophthalmology, Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Matias Iglicki
- Private Retina Service, University of Buenos Aires, Buenos Aires, Argentina
| | - Daniele Veritti
- Department of Ophthalmology, University of Udine, Udine, Italy
| | - Angeline Wang
- Gavin Herbert Eye Institute, University of California, Irvine, CA, USA
| | | | - David Bellocq
- Department of Ophthalmology, Croix-Rousse Hospices Civils de Lyon, University of Lyon, Lyon, France
- UMR-CNRS 5510 MatéisVilleurbanne, University of Lyon, Lyon, France
| | | | - Deepika Makam
- Lotus Eye Hospital and Institute, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India
| | - Nilesh Kumar
- Lotus Eye Hospital and Institute, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India
| | - Nikulaa Parachuri
- Lotus Eye Hospital and Institute, Avinashi Road, Coimbatore, Tamil Nadu, 641014, India
| | - Alan K Barriera
- University of São Paulo Medical School, University of São Paulo, São Paulo, Brazil
- HCLOE Eye Hospital, São Paulo, Brazil
| | - Rohini Sharma
- Department of Healthcare, The TIPS Global Institute, Coimbatore, Tamil Nadu, India
| | - Hafeez Faridi
- College of Pharmacy, Chicago State University, Chicago, IL, USA
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse Hospices Civils de Lyon, University of Lyon, Lyon, France
- UMR-CNRS 5510 MatéisVilleurbanne, University of Lyon, Lyon, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse Hospices Civils de Lyon, University of Lyon, Lyon, France
- UMR-CNRS 5510 MatéisVilleurbanne, University of Lyon, Lyon, France
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18
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Radeck V, Märker D, Prahs P, Helbig H, Krause L. Pseudophakes zystoides Makulaödem. Ophthalmologe 2020; 117:579-590. [DOI: 10.1007/s00347-020-01122-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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19
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Holló G, Aung T, Cantor LB, Aihara M. Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. Surv Ophthalmol 2020; 65:496-512. [PMID: 32092363 DOI: 10.1016/j.survophthal.2020.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
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Affiliation(s)
- Gábor Holló
- Glaucoma Unit, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Opthalmology, National University of Singapore, Singapore
| | - Louis B Cantor
- Department of Opthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Makoto Aihara
- Department of Opthalmology, University of Tokyo, Tokyo, Japan
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20
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Wielders LHP, Schouten JSAG, Aberle MR, Lambermont VA, van den Biggelaar FJHM, Winkens B, Simons RWP, Nuijts RMMA. Treatment of cystoid macular edema after cataract surgery. J Cataract Refract Surg 2019; 43:276-284. [PMID: 28366377 DOI: 10.1016/j.jcrs.2016.06.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/19/2022]
Abstract
The purpose of this review was to determine the optimum pharmacologic treatment for cystoid macular edema (CME) after cataract surgery in nondiabetic and diabetic patients. The Cochrane Library, Medline, and Embase databases were searched, and all randomized controlled trials (RCTs) that compared at least 2 pharmacologic strategies for CME after cataract surgery were included. Studies were excluded if preoperative CME or other risk factors for developing CME postoperatively were present. Ten RCTs were included in the systematic review. Five trials included at least 30 participants. Three RCTs showed a greater visual acuity improvement in patients treated with topical nonsteroidal antiinflammatory drugs (NSAIDs) than with a placebo. Other studies comparing the efficacy of topical NSAIDs, topical corticosteroids, sub-Tenon corticosteroids, oral NSAIDs, and oral acetazolamide did not report significant differences between treatment groups. Therefore, large RCTs are needed to provide evidence-based recommendations for the optimum treatment of CME after cataract surgery.
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Affiliation(s)
- Laura H P Wielders
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands.
| | - Jan S A G Schouten
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
| | - Merel R Aberle
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
| | - Verena A Lambermont
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
| | - Frank J H M van den Biggelaar
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
| | - Bjorn Winkens
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
| | - Rob W P Simons
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
| | - Rudy M M A Nuijts
- From the University Eye Clinic Maastricht (Wielders, Schouten, Aberle, Lambermont, van den Biggelaar, Simons, Nuijts), Maastricht University Medical Center, and the Department of Methodology and Statistics, Maastricht University (Winkens), Maastricht, the Netherlands
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Abstract
Uveitis patients represent a unique subset of the population undergoing cataract surgery and pose several challenges that require special consideration and strategy. Maintenance of disease quiescence for at least three months prior to surgery maximizes postoperative outcomes, though these patients remain at increased risk for pseudophakic cystoid macular edema, which can be refractory to the traditional steroid treatments. In this review, we detail the pillars of preoperative optimization, intraoperative considerations, and postoperative management of uveitic cataracts, with special attention on the evidence surrounding prevention and treatment of refractory postoperative cystoid macular edema.
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Affiliation(s)
- Judy L Chen
- Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pooja Bhat
- Assistant Professor of Ophthalmology, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ann-Marie Lobo-Chan
- Assistant Professor of Ophthalmology, Department of Ophthalmology, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA
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22
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Erden B, Çakır A, Aslan AC, Bölükbaşı S, Elçioğlu MN. The Efficacy of Posterior Subtenon Triamcinolone Acetonide Injection in Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm 2019; 27:1235-1241. [PMID: 31411519 DOI: 10.1080/09273948.2019.1620786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the efficacy and safety of posterior 40 mg subtenon triamcinolone acetonide (PST) injection in treating Irvine-Gass syndrome.Methods: The retrospective study included 21 patients (mean age: 76 ± 8.2) with a treatment-naïve eye subjected to topical anesthesia and injection of 40 mg/ml triamcinolone via a blunt tip SubTenon cannula through a single inferonasal peritomy. Best corrected visual acuity (BCVA; logMAR), intraocular pressure (IOP), biomicroscopic and funduscopic findings, and optical coherence tomography (OCT) measurements were recorded.Results: Baseline central macular thickness decreased from 431 ± 136 µm to 300 ± 67 µm (1st month; p = .002), to 292 ± 56 µm (3rd month; p = .002), and to 299 ± 66 µm (6th month; p = .005). Mean BCVA increased from 0.71 ± 0.23 to 0.27 ± 0.11, 0.19 ± 0.06, and 0.24 ± 0.17, respectively (all visits; p < 0.001). Mean IOP values did not change significantly (p = .12).Conclusion: PST injection is an effective and safe treatment for Irvine-Gass syndrome.
