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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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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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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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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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Ioshin IE, Tolchinskaya AI, Bagirov AM. [Treatment of postoperative macular edema (a clinical case study)]. Vestn Oftalmol 2019; 135:90-98. [PMID: 31393451 DOI: 10.17116/oftalma201913503190] [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: 06/10/2023]
Abstract
Pseudophakic cystoid macular edema (CMO) known to appear in 0.1-2.35% of patients after phacoemulsification is one of the common causes of vision decrease during the postoperative period. The authors analyze a case of CMO development in a pseudophakic patient diagnosed 7 months after uncomplicated phacoemulsification. Optical coherence tomography (OCT) was suggested for patients with low vision and a sensation of shroud before the eye for early diagnosis of pathological process. Intravitreal injection of the 0.7 mg dexamethasone micro-implant performed soon after establishing diagnosis was proved to be viable for postoperative CMO arrest in patients without previous treatment. One month after intravitreal implant injection the visual acuity in the patient's eye improved from 0.4 to 0.7, and retinal thickness in the macular area decreased from 705 to 255 μm. The result remained stable for 10 months. Intravitreal micro-implant appeared to have higher efficiency in contrast with traditional treatment methods (according to literature data), which was attributed to direct drug delivery to the area of pathological process. The use of 0.7 mg dexamethasone implant did not increase the intraocular pressure indicating its potential viability for patients with compensated glaucoma.
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Affiliation(s)
- I E Ioshin
- Clinical Hospital of the Presidential Administration, 45 Losinoostrovskaya St., Moscow, Russian Federation, 107143
| | - A I Tolchinskaya
- Clinical Hospital of the Presidential Administration, 45 Losinoostrovskaya St., Moscow, Russian Federation, 107143
| | - A M Bagirov
- Clinical Hospital of the Presidential Administration, 45 Losinoostrovskaya St., Moscow, Russian Federation, 107143
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Ioshin IE, Tolchinskaya AI, Bagirov AM. [Treatment of postoperative macular edema (a clinical case study)]. Vestn Oftalmol 2018; 134:99-107. [PMID: 29953089 DOI: 10.17116/oftalma2018134399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pseudophakic cystoid macular edema (CMO) known to appear in 0.1-2.35% of patients after phacoemulsification is one of the common causes of vision decrease during postoperative period. The authors analyzed a case of CMO development in a pseudophakic patient diagnosed 7 months after uncomplicated phacoemulsification. Optical coherence tomography (OCT) was suggested for patients with low vision and a sensation of shroud before the eye for early diagnosis of pathological process. Intravitreal injection of the 0.7 mg dexamethasone micro-implant performed soon after establishing the diagnosis was proved to be viable for postoperative CMO arrest in patients without previous treatment. One month after intravitreal implant injection, the visual acuity in the patient's eye improved from 0.4 to 0.7, and retinal thickness in the macular area decreased from 705 to 255 μm. The result remained stable for 10 months. Intravitreal micro-implant appeared to have higher efficiency in contrast with traditional treatment methods (according to literature data), which was attributed to direct drug delivery to the area of pathological process. The use of 0.7 mg dexamethasone implant did not increase the intraocular pressure indicating its potential viability for patients with compensated glaucoma.
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Affiliation(s)
- I E Ioshin
- Clinical Hospital of the Presidential Administration, 45 Losinoostrovskaya St., Moscow, Russian Federation, 107143
| | - A I Tolchinskaya
- Clinical Hospital of the Presidential Administration, 45 Losinoostrovskaya St., Moscow, Russian Federation, 107143
| | - A M Bagirov
- Clinical Hospital of the Presidential Administration, 45 Losinoostrovskaya St., Moscow, Russian Federation, 107143
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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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Boscia F, Giancipoli E, D'Amico Ricci G, Pinna A. Management of macular oedema in diabetic patients undergoing cataract surgery. Curr Opin Ophthalmol 2017; 28:23-28. [PMID: 27661663 DOI: 10.1097/icu.0000000000000328] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to describe all the treatment modalities used to prevent and manage macular oedema in diabetic patients undergoing cataract surgery. RECENT FINDINGS Topical NSAIDs have been proposed to be an effective strategy to prevent postsurgical macular oedema (PME) in diabetic patients. The prophylactic use of intravitreal antivascular endothelial growth factors (anti-VEGF) drugs and steroids in these patients, even if effective, brings some concerns with regard to possible side effects. By contrast, in patients with a diagnosis of diabetic macular oedema (DME) at the time of cataract surgery, intravitreal therapy, both with anti-VEGF drugs and steroids, appears to be the best approach in order to control PME and achieve a good visual outcome. CONCLUSION All diabetic patients undergoing cataract surgery should be treated with topical NSAIDs to prevent PME. Intravitreal anti-VEGF drugs and steroids, combined with cataract surgery, should be reserved for patients with preexisting DME.
