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Bilic T, Amblard MA, Trouvain AM, Seuthe AM, Rickmann A. [Acute Loss of Vision after Parabulbar Injection of Triamquinolone Acetonide]. Klin Monbl Augenheilkd 2024. [PMID: 38959950 DOI: 10.1055/a-2338-3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Affiliation(s)
- Tamara Bilic
- Augenheilkunde, Augenklinik Sulzbach, Deutschland
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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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Rodrigues MV, Garcia JMB, Pacheco KD, Borges FT, Isaac DLC, Avila M. Pseudophakic macular edema in nondiabetic and diabetic patients without diabetic retinopathy treated with intravitreal dexamethasone implant. Int J Retina Vitreous 2023; 9:56. [PMID: 37723594 PMCID: PMC10506302 DOI: 10.1186/s40942-023-00489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/14/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the impact of intravitreal dexamethasone (DEX) implant during a 12-month period in nondiabetic and diabetic patients without diabetic retinopathy (DR) as a treatment for refractory pseudophakic cystoid macular edema (PCME) following prior treatment with topical nepafenac 0.1% and prednisolone 1%. METHODS Forty-two consecutive medical records of patients diagnosed with PCME after uneventful cataract surgery were included. The outcomes measured included best corrected visual acuity (BCVA) and central foveal thickness (CFT). Linear regression analysis was statistically applied. RESULTS Following topical treatment, nondiabetic and diabetic subjects presented a mean ± SD gain of - 0.11 ± 0.11 and - 0.18 ± 0.11 BCVA logMAR and a CFT reduction of - 43.42 ± 53.66 µm and - 58.76 ± 36.28 µm, respectively. The mean BCVA gain at month 12 subsequent to DEX implantation was - 0.35 ± 0.17 in nondiabetic (p < 0.001) and - 0.55 ± 0.26 in diabetic patients (p < 0.001), with CFT reductions of - 195.71 ± 93.23 µm (p < 0.001) and - 260.81 ± 198.69 µm (p < 0.001), respectively. Patients who responded with better VA after topical treatment presented better visual outcomes at month 12 following DEX implantation (r2 = 0.46; rho = - 0.71, p < 0.01). CONCLUSION Nondiabetic and diabetic patients without DR demonstrated similar results after DEX implant after combined topical therapy, suggesting that selected diabetic patients may have a response comparable to that of nondiabetic patients with PCME.
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Affiliation(s)
- Magna Vanessa Rodrigues
- Centro Brasileiro da Visao, Brasilia, DF, Brazil.
- Federal University of Goias, Centro de Referencia em Oftalmologia (CEROF), Goiania, GO, Brazil.
| | | | | | | | | | - Marcos Avila
- Centro Brasileiro da Visao, Brasilia, DF, Brazil
- Federal University of Goias, Centro de Referencia em Oftalmologia (CEROF), Goiania, GO, Brazil
- Centro Brasileiro de Cirurgia de Olhos, Goiania, GO, Brazil
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Deaner JD, Mammo D, Gross A, Lee T, Sharma S, Srivastava SK, Jaffe GJ, Grewal DS. 0.18 MG FLUOCINOLONE ACETONIDE INSERT FOR THE TREATMENT OF CHRONIC POSTOPERATIVE PSEUDOPHAKIC CYSTOID MACULAR EDEMA. Retina 2023; 43:897-904. [PMID: 36796039 DOI: 10.1097/iae.0000000000003765] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE To report the outcomes of the 0.18 mg fluocinolone acetonide insert (FAi) in the treatment of chronic (>6 months) postoperative cystoid macular edema after cataract surgery. METHODS This was a retrospective consecutive case series of eyes with chronic postoperative cystoid macular edema treated with the FAi. Visual acuity, intraocular pressure, optical coherence tomography metrics, and supplemental therapies were extracted from the charts before and at 3, 6, 12, 18, and 21 months after FAi placement, when available. RESULTS Nineteen eyes of 13 patients with chronic postoperative cystoid macular edema after cataract surgery underwent FAi placement with an average follow-up of 15.4 months. Ten eyes (52.6%) had a ≥2-line gain in visual acuity. Sixteen eyes (84.2%) had a ≥20% reduction in optical coherence tomography central subfield thickness. Eight eyes (42.1%) had complete resolution of CME. Improvements in central subfield thickness and visual acuity were sustained throughout individual follow-up. Compared with 18 eyes (94.7%) requiring local corticosteroid supplementation before FAi, only six eyes (31.6%) required supplementation after FAi. Similarly, of the 12 eyes (63.2%) that were on corticosteroid drops before FAi, only 3 (15.8%) required drops after FAi. CONCLUSION Eyes with chronic postoperative cystoid macular edema after cataract surgery treated with the FAi had improved and sustained visual acuity and optical coherence tomography metrics, along with a reduction in supplemental treatment burden.