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Affiliation(s)
- Burak Erden
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Akın Çakır
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Selim Bölükbaşı
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Nuri Elçioğlu
- Retina Department, Okmeydanı Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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23
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Altintas AGK, Ilhan C. Intravitreal Dexamethasone Implantation in Intravitreal Bevacizumab Treatment-resistant Pseudophakic Cystoid Macular Edema. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:259-266. [PMID: 31179657 PMCID: PMC6557797 DOI: 10.3341/kjo.2018.0106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/09/2019] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the changes in visual acuity (VA) and central macular thickness (CMT) after intravitreal dexamethasone (IVD) implantation in intravitreal bevacizumab (IVB) treatment-resistant cases with pseudophakic cystoid macular edema (PCME). Methods This study included 10 PCME cases who underwent uneventful phacoemulsification and intraocular lens implantation with similar methods and six PCME cases referred to our hospital for treatment of low VA after cataract surgery. Due to the persistence of PCME, both topical steroid and anti-inflammatory medication were administered first, followed by IVB injection. IVD implantation was performed for all IVB treatment-resistant cases. VA and CMT values were compared before and at three months after the first IVD implantation. Results The mean VA values before and at 3 months after the first IVD implantation were 0.69 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (1.50 to 0.10 logMAR) and 0.26 ± 0.07 logMAR (1.00 to 0.00 logMAR), respectively (p < 0.001). The mean CMT was 476.13 ± 135.13 mm (314 to 750 mm) and 294.06 ± 15.26 mm (222 to 480 mm), respectively (p < 0.001). The mean number of implanted IVD was 1.44 ± 0.89 (1 to 4) and the mean follow-up time was 7.4 ± 4.6 months (6 to 24 months). After IVD implantation therapy, the mean VA and CMT values were 0.19 ± 0.05 logMAR (0.70 to 0.00 logMAR) and 268.38 ± 31.35 mm (217 to 351 mm), respectively. Conclusions To the best of our knowledge, this is the first report to show the efficacy of IVD implantation even after repeated IVB injections in treatment-resistant PCME. IVD implantation is both a safe and effective method for decreasing PCME after both uneventful and complicated cataract surgery.
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Affiliation(s)
- Ayse Gul Kocak Altintas
- Department of Ophthalmology, Ankara Ulucanlar Eye Education and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Cagri Ilhan
- Department of Ophthalmology, Hatay State Hospital, Hatay, Turkey
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24
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Kodjikian L, Bellocq D, Bandello F, Loewenstein A, Chakravarthy U, Koh A, Augustin A, de Smet MD, Chhablani J, Tufail A, García-Layana A, Sudhalkar A, Mathis T. First-line treatment algorithm and guidelines in center-involving diabetic macular edema. Eur J Ophthalmol 2019; 29:573-584. [DOI: 10.1177/1120672119857511] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Management of center-involving diabetic macular edema represents a real therapeutic challenge. Diabetic macular edema is the leading cause of visual acuity impairment in diabetic patients. Since the advent of intravitreal drugs, management of diabetic macular edema has significantly evolved. The historical grid laser photocoagulation is no longer recommended as first-line treatment of diabetic macular edema owing to the findings of the pivotal randomized controlled trials, and anti-vascular endothelial growth factor therapy has emerged as first-line therapy. Steroids also represent a valid treatment option in the management of naïve diabetic macular edema and their efficacy has also been confirmed in several studies. The optimal treatment for diabetic macular edema should consider both general and ophthalmological comorbidities. Patient compliance and motivation should also be carefully evaluated as some treatments require monthly follow-up. Based on recent literature evidence, the present review provides clinicians with a first-line treatment algorithm for center-involving diabetic macular edema tailored to the patient’s individual characteristics.
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Affiliation(s)
- Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
- CNRS UMR Mateis, Villeurbanne, France
| | - David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anat Loewenstein
- Division of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Sydney A. Fox chair of ophthalmology, Tel Aviv University, Tel Aviv, Israel
| | - Usha Chakravarthy
- Department of Ophthalmology, Queen’s University Belfast, Belfast, Northern Ireland
| | - Adrian Koh
- Eye and Retina Surgeons, Singapore, Singapore
- Singapore National Eye Centre, Singapore, Singapore
| | | | | | - Jay Chhablani
- Smt Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Adnan Tufail
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | | | - Aditya Sudhalkar
- Raghudeep Eye Hospital, Iladevi Cataract Centre, Ahmedabad, India
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France
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25
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Guclu H, Pelitli Gurlu V. Comparison of topical nepafenac 0.1% with intravitreal dexamethasone implant for the treatment of Irvine-Gass syndrome. Int J Ophthalmol 2019; 12:258-267. [PMID: 30809482 DOI: 10.18240/ijo.2019.02.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/25/2018] [Indexed: 12/30/2022] Open
Abstract
AIM To compare safety and efficacy of intravitreal dexamethasone (IVD) implant with topical nepafenac (TN) 0.1% in previously untreated Irvine-Gass syndrome (IGS) in clinical practice. METHODS This was a retrospective study of 62 eyes with IGS after phacoemulsification with posterior chamber intraocular lens (IOL) implantation. None of the patients used treatment before IVD or TN. Best-corrected visual acuity (BCVA) with Early Treatment Diabetic Retinopathy Study chart (ETDRS), slit-lamp, intraocular pressure (IOP) measurement, fundus examination, spectral-domain optical coherence tomography (OCT) and fundus florescein angiography were performed to all subjects at baseline, 1, 3 and 6mo. RESULTS The mean BCVA of the IVD group was 49.3±6.8, and the mean BCVA of the TN group was 32.9±7.3 ETDRS letters in post-treatment month 6. The mean central macular thickness (CRT) of IVD group was 266.6±53.5 µm and the mean CRT of TN group was 364.9±56.3 µm in post-treatment month 6. Baseline BCVA has correlation with final BCVA in TN group however there was no correlation between baseline BCVA and final BCVA in IVD group. CONCLUSION IVD is found to be better than TN in controlling pseudophakic macular edema and improving visual acuity. IVD group also has significantly lower CRT however IOP is not significantly different between two groups in post-treatment month 6.
