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Hanson J, Hsu D, Pillar S, Tsui E, Tsui I. Resolution of Postoperative Cystoid Macular Edema with a Suprachoroidal Triamcinolone Acetonide Injectable Suspension. Ocul Immunol Inflamm 2024:1-4. [PMID: 38781576 DOI: 10.1080/09273948.2024.2356723] [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: 04/03/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
AIM To report a case of significant postoperative cystoid macular edema (CME) in a patient with no prior history of uveitis or systemic inflammatory disease, in which a suprachoroidal (SC) triamcinolone acetonide injectable suspension resulted in complete resolution of CME. DESIGN Case report. METHODS An 81-year-old man presented with a complex, dense brunescent cataract, floppy iris, and miotic pupil in the left eye. Six weeks following cataract extraction, the intraocular lens (IOL) was dislocated completely from the visual axis. He underwent a pars plana vitrectomy and IOL exchange with an anterior chamber IOL due to a three-piece IOL dislocation. Following the operation, the patient began treatment with prednisolone acetate and ketorolac. However, 2 weeks later, he was noted to be a steroid responder and glaucoma suspect. Therefore, the decision was made to taper and discontinue topical steroids. At 6 months postoperatively, ranibizumab was injected for persistent CME. However, following injection, there was intraocular pressure (IOP) elevation and increased CME. IOP improved 1 month later with dorzolamide hydrochloride and timolol maleate. At 8 months post-operation, there was persistent CME. The patient was then treated with an SC triamcinolone acetonide injection. There was complete resolution of CME by 14 weeks later, with improvement in visual acuity. Despite the patient's known steroid response with topical steroids, IOP remained within normal limits during the entire follow-up period after injection. CONCLUSION SC triamcinolone acetonide injection is indicated for macular edema associated with uveitis; however, treatment for postoperative macular edema with this novel suprachoroidal injection may be considered.
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Affiliation(s)
- Justin Hanson
- UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
| | - David Hsu
- UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
| | - Shani Pillar
- UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
| | - Edmund Tsui
- UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
| | - Irena Tsui
- UCLA Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA
- Division of Ophthalmology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Charteris DG, Cro S, Casswell E, Edwards RT, Ezeofor V, Anthony B, Bunce C, Robertson E, Kelly J, Murphy C, Banerjee P, Cornelius VR. A randomised controlled trial of adjunctive triamcinolone acetonide in eyes undergoing vitreoretinal surgery for open globe trauma - the ASCOT study. Health Technol Assess 2023; 27:1-50. [PMID: 37840322 PMCID: PMC10591211 DOI: 10.3310/gnbj1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background Eyes sustaining open globe trauma are at high risk of severe visual impairment. Proliferative vitreoretinopathy is the most common cause of retinal detachment and visual loss in eyes with open globe trauma. There is evidence from experimental studies and pilot clinical trials that the use of adjunctive steroid medication triamcinolone acetonide can reduce the incidence of proliferative vitreoretinopathy and improve outcomes of surgery for open globe trauma. Objective The Adjunctive Steroid Combination in Ocular Trauma or ASCOT study aimed to investigate the clinical effectiveness of adjunctive triamcinolone acetonide given at the time of vitreoretinal surgery for open globe trauma. Design A phase 3 multicentre double-masked randomised controlled trial randomising patients undergoing vitrectomy following open globe trauma to either adjunctive triamcinolone acetonide or standard care. Setting Hospital vitreoretinal surgical services dealing with open globe trauma. Participants Patients undergoing vitrectomy surgery who had sustained open globe trauma. Interventions Triamcinolone acetonide 4 mg/0.1 ml into the vitreous cavity and 40 mg/1 ml sub-Tenon's or standard vitreoretinal surgery and postoperative care. Main outcome measures The primary outcome was the proportion of patients with at least 10 letters of improvement in corrected visual acuity at six months. Secondary outcomes included retinal detachment secondary to proliferative vitreoretinopathy, retinal reattachment, macula reattachment, tractional retinal detachment, number of operations, hypotony, elevated intraocular pressure and quality of life. Health-related quality of life was assessed using the EuroQol Five Domain and Visual Function Questionnaire 25 questionnaires. Results A total of 280 patients were randomised; 129 were analysed from the control group and 130 from the treatment group. The treatment group appeared, by chance, to have more severe pathology on presentation. The primary outcome (improvement in visual acuity) and principal secondary outcome (change in visual acuity) did not demonstrate any treatment benefit for triamcinolone acetonide. The proportion of patients with improvement in visual acuity was 47% for triamcinolone acetonide and 43% for standard care (odds ratio 1.03, 95% confidence interval 0.61 to 1.75, p = 0.908); the baseline adjusted mean difference in the six-month change in visual acuity was -2.65 (95% confidence interval -9.22 to 3.92, p = 0.430) for triamcinolone acetonide relative to control. Similarly, the