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Affiliation(s)
- Jordan D Deaner
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Danny Mammo
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Andrew Gross
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Terry Lee
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sumit Sharma
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Sunil K Srivastava
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Glenn J Jaffe
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
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Bernal-Morales C, Navarro-Angulo MJ, Rodriguez-Maqueda M, Velazquez-Villoria D, Cubero-Parra JM, Marticorena J, Hernández-Martínez A, Ruiz-Miguel M, Adan A, Ruiz-Casas D, Zarranz-Ventura J. Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2. J Clin Med 2023; 12:jcm12020436. [PMID: 36675364 PMCID: PMC9862359 DOI: 10.3390/jcm12020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.
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Affiliation(s)
- Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | | | | | | | | | - Joaquín Marticorena
- Instituto Oftalmológico La Esperanza, HM La Esperanza, 15705 Santiago de Compostela, Spain
- Servicio de Oftalmología, Complejo Hospitalario Universitario, 15006 A Coruña, Spain
| | | | | | - Alfredo Adan
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Diego Ruiz-Casas
- Servicio de Oftalmología, Hospital Ramon y Cajal, 28029 Madrid, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Correspondence:
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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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Chronopoulos A, Chronopoulos P, Hattenbach LO, Ashurov A, Schutz JS, Pfeiffer N, Korb C. Intravitreal fluocinolone acetonide implant for chronic postoperative cystoid macular edema - two years results. Eur J Ophthalmol 2022; 33:11206721221124688. [PMID: 36062617 DOI: 10.1177/11206721221124688] [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: 11/15/2022]
Abstract
PURPOSE We report visual and anatomical outcomes of chronic postoperative macular edema treated with a fluocinolone acetonide intravitreal implant. METHOD Retrospective study of chronic, post-surgical CME treated with a fluocinolone acetonide intravitreal implant. Best registered visual acuity (BRVA), central retinal thickness (CRT), and Goldmann tonometry intraocular pressure (IOP) were assessed over 24 months. The need for IOP lowering treatment, top-up therapy during follow-up, and complications were also assessed. RESULTS We analyzed 16 consecutive eyes of 16 patients with chronic, post-surgical CME treated with fluocinolone acetonide intravitreal implant. Surgical indications included cataract surgery, vitrectomy plus membrane peeling and combined phaco-vitrectomy. Baseline mean BRVA of 0.8 ± 0.65 logMAR improved to 0.60 ± 0.4 logMAR (p = 0.02) at 12 months and to 0.7 ± 0.5 logMAR (p = 0.32) at 24 months. At month 12, BRVA improved in 11 eyes, stabilized in 4 eyes, and decreased in 1 eye. At month 24, VA remained improved in 5 eyes, remained stabilized in 5 eyes, and decreased in 1 eye. Mean CRT decreased from 524 ± 132 μm at baseline to 389 μm at month 3, 347 μm at month 6, 355 ± 106 μm (p = 0.0003) at month 12, and 313 ± 83 μm (p = 0.0001) at month 24. At 12 months, CRT improved in 13 eyes and remained unchanged in 2 eyes. At 24 months, CRT improved further in 8 eyes, and stabilized in 3 eyes. Increased IOP (≥21 mmHg) was observed only in 4 eyes, all successfully managed with topical medication. No further side effects were observed in any patient. CONCLUSION Visual and anatomic improvements were achieved by a single fluocinolone acetonide implant with few side effects up to 24 months in CME eyes with a long and heavy prior treatment history.