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Affiliation(s)
- Hande Guclu
- Department of Opthalmology, Trakya University, Faculty of Medicine, Edirne 22030, Turkey
| | - Vuslat Pelitli Gurlu
- Department of Opthalmology, Trakya University, Faculty of Medicine, Edirne 22030, Turkey
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26
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Hernandez-Gamez AG, Garcia-Bañuelos JJ, Armendariz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomes Topical Formulation for the Treatment of Cystoid Macular Edema After Cataract Surgery: A Pilot Study. J Ocul Pharmacol Ther 2019; 35:106-115. [PMID: 30614750 PMCID: PMC6450453 DOI: 10.1089/jop.2018.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: To report tolerability, safety, and efficacy of a topical triamcinolone acetonide-loaded liposomes formulation (TA-LF) in targeting the macular area in patients with refractory pseudophakic cystoid macular edema (PCME). Methods: For tolerability, safety and efficacy evaluation, 12 eyes of 12 patients with refractory PCME were exposed to one drop of TA-LF (TA at 0.2%) every 2 h for 90 days or until best-corrected visual acuity (BCVA) was achieved. Intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. Results: Patients with refractory PCME under TA-LF therapy showed a significant improvement in BVCA and CFT without significant IOP modification (P = 0.94). On average CFT decreased to 206.75 ± 135.72 μm and BCVA improved to 20.08 ± 10.35 letters (P < 0.0005). BCVA was achieved at 10.58 ± 6.70 weeks (range 2–18). TA-LF was well tolerated in all cases. Neither ocular surface abnormalities nor adverse events were recorded. Conclusion: TA-LF was well tolerated and improved BCVA and CFT on patients with refractory PCME.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Juan Carlos Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | | | - Jesus Javier Garcia-Bañuelos
- 4 Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
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Karaca Adıyeke S, Türe G, Talay E. Intravitreal Dexamethasone Implant for Postvitrectomy Macular Edema: A Retrospective Cohort of Patients with Postvitrectomy Macular Edema Treatment. J Ocul Pharmacol Ther 2018; 34:335-339. [PMID: 29377756 DOI: 10.1089/jop.2017.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To evaluate the clinical findings and the efficacy of dexamethasone intravitreal implant in patients with postvitrectomy macular edema. METHODS The records of 14 patients diagnosed with postvitrectomy macular edema unresponsive to first-line treatment, treated with intravitreal dexamethazone implant injection and followed at least 6 months between October 2011 and May 2016 were retrospectively reviewed. All patients underwent standard ophtalmological examination, fluorescein angiography, and optical coherence tomography. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressures (IOPs) were recorded at baseline, at first and sixth months after the injection. RESULTS The mean BCVA, which was 0.2 ± 0.14 logMAR at baseline significantly increased to 0.44 ± 0.2 logMAR at first month (P = 0.05) and to 0.4 ± 0.22 logMAR at sixth month of intravitreal dexamethazone implant injection (P = 0.01). CMT was also significantly decreased to 368.3 ± 90.4 μm at first month and to 323 ± 84.6 μm at sixth month from pre-injection value of 520.7 ± 90.3 μm (P = 0.001 and P = 0.002, respectively). IOP significantly increased from was 15 ± 2.1 mmHg at baseline to 20.6 ± 5.4 mmHg at first month of intravitreal dexamethazone implant injection (P = 0.01). CONCLUSION Dexamethazone implant treatment may reduce CMT and improve BCVA in cases with postvitrectomy macular edema. IOP should be regularly screened in these cases.
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Affiliation(s)
- Seda Karaca Adıyeke
- Ophthalmology Department, Tepecik Research and Training Hospital , Izmir, Turkey
| | - Gamze Türe
- Ophthalmology Department, Tepecik Research and Training Hospital , Izmir, Turkey
| | - Ekrem Talay
- Ophthalmology Department, Tepecik Research and Training Hospital , Izmir, Turkey
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Randazzo A, Vinciguerra P. Chronic Macular Edema Medical Treatment in Irvine-Gass Syndrome: Case Report. Eur J Ophthalmol 2018; 20:462-5. [DOI: 10.1177/112067211002000233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Evaluation of Predictive Factors for Successful Intravitreal Dexamethasone in Pseudophakic Cystoid Macular Edema. J Ophthalmol 2017; 2017:4625730. [PMID: 29410912 PMCID: PMC5749279 DOI: 10.1155/2017/4625730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/31/2017] [Accepted: 10/18/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the efficacy, safety, and predictive outcome factors for intravitreal dexamethasone implant (DEX) in pseudophakic cystoid macular edema (PCME). Methods Retrospective, interventional, controlled study. Patients included had to have clinically significant PCME and have been treated with the DEX between 2012 and 2015. Charts and one-year data were selected consecutively, and efficacy and safety were abstracted. Visual acuity (VA) and central foveal thickness (CFT) were analysed. Results Nineteen patient data sets were analysed. After treatment with DEX, mean VA increased significantly by 0.2 logMAR (p = 0.034), while the mean CFT was reduced significantly by 162.79 μm (p < 0.001). Five patients receiving a combination of DEX/bevacizumab have not experienced a higher mean VA gain or CFT reduction compared to fourteen patients receiving DEX alone. Decision rules, when to combine DEX with bevacizumab, have not been defined before the study. Only posttreatment VA gains in the nonhypertensive subgroup (n = 11) were significantly better (p = 0.026). Analysis of data from diabetes patients (n = 4) versus nondiabetics yielded no significant differences in efficacy. There have been no adverse events within follow-up time. Conclusion The use of DEX in PCME showed significant improvements in VA and CFT. The VA seems to show greater improvements in patients without hypertension.