secondary outcome measures failed to show any treatment benefit. For two of the secondary outcome measures, stable complete retinal reattachment and stable macular retinal reattachment, outcomes for the treatment group were significantly worse for triamcinolone acetonide at the 5% level (respectively, odds ratio 0.59, 95% confidence interval 0.36 to 0.99, p = 0.044 and odds ratio 0.59, 95% confidence interval 0.35 to 0.98, p = 0.041) compared with control in favour of control. The cost of the intervention was £132 per patient. Health economics outcome measures (Early Treatment Diabetic Retinopathy Study, Visual Function Questionnaire 25 and EuroQol Five Dimensions) did not demonstrate any significant difference in quality-adjusted life-years. Conclusions The use of combined intraocular and sub-Tenon's capsule triamcinolone acetonide is not recommended as an adjunct to vitrectomy surgery for intraocular trauma. Secondary outcome measures are suggestive of a negative effect of the adjunct, although the treatment group appeared to have more severe pathology on presentation. Future work The use of alternative adjunctive medications in cases undergoing surgery for open globe trauma should be investigated. Refinement of clinical grading and case selection will enable better trail design for future studies. Trial registration This trial is registered as ISRCTN 30012492, EudraCT number 2014-002193-37, REC 14/LNO/1428, IRAS 156358, Local R&D registration CHAD 1031. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (12/35/64) and will be published in full in Health Technology Assessment; Vol. 27, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Suzie Cro
- Imperial College Clinical Trials Unit, Imperial College London, London, UK
| | | | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Gwynedd, UK
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Gwynedd, UK
| | - Bethany Anthony
- Centre for Health Economics and Medicines Evaluation, School of Medical and Health Sciences, Bangor University, Gwynedd, UK
| | - Catey Bunce
- Research Data and Statistics Unit (RDSU), Royal Marsden NHS Foundation Trust, London, UK
| | | | - Joanna Kelly
- King's Clinical Trial Unit, Research Management and Innovation Directorate, Institute of Psychiatry, Kings College, London, UK
| | - Caroline Murphy
- King's Clinical Trial Unit, Research Management and Innovation Directorate, Institute of Psychiatry, Kings College, London, UK
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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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Jamil MU, Naz U, Naz S. Intravitreal versus Oral Steroids for Inflammation Control in Uveitic Patients Undergoing Cataract Surgery. Ocul Immunol Inflamm 2023:1-6. [PMID: 37083589 DOI: 10.1080/09273948.2023.2198598] [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: 04/22/2023]
Abstract
BACKGROUND This prospective experimental study was conducted on 40 eyes of 40 patients with complicated uveitic cataracts to compare a single intraoperative intravitreal injection of triamcinolone acetonide (IVTA) with oral steroids for inflammation control after cataract extraction. METHODS The IVTA group (19 eyes) received an intravitreal injection of 4 mg/0.1 ml triamcinolone acetonide intraoperatively, and the oral steroid group (19 eyes) received oral steroids peri-operatively. Two patients had to be excluded from the study because they underwent extracapsular cataract extraction (ECCE), instead of phacoemulsification. RESULTS A statistically significant difference was observed in the anterior chamber cell and flare response between both groups initially, but by the last follow-up, this became insignificant. None of the patients in each group experienced a recurrence of uveitis nor developed cystoid macular edema. Five patients in the oral steroid group had IOP >21 mmHg post-operatively. CONCLUSION A single injection of 4 mg IVTA has similar efficacy to peri-operative oral steroid administration.
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Affiliation(s)
- Muhammad Usman Jamil
- Resident Ophthalmologist, Layton Rahmatulla Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital (Korangi), Karachi City, Pakistan
| | - Uzma Naz
- Consultant Ophthalmologist, Uveitis, Layton Rahmatulla Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital (Korangi), Karachi City, Pakistan
| | - Saliha Naz
- Assistant Professor, Vitreo-Retinal Diseases and Surgery, Layton Rahmatulla Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital (Korangi), Karachi City, Pakistan
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Lima-Fontes M, Leuzinger-Dias M, Barros-Pereira R, Fernandes V, Falcão M, Falcão-Reis F, Rocha-Sousa A, Alves-Faria P. Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy. Ophthalmol Ther 2023; 12:377-388. [PMID: 36417092 PMCID: PMC9834446 DOI: 10.1007/s40123-022-00613-9] [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: 09/21/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. METHODS This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300 μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. RESULTS Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5 months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6 μm, and IOP was 15.4 ± 2.4 mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2 μm in CMT. During follow-up (44.0 ± 14.8 months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28 months, respectively. The maximum IOP registered was 17.0 ± 6.0 mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. CONCLUSION FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.