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Affiliation(s)
- Francesco Boscia
- aDepartment of Surgical, Microsurgical and Medical Sciences, Ophthalmology Unit, University of Sassari bAzienda Ospedaliero Universitaria di Sassari, Sassari, 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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Anterior chamber migration of dexamethasone intravitreal implant (Ozurdex®) through basal iridectomy (Ando) in a pseudophakic patient. Eur J Ophthalmol 2016; 26:e52-4. [PMID: 26615950 DOI: 10.5301/ejo.5000715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Intravitreal implantation of dexamethasone implant (Ozurdex®) is being widely used for the treatment of macular edema (ME) after branch or central retinal vein occlusion, diabetic ME, and persistent ME associated with uveitis or Irvine-Gass syndrome. We describe a complication: migration of the dexamethasone implant into the anterior chamber through basal iridectomy (Ando) in a pseudophakic patient with development of corneal edema and secondary high intraocular pressure. METHODS This is a case report of migration of Ozurdex® through basal iridectomy in a pseudophakic patient with iris claw lens. CONCLUSIONS Pseudophakic patients, with a history of vitrectomy, even those with a basal iridectomy (Ando), are at high risk for migration of the Ozurdex® into the anterior chamber and development of corneal edema.
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Yüksel B, Uzunel UD, Kerci SG, Sağban L, Küsbeci T, Örsel T. Comparison of Subtenon Triamcinolone Acetonide Injection with Topical Nepafenac for the Treatment of Pseudophakic Cystoid Macular Edema. Ocul Immunol Inflamm 2016; 25:513-519. [PMID: 27015572 DOI: 10.3109/09273948.2016.1147587] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare the efficacy and safety of subtenon triamcinolone acetonide (TA) injection with topical nepafenac 0.1% for the treatment of pseudophakic cystoid macular edema (CME). METHODS In this prospective study, the TA group comprised 24 eyes and the nepafenac group 24 eyes. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), intraocular pressure measurements, and slit-lamp fundoscopy were performed in all subjects at baseline, 1, 2, 3, and 6 months. RESULTS Changes in BCVA and CRT over four follow-up visits were statistically significant (p<0.001). The mean CRT decreased from 513.3 to 318.9 μm in the TA group and from 483.7 to 278.0 μm in the nepafenac group. This reduction was statistically significant (p<0.001 for both groups). CONCLUSIONS Our visual and OCT results suggest that both treatment modalities are effective with few side-effects. However, nepafenac is more efficacious than subtenon TA in terms of visual gain and its correlation with the reduction in CRT.
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Affiliation(s)
- Bora Yüksel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Umut Duygu Uzunel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Süleyman Gökhan Kerci
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Levent Sağban
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Tuncay Küsbeci
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
| | - Tümay Örsel
- a Izmir Bozyaka Training and Research Hospital , Department of Ophthalmology , Izmir , Turkey
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Twelve-Month Results of a Single or Multiple Dexamethasone Intravitreal Implant for Macular Edema following Uncomplicated Phacoemulsification. BIOMED RESEARCH INTERNATIONAL 2015; 2015:362564. [PMID: 26509151 PMCID: PMC4609771 DOI: 10.1155/2015/362564] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022]
Abstract
The clinical efficacy of one or two intravitreal injections of a continued deliverance dexamethasone 700 μg implant in ten patients with persistent macular edema following uncomplicated phacoemulsification was evaluated. Complete ophthalmological examination and spectral domain optical coherence tomography were carried out. Follow-up was at day 7 and months 1, 2, 4, 6, 8, and 12. At baseline mean best corrected visual acuity was 62 Early Treatment Diabetic Retinopathy Study Chart letters, which showed statistically significant improvement at each follow-up, except at month 6, to reach 79 letters at month 12 (P = 0.018). Prior to treatment mean central foveal thickness was 622 μm, which showed statistically significant improvement at each follow-up to reach a mean value of 282 μm (P = 0.012) at month 12. Five patients received a second dexamethasone implant at month 7. Two patients were excluded from the study at months 4 and 8. Intraocular pressure remained stable during the study period with the exception of mild increase in two patients requiring topical therapy. In conclusion there was statistically significant improvement of best corrected visual acuity and mean central foveal thickness with one or two intravitreal dexamethasone implants over 12 months.
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