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Matet A, Daruich A, Behar-Cohen F. Irvine-Gass Macular Edema Responding to the Combination of Oral Mineralocorticoid-Receptor Antagonist With Dexamethasone Drops. Ophthalmic Surg Lasers Imaging Retina 2017; 48:936-942. [PMID: 29121365 DOI: 10.3928/23258160-20171030-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/02/2017] [Indexed: 11/20/2022]
Abstract
Long-lasting postoperative macular edema is a therapeutic challenge. The authors report an efficient combination therapy of oral mineralocorticoid receptor antagonists (eplerenone [Inspra; Pfizer, New York City, NY] or spironolactone, 25 mg/day to 50 mg/day) and topical dexamethasone (four times/day and progressive dose tapering) in three refractory cases following complex cataract or retinal detachment surgery. In Case 1, central macular thickness (CMT) decreased from 523 μm to 214 μm and visual acuity (VA) improved from 20/200 to 20/50 during a 6-month period. In Cases 2 and 3, CMT improved from 505 μm to 333 μm and from 438 μm to 316 μm during 5- and 3-month periods, respectively; however, VA remained unchanged (20/100 and 20/200) due to photoreceptor damage. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:936-942.].
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Management of Irvine-Gass syndrome. J Fr Ophtalmol 2017; 40:788-792. [PMID: 28987449 DOI: 10.1016/j.jfo.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/30/2017] [Indexed: 11/23/2022]
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Bonfiglio V, Reibaldi M, Fallico M, Russo A, Pizzo A, Fichera S, Rapisarda C, Macchi I, Avitabile T, Longo A. Widening use of dexamethasone implant for the treatment of macular edema. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:2359-2372. [PMID: 28860707 PMCID: PMC5566324 DOI: 10.2147/dddt.s138922] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Sustained-release intravitreal 0.7 mg dexamethasone (DEX) implant is approved in Europe for the treatment of macular edema related to diabetic retinopathy, branch retinal vein occlusion, central retinal vein occlusion, and non-infectious uveitis. The implant is formulated in a biodegradable copolymer to release the active ingredient within the vitreous chamber for up to 6 months after an intravitreal injection, allowing a prolonged interval of efficacy between injections with a good safety profile. Various other ocular pathologies with inflammatory etiopathogeneses associated with macular edema have been treated by DEX implant, including neovascular age-related macular degeneration, Irvine-Gass syndrome, vasoproliferative retinal tumors, retinal telangiectasia, Coats' disease, radiation maculopathy, retinitis pigmentosa, and macular edema secondary to scleral buckling and pars plana vitrectomy. We undertook a review to provide a comprehensive collection of all of the diseases that benefit from the use of the sustained-release DEX implant, alone or in combination with concomitant therapies. A MEDLINE search revealed lack of randomized controlled trials related to these indications. Therefore we included and analyzed all available studies (retrospective and prospective, comparative and non-comparative, randomized and nonrandomized, single center and multicenter, and case report). There are reports in the literature of the use of DEX implant across a range of macular edema-related pathologies, with their clinical experience supporting the use of DEX implant on a case-by-case basis with the aim of improving patient outcomes in many macular pathologies. As many of the reported macular pathologies are difficult to treat, a new treatment option that has a beneficial influence on the clinical course of the disease may be useful in clinical practice.
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Affiliation(s)
| | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alessandra Pizzo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Stefano Fichera
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Carlo Rapisarda
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Iacopo Macchi
- Department of Ophthalmology, University of Catania, Catania, Italy
| | | | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
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Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine-Gass syndrome: a prospective case series. Eye (Lond) 2016; 30:1549-1557. [PMID: 27858937 DOI: 10.1038/eye.2016.205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 06/15/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeTo determine the preliminary efficacy and safety of off-label dexamethasone implant for treatment of recurrent cystoid macular edema (CME) secondary to Irvine-Gass syndrome (IGS).Patients and methodsThis study was set in Raghudeep Eye Clinic, Ahmedabad and LV Prasad Eye Institute, Hyderabad (India). It is a Prospective Case Series. Prospective case series comprising of patients with uncomplicated pseudophakia and CME due to IGS who recurred after one course of topical steroids with NSAIDS and a sub-Tenon corticosteroid injection. A complete ocular and systemic exam, fluorescein angiography, and central subfield thickness (CST) on optical coherence tomography scans were performed. Follow-up visits were on days 1, 15, and 30 and then monthly for a year. Appropriate statistical analysis was done. The primary outcome measure was the change in CDVA at months 1, 6, and 12. Secondary outcome measures were recurrence of CME and complications if any as noted at months 1, 2, 6, and 12.ResultsAbout 27 patients (27 eyes) with 16 males were included. Median age: 63.24±5.62 years. At 1 month, the CDVA improved to 0.04±0.02 (20/25) logMAR from 0.52±0.12 logMAR (20/70) (P=0.001) with a reduction in CST from 454.2±45.3 to 218.32±38.15 microns(P=0.013). The CDVA was 0.04±0.03 logMAR(P<0.001) at month 6 and 0.05±0.02 logMAR(P<0.001) at month 12. The CST was 221±35.2 microns (P=0.013) at month 6 and 214±43.34 microns (P=0.0124) at month 12. All improvements were maintained for a year. Only one patient required a second injection. No complications were noted.ConclusionThe implant is safe and effective for the treatment of recurrent CME due to IGS.