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Affiliation(s)
- Mário Lima-Fontes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Leuzinger-Dias
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ricardo Barros-Pereira
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Vítor Fernandes
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Manuel Falcão
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Amândio Rocha-Sousa
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Pedro Alves-Faria
- grid.414556.70000 0000 9375 4688Department of Ophthalmology, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal ,grid.5808.50000 0001 1503 7226Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS. Retina 2021; 41:2035-2040. [PMID: 34543241 DOI: 10.1097/iae.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage. METHODS Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B). RESULTS Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory). CONCLUSION In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.
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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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Case Report: Subconjunctival Bevacizumab for the Treatment of Refractory Pseudophakic Cystoid Macular Edema. Optom Vis Sci 2021; 98:881-885. [PMID: 34460450 DOI: 10.1097/opx.0000000000001749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE In this report, the authors present a case of a 63-year-old man with recurrent pseudophakic cystoid macular edema. Macular edema was refractory to the treatments with periocular corticosteroid injection and topical anti-inflammatory medications. It was treated with subconjunctival bevacizumab (2.5 mg) injections. PURPOSE The purpose of this report was to demonstrate the efficacy and safety of repeated injections of subconjunctival bevacizumab in pseudophakic cystoid macular edema. CASE REPORT A 63-year-old White man presented with ongoing blurred vision in his left eye 4 months after a complicated cataract surgery. Despite the administration of sub-Tenon triamcinolone in the first-month visit because of cystoid macular edema and the use of topical steroid and nonsteroidal anti-inflammatory medications during the 4 months, there was no change in his vision. The first subconjunctival bevacizumab injection was performed 16 weeks after cataract surgery. The best-corrected visual acuity was significantly improved, and central retinal thickness dramatically decreased after the first injection. Macular edema reoccurred 26 and 46 weeks after cataract surgery. At these relapses, repeated subconjunctival injections of bevacizumab were influential in resolving macular edema and restoration of vision, even in the chronic phase. After 6 months, visual acuity (20/20) and central retinal thickness (274 μm) were stable after four total injections. No drug-related adverse events were observed during the follow-up period. CONCLUSIONS The repeated subconjunctival injections of bevacizumab were effective and well tolerated in pseudophakic cystoid macular edema. Subconjunctival bevacizumab may be a safe alternative to intravitreal applications in patients with pseudophakic cystoid macular edema.
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Kuley B, Storey PP, Wibbelsman TD, Pancholy M, Zhang QE, Sharpe J, Bello N, Obeid A, Regillo C, Kaiser RS, Chiang A, Fineman MS, Vander JF, Gupta OP, Spirn MJ, Dunn JP, Mehta S, Park CH, Maguire JI, Garg S. Resolution of Pseudophakic Cystoid Macular Edema: 2 mg Intravitreal Triamcinolone Acetonide versus 40 mg Posterior Sub-Tenon Triamcinolone Acetonide. Curr Eye Res 2021; 46:824-830. [PMID: 33522311 DOI: 10.1080/02713683.2020.1842458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare 2 mg intravitreal triamcinolone (IVT) versus 40 mg posterior sub-Tenon triamcinolone acetonide (STT) for the treatment of eyes with pseudophakic cystoid macular edema. METHODS A retrospective, single-center review of eyes receiving 2 mg IVT between 3/1/2012-3/1/2017 and 40 mg STT between 1/1/2015-3/1/2017. Visual acuity (VA) and central macular thickness (CMT) were recorded at baseline, 1-, 3-, and 6-month follow-up visits. RESULTS Forty-five eyes were included in the IVT group and 50 eyes in the STT group. Change in VA from baseline to 1, 3, and 6 months was not significantly different between IVT and STT (6 months: 2.3 lines vs. 2.4 lines, p = .10). The IVT group achieved significantly better CMT improvement from baseline compared to STT at 1 month (255 μm vs. 187 μm; p = .03), but this difference was not present at month 3 (214 μm vs. 212 μm; p = .79) or month 6 (176 μm vs. 207 μm; p = .29). During the 6-month follow-up period, approximately 7% of eyes in the IVT group and 12% of eyes in the STT group developed ocular hypertension (p = .43), and all cases were successfully managed with topical anti-ocular hypertensive therapy or observation. CONCLUSIONS 2 mg IVT and 40 mg STT both achieved significant improvement in vision and CMT with no significant difference between interventions at 3- and 6-month follow-up.