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Affiliation(s)
- Argyrios Chronopoulos
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Panagiotis Chronopoulos
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - L O Hattenbach
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Agharza Ashurov
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - James S Schutz
- Department of Ophthalmology, 9209Ludwigshafen Hospital, Ludwigshafen am Rhein, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Christina Korb
- Department of Ophthalmology, 39068University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Herold TR, Vounotrypidis E, Liegl R, Koenig SF, Priglinger SG, Wolf A. LONG-TERM EFFICACY OF FLUOCINOLONE IN EYES WITH IRIS-LENS DIAPHRAGM DISRUPTION AND PCME WITH MEDICATION FIXED IN THE SCLERA (MEFISTO). Retina 2022; 42:1392-1398. [PMID: 35321998 PMCID: PMC9200227 DOI: 10.1097/iae.0000000000003472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of our prospective off-label, interventional clinical trial was to evaluate the efficacy and safety of the fluocinolone-loop-anchoring technique over two years in eyes with iris-lens diaphragm disruption and pseudophakic cystoid macular edema. METHODS In 10 eyes, scleral fixation of fluocinolone implant was performed. Main outcome measures were the development of best-corrected visual acuity (BCVA), central retinal thickness over 24 months, and general safety of the procedure. RESULTS A significant improvement to 0.57 ± 0.38 log MAR (Snellen 20/80) (range 0-1.30) was observed (P = 0.003) at 1 month. Further improvement to 0.45 ± 036 log MAR (Snellen 20/60) was observed until month 18 (P = 0.081). Mean central retinal thickness decreased by 22% from 601.6 ± 235.5 µm to 449.1 ± 128.9 µm at 1 month. In one patient, the implant has to be removed at Month 7 because of elevated intraocular pressure and one patient after globe rupture had a retinal redetachment at Month 4. CONCLUSION In this study, we showed that the treatment of recalcitrant pseudophakic cystoid macular edema with scleral fixated fluocinolone implant in eyes with disruption of the iris-lens diaphragm provides good anatomical and functional results with a reasonable safety profile over 24 months in eyes where pseudophakic cystoid macular edema is otherwise difficult to treat and often left untreated.
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Affiliation(s)
- Tina R. Herold
- Department of Ophthalmology, University Hospital, LMU Munich, Germany
| | | | - Raffael Liegl
- Department of Ophthalmology, University Hospital, Bonn, Germany; and
| | - Susanna F. Koenig
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Armin Wolf
- Department of Ophthalmology, University Hospital, Ulm, Germany
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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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Tariq F, Wang Y, Ma B, He Y, Zhang S, Bai L. Efficacy of Intravitreal Injection of Filtered Modified Low-Dose Triamcinolone Acetonide and Ranibizumab on Pseudophakic Cystoid Macular Edema. Front Med (Lausanne) 2022; 9:777549. [PMID: 35252233 PMCID: PMC8888519 DOI: 10.3389/fmed.2022.777549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To compare the visual and morphological effects between intravitreal injection of filtered modified 2 mg triamcinolone acetonide (TA) and 0. 5 mg ranibizumab in patients with pseudophakic cystoid macular edema (PCME). Methods A retrospective, interventional study was conducted from January 2015 to February 2020 involving patients with PCME after uneventful cataract surgery. A total of 25 patients (25 eyes) with PCME received an intravitreal injection of 0.22 μm filtered modified 2 mg TA, while 15 patients (15 eyes) received 0.5 mg ranibizumab injection. Central macular thickness (CMT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), times of repeated injections, and other side effects were observed at 2 weeks, 1 month, 3 months, and 6 months after injection; then, the data were compared with preinjection information in each group and between the two groups. Results Both the TA and ranibizumab intravitreal injection can achieve improved BCVA and reduced CMT in patients with PCME (P < 0.05), with a trend toward greater improvement in the TA group, but the difference was only significant at 3 months (P < 0.05). IOP was in the normal range without any significant difference (P > 0.05). Thirty-three percent of patients in the ranibizumab group required repeated intravitreal injection compared to 4% in the TA group. Further stratified analysis showed that the better therapeutic effect of the TA group at 3 months after injection only existed in patients with diabetes mellitus (DM), while not in patients without DM. There was no repeat injection in the TA group and 12.5% in the ranibizumab group for patients without DM, while 16.7% in the TA group and 57.1% in the ranibizumab group required repeated injection for patients with DM, which had a significant difference (P < 0.05). Conclusion Intravitreal injection of filtered modified 2 mg TA is safe, effective, and an inexpensive alternative to antivascular endothelial growth factor (anti-VEGF) agents for patients with PCME, especially for patients concurrently with DM. A large number of clinical randomized controlled studies along with long-term follow-up observations are needed.