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USE OF AFLIBERCEPT FOR THE MANAGEMENT OF REFRACTORY PSEUDOPHAKIC MACULAR EDEMA IN IRVINE-GASS SYNDROME AND LITERATURE REVIEW. Retin Cases Brief Rep 2016; 12:59-62. [PMID: 27617392 DOI: 10.1097/icb.0000000000000414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE To present the patient treated for pseudophakic cystoid macular edema with intravitreal aflibercept. METHODS Interventional case report. CASE An 83-year-old woman presented with decreased vision 1 month after uneventful cataract surgery. After failure to respond to posterior subtenons triamcinolone and three Ranibizumab injections, the patient responded to one intravitreal aflibercept injection. Recurrence occurred two months later, and therefore three monthly injections were then given. Again the patient responded although recurrence occurred two months after treatment. The patient refused further treatment. CONCLUSION Intravitreal aflibercept may be effective for the treatment of pseudophakic cystoid macular edema.
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Mayer WJ, Kurz S, Wolf A, Kook D, Kreutzer T, Kampik A, Priglinger S, Haritoglou C. Dexamethasone implant as an effective treatment option for macular edema due to Irvine-Gass syndrome. J Cataract Refract Surg 2016; 41:1954-61. [PMID: 26603404 DOI: 10.1016/j.jcrs.2015.10.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/10/2015] [Accepted: 01/13/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the effectiveness and safety of a dexamethasone implant (Ozurdex) to treat pseudophakic macular edema (Irvine-Gass syndrome). SETTING Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany. DESIGN Prospective nonrandomized study. METHODS Preoperatively and in 12 monthly postoperative intervals, a complete ophthalmic examination was performed in study patients, including measurement of corrected distance visual acuity (CDVA) using the standard Early Treatment Diabetic Retinopathy Study chart, intraocular pressure, foveal thickness using spectral-domain optical coherence tomography (SD-OCT), and retinal sensitivity (mean defect depth) using microperimetry. Morphological aspects of the inner segment-outer segment junction and visual function were correlated. RESULTS Twenty-three eyes (23 patients) with pseudophakic macular edema after uneventful cataract surgery were included. The mean duration of macular edema before treatment with a dexamethasone implant was 5.4 months (range 2 to 8 months). The CDVA increased in all patients from 30.2 letters ± 4.3 (SD) at baseline to 50.4 ± 4.9 letters at 12 months (P = .0016), regardless of the time of macular edema duration. Foveal thickness decreased from 520.8 ± 71.4 μm to 232.7 ± 26.6 μm (P < .002). Retinal sensitivity (mean defect depth) increased significantly over a 12-month follow-up, correlating positively with a restored inner segment-outer segment junction on SD-OCT analyses. No relevant adverse events were reported, and 9 recurrences occurred with a peak after 3 months and required a second dexamethasone implant injection. CONCLUSION The dexamethasone implant was safe and effective in treating pseudophakic macular edema regardless of the duration of the edema. FINANCIAL DISCLOSURE Drs. Mayer and Haritoglou are consultants to Allergan, Inc. No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Wolfgang J Mayer
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria.
| | - Stefanie Kurz
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
| | - Armin Wolf
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
| | - Daniel Kook
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
| | - Thomas Kreutzer
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
| | - Anselm Kampik
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
| | - Siegfried Priglinger
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
| | - Christos Haritoglou
- From the Department of Ophthalmology (Mayer, Kurz, Wolf, Kook, Kreutzer, Kampik, Priglinger, Haritoglou), Ludwig-Maximilians-University, and Herzog Carl Theodor Eye Clinic (Haritoglou), Munich, Germany; the Department of Ophthalmology (Kreutzer, Priglinger), Allgemeines Krankenhaus Linz, Linz, Austria
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Bellocq D, Pierre-Kahn V, Matonti F, Burillon C, Voirin N, Dot C, Akesbi J, Milazzo S, Baillif S, Soler V, Wolff B, Scemama C, Malclès A, Weber M, Kodjikian L. Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study. Br J Ophthalmol 2016; 101:333-341. [PMID: 27190126 DOI: 10.1136/bjophthalmol-2016-308544] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 11/04/2022]
Abstract
AIM To assess the effectiveness of intravitreal dexamethasone implants for treating postsurgical macular oedema (PSMO) including Irvine-Gass syndrome and determining the predictive factors of treatment response. METHODS Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. One hundred patients were included between April 2011 and June 2014, with a minimum of 1-year follow-up. Patients received dexamethasone implant 0.7 mg at baseline. Clinical characteristics, best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT) and intraocular pressure were measured at each visit. The main outcome measure was the change in BCVA (Early Treatment of Diabetic Retinopathy Study (ETDRS) letters: L). An analysis of predictive factors of treatment response is also provided. RESULTS Mean improvement in BCVA was 9.6 (±10.6) L at month 6 and 10.3 (±10.7) L at month 12 (p<0.001). The proportion of eyes with gains in BCVA of 15 or more letters was 32.5% and 37.5% at months 6 and 12, respectively. The mean reduction in CSMT was 135.2 and 160.9 µm at months 6 and 12, respectively (p<0.001). Thirty-seven per cent of patients did not need a second injection after the first injection during follow-up. The presence of at least one PSMO risk factor decreases the probability of a gain in visual acuity (VA) ≥10 L (p=0.006). Initial VA ≤50 L at baseline and non-naïve status decrease the probability of having only one injection during follow-up (p=0.044). CONCLUSIONS The significant gain in BCVA from baseline achieved at month 6 was maintained at month 12 after intravitreal injection of dexamethasone implant. Naïve status seems to be a good predictive factor of treatment response.