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Affiliation(s)
- Brandon Kuley
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Philip P Storey
- Austin Retina, University of Texas Dell Medical School, Austin, TX, USA
| | - Turner D Wibbelsman
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Maitri Pancholy
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Qiang Ed Zhang
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - James Sharpe
- Biostatistics Consulting Core, Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, PA, USA
| | - Nicholas Bello
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Anthony Obeid
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Carl Regillo
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Richard S Kaiser
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Allen Chiang
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Mitchell S Fineman
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - James F Vander
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | | | - Marc J Spirn
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - James P Dunn
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Sonia Mehta
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Carl H Park
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Joseph I Maguire
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
| | - Sunir Garg
- Mid Atlantic Retina, The Retina Service of Wills Eye Hospital, Philadelphia, PA, USA
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Moon CW, Park DG, Sagong M. Effect of Topical Bromfenac as a Treatment of Cystoid Macular Edema Following Pars Plana Vitrectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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PREOPERATIVE VITREORETINAL INTERFACE ABNORMALITIES ON SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY AS RISK FACTOR FOR PSEUDOPHAKIC CYSTOID MACULAR EDEMA AFTER PHACOEMULSIFICATION. Retina 2020; 39:2225-2232. [PMID: 30157113 DOI: 10.1097/iae.0000000000002298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We assessed the role of vitreoretinal interface status in the development of pseudophakic cystoid macular edema (PCME) after cataract surgery. METHODS Prospective cohort study in which 112 patients (112 eyes) scheduled for cataract surgery were selected at random to undergo spectral domain optical coherence tomography (OCT) within 1 week preoperatively and at 1 and 3 months postoperatively. Spectral domain OCT macular images included no vitreoretinal contact, focal and diffuse vitreomacular adhesion, focal and diffuse vitreomacular traction, epiretinal membrane, macular hole, and macular edema. RESULTS The incidence of PCME was 11.6% (13 eyes), all of them being diagnosed at 1 month, and 7 eyes resolved at 3 months. The only risk factor for PCME was detection of nonsurgical epiretinal membrane by spectral domain OCT before phacoemulsification, being developed in 5 of 16 eyes (χ = 0.08, odds ratio 4.53, 95% confidence interval 1.28-16.13). Other variables such as posterior vitreous detachment, subfoveal choroidal thickness, diabetes, or hypertension were not significantly associated with PCME. CONCLUSION In this cohort, preoperative detection of epiretinal membrane by spectral domain OCT was a risk factor for PCME after cataract extraction. It is recommended to perform a spectral domain OCT before cataract surgery because the presence of an epiretinal membrane may be passed unnoticed by fundus examination.
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Aaronson A, Achiron A, Tuuminen R. Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac. J Clin Med 2020; 9:jcm9093034. [PMID: 32967137 PMCID: PMC7563612 DOI: 10.3390/jcm9093034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background: To evaluate the clinical course of pseudophakic cystoid macular edema (PCME) treated with topical non-steroidal anti-inflammatory drugs (NSAIDs). Methods: An analysis of the clinical course of PCME consisting of 536 eyes of 536 patients from five consecutive randomized clinical trials aimed at the optimization of anti-inflammatory medication in patients undergoing routine cataract surgery. PCME was classified as (i) grade 0a; no macular thickening, (ii) grade 0b; macular thickening (central subfield macular thickness (CSMT) increase of at least 10%) without signs of macular edema, (iii) grade I; subclinical PCME, (iv) grade II; acute PCME, (v) grade III; long-standing PCME. Eyes with PCME classification from grade I onwards were treated with nepafenac 1 mg/mL t.i.d. for two months. Results: CSMT increase of at least 10% at any postoperative timepoint with cystoid changes—a criterion for PCME—was found in 19 of 536 eyes (total incidence 3.5%). Of these 19 eyes, 13 eyes (total incidence 2.4%) had clinically significant PCME. PCME was considered clinically significant when both of the following visual acuity criteria were fulfilled. At any timepoint after the cataract surgery both the corrected distance visual acuity (CDVA) gain was less than 0.4 decimals from that of preoperative CDVA, and the absolute CDVA level remained below 0.8 decimals. Only one of the 19 eyes with criteria for PCME (total incidence 0.2%, incidence of PCME eyes 5.3%) showed no macular edema resolution within 2 months after topical nepafenac administration. Conclusions: PCME in most cases is self-limiting using topical nepafenac without any further need for intravitreal treatment.