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Affiliation(s)
- Farheen Tariq
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanfen Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Ma
- Department of Ophthalmology, The No.4 Hospital of Xi'an, Xi'an, China
| | - Yidan He
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shu Zhang
- Experimental Teaching Center for Clinical Skills and Department of Geriatric Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- *Correspondence: Shu Zhang
| | - Ling Bai
- Department of Ophthalmology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Ling Bai
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Ocular Injectable Treatment Options for Post-Cataract Macular Edema: A Systematic Review of Current Literature. J Cataract Refract Surg 2022; 48:1197-1202. [PMID: 35171142 DOI: 10.1097/j.jcrs.0000000000000908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT The incidence of pseudophakic cystoid macular edema (PCME) ranges from 0.1% to 20% and is the most common cause of post-procedure vision loss. Currently there is no widely accepted treatment for PCME. Topical non-steroidal anti-inflammatory (NSAID) drops given alone or in combination with topical corticosteroids are often used; however, there is a growing body of literature surrounding the off-label use of various ocular injectable medications. The purpose of this systematic literature review was to characterize the current evidence surrounding these treatments and conduct qualitative analysis to assess the risk for bias of each study. Eighteen total studies were found and evaluated to have moderate (n=3, 17%) to high risk (n=15, 83%) of bias. Although the growing body of real-world data favors improvements in visual acuity and anatomical outcomes with these injectable treatments, larger studies with better study design are needed to demonstrate their role in the management of PCME.
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12
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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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13
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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: 11] [Impact Index Per Article: 3.7] [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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Vounotrypidis E, Freissinger S, Cereda M, Monteduro D, Kortuem K, Priglinger S, Mayer B, Wolf A. Intravitreal injection associated rhegmatogenous retinal detachment: outcomes of a European analysis. Graefes Arch Clin Exp Ophthalmol 2021; 259:3655-3664. [PMID: 34216254 PMCID: PMC8589788 DOI: 10.1007/s00417-021-05261-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 04/19/2021] [Accepted: 05/28/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose As the number of intravitreal injections (IVI) increases annually, this study aimed to assess the anatomical and functional outcomes following rhegmatogenous retinal detachment (RRD) surgery for IVI-associated RRD (IVARD). Methods All non-vitrectomized eyes developing IVARD since 2007 in two European vitreoretinal centers (Department of Ophthalmology, LMU Munich, Germany, and Eye Clinic Luigi Sacco, University of Milan, Milan, Italy) were included. Main outcomes were primary and secondary retinal attachment rate after surgery, rate of proliferative vitreoretinopathy (PVR), and final functional result. Ten years of incidence rates per injection were calculated for one center. Results Fifty-two eyes of 52 patients comprised the study. Primary anatomic success rate was 83% (n = 43) and secondary 96% (n = 50). PVR was observed in all uveitic eyes (n = 3), in eyes with postoperative cystoid macular edema (n = 2), and in 8 of 9 eyes that received the dexamethasone implant (DEX). Age, number of prior injections, duration of symptoms, or time between last IVI and RRD did not show any statistically significant differences with regard to presence of PVR or not. Mean BCVA improved in 28 cases, remained stable in 16 cases, and worsened in 8 cases. The RRD incidence rate was statistically significant higher for DEX and ocriplasmin compared with that for anti-VEGF agents. Conclusion The anatomical result after one surgical intervention seems acceptable, but the final visual outcome remains rather poor, because of the underlying macular disease. In our population, injection with DEX is associated with higher IVARD rate, presence and development of PVR, and recurrent RRD in comparison with anti-VEGF agents.
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Affiliation(s)
| | - Sigrid Freissinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matteo Cereda
- Eye Clinic, Department of Clinical and Biomedical Science Luigi Sacco, Sacco Hospital, University of Milan, Milan, Italy
| | - Davide Monteduro
- Eye Clinic, Department of Clinical and Biomedical Science Luigi Sacco, Sacco Hospital, University of Milan, Milan, Italy
| | - Karsten Kortuem
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Benjamin Mayer
- Department of Statistics, University of Ulm, Ulm, Germany
| | - Armin Wolf
- Department of Ophthalmology, University of Ulm, Prittwitzstr 43, D-89075, Ulm, Germany.