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Affiliation(s)
- David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,CNRS UMR 5510 Mateis, Villeurbanne, France
| | | | - Frédéric Matonti
- Department of Ophthalmology, Nord Hospital, Aix Marseille University, Institut de Neurosciences de la Timone, CNRS/ UMR7289, Marseille, France
| | - Carole Burillon
- Department of Ophthalmology, Edouard Herriot Hospital, University of Lyon I, Institut de Biologie et Chimie des Protéines, CNRS/ UMR5086, Lyon, France
| | - Nicolas Voirin
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, CNRS, UMR 5558, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes military Hospital, University of Val de Grâce, Paris, France
| | - Jad Akesbi
- Department of Ophthalmology, XV XX Ophthalmic National Hospital Center, Paris, France
| | - Solange Milazzo
- Department of Ophthalmology, University of Picardie Jules Verne, CHU Amiens Picardie -Site Sud D408 Amiens cedex 1 80054 . France. Center n° 86 of network EVICR-net, Amiens, France
| | - Stéphanie Baillif
- Department of Ophthalmology, Saint Roch University Hospital, Nice Sophia Antipolis, France
| | - Vincent Soler
- Department of Ophthalmology, University Hospital, Toulouse, France
| | | | - Claire Scemama
- Department of Ophthalmology, Fondation Rotschild, Paris, France
| | - Ariane Malclès
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,CNRS UMR 5510 Mateis, Villeurbanne, France
| | - Michel Weber
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France.,CNRS UMR 5510 Mateis, Villeurbanne, France
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Schmier JK, Covert DW, Hulme-Lowe CK, Mullins A, Mahlis EM. Treatment costs of cystoid macular edema among patients following cataract surgery. Clin Ophthalmol 2016; 10:477-83. [PMID: 27041989 PMCID: PMC4801125 DOI: 10.2147/opth.s98892] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose The current costs of treating cystoid macular edema (CME), a complication that can follow cataract surgery, are largely unknown. This analysis estimates the treatment costs for CME based on the recently released US Medicare data. Setting Nationally representative database. Design Retrospective analysis of the 2011 through 2013 Medicare 5% Beneficiary Encrypted Files. Methods Beneficiaries who underwent cataract surgery were identified and stratified by diagnosis of CME (cases) or no diagnosis of CME (controls) within 6 months following surgery. Claims and reimbursements for ophthalmic care were identified. Subgroup analyses explored the rates of CME in beneficiaries based on the presence of selected comorbidities and by the type of procedure (standard vs complex). Total Medicare and ophthalmic costs for cases and controls are presented. The analysis explored the effect of considering diabetic macular edema (DME) and macular edema (ME) as exclusion criteria. Results Of 78,949 beneficiaries with cataract surgery, 2.54% (n=2,003) were diagnosed with CME. One-third of beneficiaries had one or more conditions affecting retinal health (including diabetes), 4.5% of whom developed CME. The rate of CME, at 22.5%, was much higher for those patients with preoperative DME or ME. Ophthalmic charges were almost twice as high for cases compared with controls (US$10,410 vs $5,950); payments averaged 85% higher ($2,720 vs $1,470) (both P<0.0001). Conclusion Substantial costs can be associated with CME; beneficiaries whose retinas are already compromised before cataract surgery face higher risk. Cost savings could be realized with the use of therapies that reduce the risk of developing CME. Future analyses could identify whether and to what extent comorbidities influence costs.
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Landré C, Zourdani A, Gastaud P, Baillif S. [Treatment of postoperative cystoid macular edema (Irvine-Gass syndrome) with dexamethasone 0.7 mg intravitreal implant]. J Fr Ophtalmol 2015; 39:5-11. [PMID: 26520410 DOI: 10.1016/j.jfo.2015.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the efficacy of dexamethasone 0.7 mg intravitreal implant in patients with postoperative cystoid macular edema. MATERIALS AND METHODS Fourteen patients' charts with postoperative cystoid macular edema were retrospectively reviewed. The main outcome measures were best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT). RESULTS Patients' mean age was 72.1 years old. Five patients were diabetic. All patients had previously been treated with non-steroidal anti-inflammatory drops. Four patients had received a previous treatment with intravitreal ranibizumab. The mean follow-up period was 8.7 months. Mean BCVA before intravitreal dexamethasone was 0.72 logMAR. After injection, it improved to 0.50 at month 1, was 0.47 at month 3, and 0.60 logMAR at month 12. The pre-injection mean CRT was 598 μm. It improved to 286 μm at month 1, 338 μm at month 3, and was 441 μm at month 12. Eight patients received 2 intravitreal injections of dexamethasone. Five patients presented with elevated intraocular pressure during follow-up, which was treated with drops. CONCLUSIONS Intravitreal dexamethasone injection improved visual acuity and macular thickness at month 1 and month 3 in patients with postoperative cystoid macular edema. A second injection was necessary after a mean period of 5 months.
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Affiliation(s)
- C Landré
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - A Zourdani
- Cabinet Nice-Retina, 5, rue Eugène-Emmanuel, 06000 Nice, France
| | - P Gastaud
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - S Baillif
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France.