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Affiliation(s)
- Alexander Aaronson
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Department of Ophthalmology, Helsinki University Hospital, FI-00290 Helsinki, Finland
| | - Asaf Achiron
- Department of Ophthalmology, The Edith Wolfson Medical Center, 58100 Holon, Israel;
- Department of Ophthalmology, Sackler School of Medicine, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Raimo Tuuminen
- Helsinki Retina Research Group, University of Helsinki, FI-00290 Helsinki, Finland;
- Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotkantie 41, FI-48210 Kotka, Finland
- Correspondence: ; Tel.: +358-50-411-3870; Fax: +358-9-2411-227
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The effects of intravitreal adalimumab injection on pseudophakic macular edema. BMC Res Notes 2020; 13:354. [PMID: 32711577 PMCID: PMC7382825 DOI: 10.1186/s13104-020-05197-w] [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: 06/03/2020] [Accepted: 07/18/2020] [Indexed: 01/12/2023] Open
Abstract
Objective Pseudophakic macular edema is a frequent complication following cataract surgery. Inflammation is a major etiologic factor in the development of pseudophakic cystoid macular edema. Tumor necrosis factor-alpha has an important role in ocular inflammation. Adalimumab (Humira) is an inhibitor of tumor necrosis factor-alpha that has been approved in the United States. An open-label, uncontrolled, prospective, interventional study of five consecutive patients (5 eyes) with cystoid macular edema who were treated with off-label intravitreal adalimumab at Khalili Hospital was conducted. Slit-lamp examination and optical coherence tomography were done for all patients. Results No statistically significant difference was detected between best corrected visual acuity and central macular thickness before and after injection in pseudophakic macular edema. One patient developed uveitis approximately 2 weeks after injection. Based on the results, adalimumab does not appear to be an effective treatment for pseudophakic macular edema, and it may cause uveitis. Caution should be exercised when using this drug. Trial registration Iranian Registry of Clinical Trials IRCT2016100430130N1, 2016.12.03, Retrospectively registered
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Holló G, Aung T, Cantor LB, Aihara M. Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management. Surv Ophthalmol 2020; 65:496-512. [PMID: 32092363 DOI: 10.1016/j.survophthal.2020.02.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/23/2022]
Abstract
Cystoid macular edema (CME) is a form of macular retina thickening that is characterized by the appearance of cystic fluid-filled intraretinal spaces. It has classically been diagnosed upon investigation after a decrease in visual acuity; however, improvements in imaging technology make it possible to noninvasively detect CME even before a clinically significant decrease in central vision. Risk factors for the development of CME include diabetic retinopathy, retinal vein occlusion, uveitis, and cataract surgery. It has been proposed that eyes with elevated intraocular pressure after cataract surgery, including those treated with prostaglandin analog eye drops, may be at higher risk for the development of CME. We summarize the current knowledge of the molecular mechanisms underlying CME, the potential role of ocular surgery and topical glaucoma medication in increasing the risk of CME, the newly developed imaging methods for diagnosing CME, and the clinical management of CME.
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Affiliation(s)
- Gábor Holló
- Glaucoma Unit, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
| | - Tin Aung
- Glaucoma Department, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Opthalmology, National University of Singapore, Singapore
| | - Louis B Cantor
- Department of Opthalmology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Makoto Aihara
- Department of Opthalmology, University of Tokyo, Tokyo, Japan
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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Jauregui-Garcia GD, Acosta-Gonzalez R, Ibanez-Hernandez MA, Mora-Gonzalez GF, Armendáriz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomal Topical Formulation Improves Contrast Sensitivity Outcome After Femtosecond Laser-Assisted Cataract Surgery. J Ocul Pharmacol Ther 2019; 35:512-521. [PMID: 31486694 PMCID: PMC6839423 DOI: 10.1089/jop.2019.0032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose: To assess visual results, macular modifications, and the incidence of clinically significant macular edema (CSME) in patients using a topical triamcinolone acetonide-loaded liposomal formulation (TA-LF) after femtosecond laser-assisted cataract surgery (FLACS). Methods: Fifty-six eyes after FLACS were selected. Twenty-eight eyes in the combined therapy group (P + N) were treated with prednisolone 1% and nepafenac 0.1% for 21 days postoperatively, whereas 28 eyes in the TA-LF group received a liposomal formulation containing 2 mg/mL of TA (0.2%) for the same period of time. Follow-up visits at 1 day, 6 weeks, and 12 weeks after surgery consisted of visual acuity, contrast sensitivity (CS), central foveal thickness (CFT), total macular volume (TMV) measurements, and the detection of CSME. Results: CS improved in the TA-LF group (basal value: 1.087 ± 0.339 vs. 1.276 ± 0.147 at week 12, P = 0.0346), whereas in the P + N group, CS was not different from the baseline (basal value: 1.130 ± 0.331 vs. 1.274 ± 0.133 at week 12, P = 0.1276). There were similar increases in postoperative CFT and TMV in both groups. CFT and TMV significantly correlate with CS only in the TA-LF group. The r2 for CFT and CS was 0.1963 (P = 0.0206), whereas the r2 for TMV and CS was 0.3615 (P = 0.0007) at 12 weeks. No difference was observed in the incidence of CSME between the groups. Conclusion: TA-LF is associated with better CS outcomes compared to combined therapy after FLACS.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Jose Navarro-Partida