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15
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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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16
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Perioperative Management of Diabetic Macular Edema. Int Ophthalmol Clin 2020; 60:41-50. [PMID: 32576722 DOI: 10.1097/iio.0000000000000320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Han JV, Patel DV, Squirrell D, McGhee CN. Cystoid macular oedema following cataract surgery: A review. Clin Exp Ophthalmol 2020; 47:346-356. [PMID: 30953417 DOI: 10.1111/ceo.13513] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Abstract
Pseudophakic cystoid macular oedema (PCMO) remains a significant cause of compromised postoperative vision in contemporary cataract surgery. Well-established risk factors include intraoperative complications such as posterior capsule rupture and preoperative factors including: diabetes mellitus, uveitis, retinal vein occlusion, epiretinal membrane. The role of topical glaucoma medications in PCMO continues to be debated. Current treatment strategies largely target suppression of inflammation. Topical NSAIDs remain the mainstay in prophylaxis and treatment of PCMO. Topical corticosteroids are commonly used as monotherapy or in combination with NSAIDs. Unfortunately, high-quality trials are notably lacking for other PCMO treatment modalities such as: periocular corticosteroids, orbital floor triamcinolone, intravitreal triamcinolone, corticosteroid implants, intravitreal bevacizumab and pars-plana vitrectomy. A lack of consistency in defining PCMO and resolution of PCMO explains why even large systematic reviews may come to contradictory conclusions. This review explores the varied contemporary evidence-base in relation to the aetiology, diagnosis, prophylaxis and treatment of PCMO.
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Affiliation(s)
- Jina V Han
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Dipika V Patel
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - David Squirrell
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Charles Nj McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Erikitola OO, Siempis T, Foot B, Lockington D. The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery-a Scottish Ophthalmological Surveillance Unit study. Eye (Lond) 2020; 35:584-591. [PMID: 32376978 PMCID: PMC7202460 DOI: 10.1038/s41433-020-0908-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose Post-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients. Methods A Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation. Results Fourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44–86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2–0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270–788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1–0.3) with average mean CRT of 327microns (245–488). Conclusions We identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.
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Affiliation(s)
- Ore-Oluwa Erikitola
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK
| | - Thomas Siempis
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK
| | - Barny Foot
- Royal College of Ophthalmologists, London, UK
| | - David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, Scotland, UK.
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Evaluation of Functional Outcomes and OCT-Biomarkers after Intravitreal Dexamethasone Implant for Postoperative Cystoid Macular Edema in Vitrectomized Eyes. J Ophthalmol 2020; 2020:3946531. [PMID: 32411428 PMCID: PMC7204163 DOI: 10.1155/2020/3946531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the efficacy of dexamethasone implant (DEX) for the treatment of postoperative cystoid macular edema (PCME) in vitrectomized eyes and to investigate visual and morphological OCT predictive factors. Methods In this retrospective study, eyes with PCME after vitrectomy were treated with at least one DEX injection and were observed over 12 months. Indications for surgery were epiretinal membrane (ERM) or rhegmatogenous retinal detachment (RRD) without macular involvement. Prior treatments, if any, were noted. Best corrected visual acuity (BCVA), central foveal thickness (CFT), and OCT morphology including the presence of intraretinal cysts/fluid or subretinal fluid (IRF/SRF) and ellipsoid zone (EZ) continuity were evaluated. Correlations between OCT measures and visual outcomes were analyzed by the generalized estimating equations procedure. Results Forty-six eyes with ERM and 15 eyes with RRD were enrolled. The ERM group was more likely to gain BCVA than RRD (odds ratio (OR), 1.168; 95% confidence interval (CI), 1.003–1.360; p=0.046). The absence of SRF (OR, 0.860; 95% CI, 0.743–0.995; p=0.043) was predictive of worse BCVA, whereas the integrity of EZ (OR, 1.094; 95% CI, 0.951–1.257; p=0.209) or naïve status (OR, 0.946; 95% CI, 0.871–1.137, p=0.853) was not. Eyes with a worse baseline BCVA were more likely to gain >1 line after 12 months (OR, 1.485; 95% CI, 1.171–1.884; p=0.001). Conclusion The efficacy of the treatment of PCME in vitrectomized eyes seems to be affected by baseline BCVA, the absence of SRF, and the indication for surgery. Naïve status appears not to play any significant role in the prediction of BCVA. This trial is registered with DRKS00018955.