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Sigler EJ, Randolph JC, Kiernan DF. Longitudinal analysis of the structural pattern of pseudophakic cystoid macular edema using multimodal imaging. Graefes Arch Clin Exp Ophthalmol 2015; 254:43-51. [DOI: 10.1007/s00417-015-3000-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/21/2015] [Accepted: 03/25/2015] [Indexed: 11/29/2022] Open
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Bellocq D, Korobelnik JF, Burillon C, Voirin N, Dot C, Souied E, Conrath J, Milazzo S, Massin P, Baillif S, Kodjikian L. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study. Br J Ophthalmol 2015; 99:979-83. [PMID: 25583283 DOI: 10.1136/bjophthalmol-2014-306159] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/26/2014] [Indexed: 11/03/2022]
Abstract
AIM To assess the effectiveness and safety of intravitreal dexamethasone implants for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments. METHODS Descriptive, observational, retrospective, consecutive, uncontrolled, multicentre, national case series. 50 patients were included in the study between March 2011 and June 2013 with a minimum 6 months follow-up. At baseline, each patient received a dexamethasone implant 0.7 mg (Ozurdex). Best-corrected visual acuity (BCVA), central subfield macular thickness (CSMT), and intraocular pressure (IOP) were measured at baseline and then monthly. The main outcome measure was the mean change in BCVA (in ETDRS letters (Early Treatment Diabetic Retinopathy Study): L) RESULTS: Baseline mean±SD BCVA was 55.7±15.4 L. At month 2, BCVA was 71.8±10.5 L and 61.2% of patients had an increase of more than 15 letters. Baseline mean CSMT was 544±117.2 μm and this decreased to 302 μm at month 2. Anatomic and functional recurrences were both first detected from month 3 and continued throughout follow-up, with values consistently above baseline. The peak in IOP was reached in month 1 with mean IOP of 15.3±4.6 mm Hg. Of the 39/50 patients followed up for 12 months, 49% received a second injection. The anatomic and functional response and safety patterns were similar to that obtained with the first intravitreal injection, demonstrating Ozurdex's reproducibility. However, more than half of the patients followed-up for at least 1 year presented neither functional nor anatomical recurrence. CONCLUSIONS Ozurdex would appear to be an interesting alternative therapy for treating post-surgical macular oedema, including Irvine-Gass syndrome refractory to first-line treatments.
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Affiliation(s)
- David Bellocq
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France CNRS UMR 5510 Mateis, Villeurbanne, France
| | - Jean-François Korobelnik
- Université de Bordeaux, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France INSERM, ISPED, CHUde Bordeaux, France Service d'ophtalmologie, CHUde Bordeaux, France
| | - Carole Burillon
- Department of Ophthalmology, Edouard Herriot Hospital, University of Lyon I, Lyon, France Institut de Biologie et Chimie des Protéines, CNRS/UMR5086, Lyon, France
| | - Nicolas Voirin
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France Université de Lyon, Lyon, France Université Lyon 1, Villeurbanne, France CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Corinne Dot
- Department of Ophthalmology, Desgenettes military Hospital, University of Val de Grâce, Lyon, France
| | - Eric Souied
- Hopital Intercommunal de Creteil, University Paris Est, Creteil, France
| | - John Conrath
- Centre d'Ophtalmologie Monticelli-Paradis, Marseille, France
| | - Solange Milazzo
- Department of Ophthalmology, University of Picardie Jules Verne, Clinic Saint Victor, 354, Boulevard of Beauville, Amiens, France Center n° 86 of network EVICR-net
| | - Pascale Massin
- Department of Ophthalmology, Assistance Publique-Hôpitaux de Paris (AP-HP) Université Paris 7, Hôpital Lariboisière, Paris, France
| | - Stéphanie Baillif
- Departement of Ophthalmology, Saint Roch University Hospital, Nice Sophia Antipolis, Nice, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, Hospices Civils de Lyon, University of Lyon I, Lyon, France CNRS UMR 5510 Mateis, Villeurbanne, France
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Khurana RN, Palmer JD, Porco TC, Wieland MR. Dexamethasone Intravitreal Implant for Pseudophakic Cystoid Macular Edema in Patients With Diabetes. Ophthalmic Surg Lasers Imaging Retina 2015; 46:56-61. [PMID: 25559510 DOI: 10.3928/23258160-20150101-09] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/20/2014] [Indexed: 11/20/2022]
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Al Zamil WM. Short-term safety and efficacy of intravitreal 0.7-mg dexamethasone implants for pseudophakic cystoid macular edema. Saudi J Ophthalmol 2014; 29:130-4. [PMID: 25892932 PMCID: PMC4398816 DOI: 10.1016/j.sjopt.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/07/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS To determine the feasibility, safety, and clinical efficacy of intravitreal 0.7-mg dexamethasone implants (Ozurdex) in patients with refractory cystoid macular edema after uncomplicated cataract surgery. METHODS AND MATERIALS In this study, 11 eyes of 11 patients affected by pseudophakic cystoid macular edema refractory to medical treatment were treated with a single intravitreal injection of a dexamethasone implant. Follow-up visits involved Early Treatment Diabetic Retinopathy Study visual acuity testing, optical coherence tomography imaging, and ophthalmoscopic examination. RESULTS The follow-up period was six months. The mean duration of cystoid macular edema before treatment with Ozurdex was 7.7 months (range, 6-10 months). The baseline mean best corrected visual acuity (BCVA) was 0.58 ± 0.17 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.37 ± 0.16 logMAR (p = 0.008) and 0.20 ± 0.13 logMAR (p = 0.001) after 1 and 3 months, respectively. At the last follow-up visit (6-month follow-up), the mean BCVA was 0.21 ± 0.15 logMAR (p = 0.002). The mean foveal thickness at baseline (513.8 μm, range, 319-720 μm) decreased significantly (308.0 μm; range, 263-423 μm) by the end of the follow-up period (p < 0.0001). Final foveal thickness was significantly correlated with baseline BCVA (r = 0.57, p = 0.002). No ocular or systemic adverse events were observed. CONCLUSIONS Short-term results suggest that the intravitreal dexamethasone implant is safe and well tolerated in patients with pseudophakic cystoid macular edema. Treated eyes had revealed a significant improvement in BCVA and decrease in macular thickness by optical coherence tomography.