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Juan Carlos Altamirano-Vallejo
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | - Gerardo Daniel Jauregui-Garcia
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
| | | | | | | | - Juan Armendáriz-Borunda
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Arturo Santos
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, Mexico.,Centro de Retina Médica y Quirúrgica, S.C., Centro Médico Puerta de Hierro, Zapopan, Mexico
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Dimopoulos S, Deuter CME, Blumenstock G, Zierhut M, Dimopoulou A, Voykov B, Bartz-Schmidt KU, Doycheva D. Interferon Alpha for Refractory Pseudophakic Cystoid Macular Edema (Irvine-Gass Syndrome). Ocul Immunol Inflamm 2019; 28:315-321. [DOI: 10.1080/09273948.2019.1585883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Manfred Zierhut
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Deshka Doycheva
- Centre for Ophthalmology, University Hospital Tuebingen, Tuebingen, Germany
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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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Gonzalez-De la Rosa A, Navarro-Partida J, Altamirano-Vallejo JC, Hernandez-Gamez AG, Garcia-Bañuelos JJ, Armendariz-Borunda J, Santos A. Novel Triamcinolone Acetonide-Loaded Liposomes Topical Formulation for the Treatment of Cystoid Macular Edema After Cataract Surgery: A Pilot Study. J Ocul Pharmacol Ther 2019; 35:106-115. [PMID: 30614750 PMCID: PMC6450453 DOI: 10.1089/jop.2018.0101] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: To report tolerability, safety, and efficacy of a topical triamcinolone acetonide-loaded liposomes formulation (TA-LF) in targeting the macular area in patients with refractory pseudophakic cystoid macular edema (PCME). Methods: For tolerability, safety and efficacy evaluation, 12 eyes of 12 patients with refractory PCME were exposed to one drop of TA-LF (TA at 0.2%) every 2 h for 90 days or until best-corrected visual acuity (BCVA) was achieved. Intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. Results: Patients with refractory PCME under TA-LF therapy showed a significant improvement in BVCA and CFT without significant IOP modification (P = 0.94). On average CFT decreased to 206.75 ± 135.72 μm and BCVA improved to 20.08 ± 10.35 letters (P < 0.0005). BCVA was achieved at 10.58 ± 6.70 weeks (range 2–18). TA-LF was well tolerated in all cases. Neither ocular surface abnormalities nor adverse events were recorded. Conclusion: TA-LF was well tolerated and improved BCVA and CFT on patients with refractory PCME.
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Affiliation(s)
- Alejandro Gonzalez-De la Rosa
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Jose Navarro-Partida
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | - Juan Carlos Altamirano-Vallejo
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
| | | | - Jesus Javier Garcia-Bañuelos
- 4 Instituto de Biología Molecular y Terapia Génica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | | | - Arturo Santos
- 1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Zapopan, México.,2 Centro de Retina Medica y Quirúrgica, S.C., Centro Medico Puerta de Hierro. Zapopan, Jalisco, México
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20
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Tsai MJ, Yang CM, Hsieh YT. Posterior subtenon injection of triamcinolone acetonide for pseudophakic cystoid macular oedema. Acta Ophthalmol 2018; 96:e891-e893. [PMID: 27502789 DOI: 10.1111/aos.13200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Meng-Ju Tsai
- Department of Ophthalmology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
| | - Chung-May Yang
- Department of Ophthalmology; National Taiwan University Hospital; Taipei Taiwan
| | - Yi-Ting Hsieh
- Department of Ophthalmology; Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation; New Taipei Taiwan
- Department of Ophthalmology; National Taiwan University Hospital; Taipei Taiwan
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21
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Agarwal A, Pichi F, Invernizzi A, Gupta V. Disease of the Year: Differential Diagnosis of Uveitic Macular Edema. Ocul Immunol Inflamm 2018; 27:72-88. [DOI: 10.1080/09273948.2018.1523437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Aniruddha Agarwal
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Francesco Pichi
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alessandro Invernizzi
- Eye Clinic, Department of Biomedical and Clinical Science ‘Luigi Sacco’, Luigi Sacco Hospital, University of Milan, Milan, Italy