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Scleral Fixation of the Fluocinolone Acetonide Implant in Eyes with Severe Iris-Lens Diaphragm Disruption and Recalcitrant CME: The Fluocinolone-Loop-Anchoring Technique (FLAT). Ophthalmol Ther 2020; 9:175-179. [PMID: 32056140 PMCID: PMC7054516 DOI: 10.1007/s40123-020-00232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION While proven to be an effective treatment for cystoid macular edema (CME) and diabetic macular edema, intravitreal steroid implants (IVSI) may cause undesirable side effects, including steroid-related glaucoma or migration into the anterior chamber in the case of iris-lens diaphragm disruption. Here we present a new surgical technique that allows for the easy implantation and subsequent fixation of the fluocinolone acetonide intravitreal implant without the risk of migration as a feasible and possibly reversible approach in the treatment of persistent CME in severely damaged eyes. METHODS In this single-center, prospective off-label, proof of principle, scleral fixation of the fluocinolone implant was performed in two eyes with disrupted anterior-posterior segment border and persistent CME. Both eyes were then followed monthly in accordance to a detailed protocol. RESULTS The procedure was overall well tolerated without severe side effects. There was no migration of the implant in the anterior chamber in either eye. CONCLUSION Scleral fixation of the fluocinolone implant proved to be a safe and feasible approach in eyes with persistent CME and disrupted anterior-posterior segment border. This new technique also allows for the possible removal of the implant and may therefore be suitable even for eyes at higher risk for side effects, such as glaucoma.
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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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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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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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Intravitreal Steroid Implants in the Management of Retinal Disease and Uveitis. Int Ophthalmol Clin 2018; 56:127-49. [PMID: 27575764 DOI: 10.1097/iio.0000000000000132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Errera MH, Westcott M, Benesty J, Falah S, Smadja J, Orès R, Pratas AC, Sedira N, Bensemlali A, Héron E, Goldschmidt P, Bodaghi B, Sahel JA. A Comparison of the Dexamethasone Implant (Ozurdex®) and Inferior Fornix-Based Sub-Tenon Triamcinolone Acetonide for Treatment of Inflammatory Ocular Diseases. Ocul Immunol Inflamm 2018; 27:319-329. [DOI: 10.1080/09273948.2018.1501492] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Marie-Hélène Errera
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
- UPMC Univ Paris VI, Sorbonne Université, Paris, France
| | - Mark Westcott
- Department of Medical Retina, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Biomedical Research Centre, UCL Institute of Ophthalmology, London, UK
- Internal Medicine, DHU Sight Restore, Quinze-Vingts Hospital, Paris, France
| | - Jonathan Benesty
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
- UPMC Univ Paris VI, Sorbonne Université, Paris, France
| | - Sabrina Falah
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | - Jérôme Smadja
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | - Raphaëlle Orès
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | | | - Neila Sedira
- Internal Medicine, DHU Sight Restore, Quinze-Vingts Hospital, Paris, France
| | - Amine Bensemlali
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
| | - Emmanuel Héron
- Internal Medicine, DHU Sight Restore, Quinze-Vingts Hospital, Paris, France
| | | | - Bahram Bodaghi
- DHU Sight Restore, Pitié-Salpêtrière Hospital, UPMC Univ Paris VI, Sorbonne Universités, Paris, France
| | - José-Alain Sahel
- DHU Sight Restore, INSERM-DHOS CIC, Quinze-Vingts Hospital, Paris, France
- UPMC Univ Paris VI, Sorbonne Université, Paris, France
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26
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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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Garweg JG, Baglivo E, Freiberg FJ, Pfau M, Pfister IB, Michels S, Zandi S. Response of Postoperative and Chronic Uveitic Cystoid Macular Edema to a Dexamethasone-Based Intravitreal Implant (Ozurdex). J Ocul Pharmacol Ther 2016; 32:442-50. [DOI: 10.1089/jop.2016.0035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Justus G. Garweg
- Berner Augenklinik am Lindenhofspital, Swiss Eye Institute, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Edoardo Baglivo
- Department of Ophthalmology, Clinique de l'oeil, Geneva, Switzerland
| | | | - Maximilian Pfau
- Department of Ophthalmology, Stadtspital Triemli, Zürich, Switzerland
| | - Isabel B. Pfister
- Berner Augenklinik am Lindenhofspital, Swiss Eye Institute, Bern, Switzerland
| | - Stephan Michels
- Department of Ophthalmology, Stadtspital Triemli, Zürich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Souska Zandi
- Berner Augenklinik am Lindenhofspital, Swiss Eye Institute, Bern, Switzerland
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28
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Takkar B. Dexamethasone implant as an effective treatment option for macular edema in Irvine-Gass syndrome. J Cataract Refract Surg 2016; 42:648. [DOI: 10.1016/j.jcrs.2016.02.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022]
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