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Affiliation(s)
- Waseem M. Al Zamil
- Address: Department of Ophthalmology, P.O. Box 2208, Khobar 31952, Saudi Arabia. Tel.: +966 138966666; fax: +966 138966776.
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Guo S, Patel S, Baumrind B, Johnson K, Levinsohn D, Marcus E, Tannen B, Roy M, Bhagat N, Zarbin M. Management of pseudophakic cystoid macular edema. Surv Ophthalmol 2014; 60:123-37. [PMID: 25438734 DOI: 10.1016/j.survophthal.2014.08.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 01/08/2023]
Abstract
Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.
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Affiliation(s)
- Suqin Guo
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA.
| | - Shriji Patel
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Ben Baumrind
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Keegan Johnson
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Daniel Levinsohn
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Edward Marcus
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Brad Tannen
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Monique Roy
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Neelakshi Bhagat
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Marco Zarbin
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
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Sacchi M, Villani E, Gilardoni F, Nucci P. Efficacy of intravitreal dexamethasone implant for prostaglandin-induced refractory pseudophakic cystoid macular edema: case report and review of the literature. Clin Ophthalmol 2014; 8:1253-7. [PMID: 25061272 PMCID: PMC4086850 DOI: 10.2147/opth.s63829] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Macular edema is a known complication even after uneventful cataract surgery. The chronic use of prostaglandin analogs is a risk factor for the development of pseudophakic cystoid macular edema (CME). Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first-line therapy but refractory postsurgical CME represents a therapeutic challenge, as there is not an evidence-based treatment. Objective To report the use of a single implant of intravitreal dexamethasone for tafluprost-associated pseudophakic CME refractory to NSAIDs and to sub-Tenon’s corticosteroid injections. Case report A 64-year-old female with ocular hypertension treated with tafluprost experienced decreased vision (visual acuity 20/60) and metamorphopsia 2 months after uneventful cataract extraction. Spectral domain optical coherence tomography (SD-OCT) revealed CME. After 1 month of topical and oral NSAIDs, CME was still evident on SD-OCT (visual acuity 20/50). Two sub-Tenon’s betamethasone injections were performed at a 2-week interval. As CME was still present, 2 months after the diagnosis of CME (visual acuity 20/40), the patient underwent a single dexamethasone intravitreal implant. One month later, macular appearance was normal, and visual acuity increased to 20/30. This result was maintained throughout the 6 months of follow-up. Conclusion In this report, a single implant of intravitreal dexamethasone successfully treated pseudophakic CME associated with the use of prostaglandin analogs unresponsive to NSAIDs and sub-Tenon’s betamethasone. The results of this report need to be corroborated by powered, prospective, randomized trials. The need for repeated treatments as well as the retreatment interval in patients requiring more than a single injection are issues still needing further investigations.
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Affiliation(s)
- Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Francesca Gilardoni
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
| | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy
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Kiernan DF, Hariprasad SM. Controversies in the management of Irvine-Gass syndrome. Ophthalmic Surg Lasers Imaging Retina 2014; 44:522-7. [PMID: 24221459 DOI: 10.3928/23258160-20131105-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mitropoulos PG, Chatziralli IP, Peponis VG, Drakos E, Parikakis EA. Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm 2014; 23:225-31. [PMID: 24678790 DOI: 10.3109/09273948.2014.898775] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME). METHODS This retrospective study comprised 7 eyes with CME treated with intravitreal ranibizumab. Patients were examined at 1 week and 1 month after injection and monthly thereafter. Main outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects. RESULTS There was a statistically significant difference on BCVA (p < 0.001) and CRT (p < 0.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in 1 patient, in a long-term follow-up. No observable ocular or systemic side effects were found. CONCLUSIONS Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.
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Brynskov T, Laugesen CS, Halborg J, Kemp H, Sørensen TL. Longstanding refractory pseudophakic cystoid macular edema resolved using intravitreal 0.7 mg dexamethasone implants. Clin Ophthalmol 2013; 7:1171-4. [PMID: 23818753 PMCID: PMC3693843 DOI: 10.2147/opth.s46399] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Refractory pseudophakic cystoid macular edema (PCME) following cataract surgery has long posed a challenge to clinicians, but intravitreal injections with a sustained delivery 0.7 mg dexamethasone implant has emerged as a promising therapy for this condition. Objective To present a case of longstanding and refractory PCME with complete remission through 189 days of follow-up after two successive injections with intravitreal dexamethasone implants. Case report A 59-year-old male had experienced metamorphopsia for approximately 4 years and had been diagnosed with PCME 15 months earlier. Since the time of the diagnosis, the condition had been refractory to both subtenon triamcinolone acetonide and a total of five injections with intravitreal ranibizumab. After the last injection with ranibizumab, central subfield mean thickness was 640 μm, and the best corrected visual acuity was 78 Early Treatment Diabetic Retinopathy Study letters. Following an intravitreal injection with a dexamethasone implant, the macular edema resolved at the next follow-up. The macular edema returned 187 days after the first injection and was treated with another intravitreal dexamethasone implant. Again, the macular edema subsided completely, and best corrected visual acuity improved to 84 Early Treatment Diabetic Retinopathy Study letters, a condition which was maintained through an additional 189 days of follow-up. Conclusion Chronic PCME is traditionally a difficult condition to treat, but we are encouraged by the optimal response experienced with intravitreal sustained release dexamethasone implants in our patient whose longstanding PCME had been refractory to previous treatments with both subtenon triamcinolone and intravitreal ranibizumab. In this case, the condition appeared to be fully reversible once inflammation was controlled, but the need for monitoring and repeated injections remains an issue of concern.
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Affiliation(s)
- Troels Brynskov
- Department of Ophthalmology, Copenhagen University Hospital Roskilde, Roskilde, Denmark ; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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