- Department of Ophthalmology, Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Center, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Martin DF. Evolution of Intravitreal Therapy for Retinal Diseases-From CMV to CNV: The LXXIV Edward Jackson Memorial Lecture. Am J Ophthalmol 2018; 191:xli-lviii. [PMID: 29339063 DOI: 10.1016/j.ajo.2017.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To present the evolution of intravitreal therapy for retinal diseases and its impact on clinical practice. DESIGN Retrospective literature review and personal perspective. METHODS Retrospective literature review and personal perspective. RESULTS Pharmacotherapeutic advances in retinal disease have been remarkable over the last 25 years. Almost all of the new drugs developed have required intravitreal administration to be highly effective, leading to an exponential increase in the annual number of intravitreal injections given. The use of intravitreal antibiotic injections to treat endophthalmitis, usually on a one-time basis, first familiarized ophthalmologists with this method of drug delivery. Ganciclovir was the first widely available, relatively inexpensive compounded drug that was used for repeat intravitreal injection to treat a chronic retinal disease, followed by triamcinolone for diabetic macular edema and bevacizumab for neovascular age-related macular degeneration. Ganciclovir was formulated for sustained-release drug delivery to avoid frequent intravitreal injections, a goal that has been more elusive for anti-VEGF drugs. Political obstacles encountered while conducting some of the trials to evaluate these treatments were substantial. Addressing the issues they raised led to important national policy changes that will impact the conduct of future clinical trials. The first comparative efficacy trial of intravitreal therapies was the Comparison of AMD Treatments Trials (CATT). The primary results from CATT and the many publications that followed continue to shape the use of intravitreal therapy today. CONCLUSION Intravitreal therapy has proven highly effective for the treatment of many retinal diseases. The treatment burden for patients from numerous injections, the cost to health care systems, and the impact on workflows in clinical practice have been substantial. Efforts to develop effective intravitreal therapies with reduced treatment burden and cost are ongoing.
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Affiliation(s)
- Georgios D Panos
- Eye Treatment Centre, 156708Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
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25
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Broadgate S, Kiire C, Halford S, Chong V. Diabetic macular oedema: under-represented in the genetic analysis of diabetic retinopathy. Acta Ophthalmol 2018; 96 Suppl A111:1-51. [PMID: 29682912 DOI: 10.1111/aos.13678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/21/2017] [Indexed: 12/15/2022]
Abstract
Diabetic retinopathy, a complication of both type 1 and type 2 diabetes, is a complex disease and is one of the leading causes of blindness in adults worldwide. It can be divided into distinct subclasses, one of which is diabetic macular oedema. Diabetic macular oedema can occur at any time in diabetic retinopathy and is the most common cause of vision loss in patients with type 2 diabetes. The purpose of this review is to summarize the large number of genetic association studies that have been performed in cohorts of patients with type 2 diabetes and published in English-language journals up to February 2017. Many of these studies have produced positive associations with gene polymorphisms and diabetic retinopathy. However, this review highlights that within this large body of work, studies specifically addressing a genetic association with diabetic macular oedema, although present, are vastly under-represented. We also highlight that many of the studies have small patient numbers and that meta-analyses often inappropriately combine patient data sets. We conclude that there will continue to be conflicting results and no meaningful findings will be achieved if the historical approach of combining all diabetic retinopathy disease states within patient cohorts continues in future studies. This review also identifies several genes that would be interesting to analyse in large, well-defined cohorts of patients with diabetic macular oedema in future candidate gene association studies.
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Affiliation(s)
- Suzanne Broadgate
- Nuffield Laboratory of Ophthalmology; Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford UK
| | - Christine Kiire
- Nuffield Laboratory of Ophthalmology; Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford UK
- Oxford Eye Hospital; John Radcliffe Hospital; Oxford University NHS Foundation Trust; Oxford UK
| | - Stephanie Halford
- Nuffield Laboratory of Ophthalmology; Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford UK
| | - Victor Chong
- Nuffield Laboratory of Ophthalmology; Nuffield Department of Clinical Neurosciences; University of Oxford; Oxford UK
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Sakalova ED, Avetisov KS, Budzinskaya MV, Andreeva IV. [Pathogenesis and diagnostics of postsurgical macular edema]. Vestn Oftalmol 2018. [PMID: 29543208 DOI: 10.17116/oftalma20181341107-112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postsurgical macular edema, known as Irvine-Gass syndrome, is one of the possible causes of reduced visual acuity in phaco surgery. The literature review provides summarized data on pathogenesis, risk factors, clinical manifestations, classification and basic approaches to diagnosis based on modern techniques.
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Affiliation(s)
- E D Sakalova
- Research Institute of Eye Diseases, Rossolimo St., 11 A, B, Moscow, Russian Federation, 119021
| | - K S Avetisov
- Research Institute of Eye Diseases, Rossolimo St., 11 A, B, Moscow, Russian Federation, 119021
| | - M V Budzinskaya
- Research Institute of Eye Diseases, Rossolimo St., 11 A, B, Moscow, Russian Federation, 119021
| | - I V Andreeva
- Research Institute of Eye Diseases, Rossolimo St., 11 A, B, Moscow, Russian Federation, 119021
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28
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Jonas JB, Akkoyun I, Kamppeter B, Kreissig I, Degenring RF. Intravitreal Triamcinolone Acetonide for Treatment of Central Retinal Vein Occlusion. Eur J Ophthalmol 2018; 15:751-8. [PMID: 16329061 DOI: 10.1177/112067210501500615] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and intraocular pressure in patients with central retinal vein occlusion. METHODS This prospective comparative non-randomized clinical interventional study included 32 patients (33 eyes) with central retinal vein occlusion. The study group (12 patients; 13 eyes) received an intravitreal injection of about 20 mg of triamcinolone acetonide. The control group (20 patients) did not receive any treatment. Mean follow-up was 10.1+/-8.6 months in the study group and 6.0+/-5.2 months in the control group. RESULTS In the study group, mean visual acuity increased significantly (p=0.018) from 0.11+/-0.11 preoperatively to a best visual acuity during follow-up of 0.18+/-0.15. An improvement in visual acuity by at least 2 Snellen lines and 3 Snellen lines, respectively, was found for 8 (62%) eyes and 5 (38) eyes. Visual acuity measurements determined 1 month (p=0.038) and 3 months (p=0.046) after the injection were significantly higher than the baseline values. Increase in visual acuity was higher in the non-ischemic subgroup than in the ischemic subgroup. In the control group, baseline visual acuity and best visual acuity during the followup did not vary significantly (p=0.33). Visual acuity decreased significantly (p=0.007) towards the end of the follow-up. Comparing study group and control group, gain in visual acuity was significantly (p=0.01) higher in the study group. In the study group, intraocular pressure increased significantly (p=0.018) from 14.4+/-3.9 mmHg to a mean maximal value of 21.6+/-9.2 mmHg (range, 10-44 mmHg), and re-decreased (p=0.012) towards the end of follow-up to 15.3+/-5.1 mmHg (range, 10-21 mmHg). CONCLUSIONS Intravitreal triamcinolone acetonide temporarily increases visual acuity in central retinal vein occlusion. It is accompanied by an increase in intraocular pressure.
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Affiliation(s)
- J B Jonas
- Department of Ophthalmology and Eye Hospital, Faculty for Clinical Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
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Marullo M, Perilli R, Balestrazzi E. Intravitreal Triamcinolone in Cystoid Macular Edema Due to Uveitis and Repeated Surgery after a Penetrating Trauma. Eur J Ophthalmol 2018; 14:581-3. [PMID: 15638114 DOI: 10.1177/112067210401400624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To test the effectiveness of intravitreal triamcinolone acetonide in treating macular edema due to multiple vitreoretinal surgical procedures and uveitis after a penetrating trauma with metallic foreign body retention in a 37-year-old man. METHODS The patient received two intravitreal injections of triamcinolone acetonide-2 mg/0.05 mL and 4 mg/0.1 ml(-1) month apart. The 6-month follow-up included best-corrected visual acuity (BCVA) measurement and optical coherence tomography evaluation. RESULTS After the first injection (2 mg) the foveal thickness (685 microm, as compared to a normal value of <165 microm) and the BCVA (20/200) remained unchanged with respect to the preinjection values; 1 week after the second injection (4 mg), the foveal thickness went down to 130 microm and the BCVA improved (20/80). Such results were unchanged at the 6-month control. No complications occurred. CONCLUSIONS A 2 mg dose of triamcinolone acetonide did not improve the anatomic and functional status of the macula. A 4 mg dose markedly improved BCVA and reduced the macular thickness in this case of macular edema.
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Affiliation(s)
- M Marullo
- Department of Ophthalmology, Ospedale Civile dello Spirito Santo, Pescara - Italy.
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Boscia F, Furino C, Dammacco R, Ferreri P, Sborgia L, Sborgia C. Intravitreal Triamcinolone Acetonide in Refractory Pseudophakic Cystoid Macular Edema: Functional and Anatomic Results. Eur J Ophthalmol 2018; 15:89-95. [PMID: 15751245 DOI: 10.1177/112067210501500114] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate safety and efficacy of intravitreal triamcinolone acetonide (TAAC) injections in the treatment of refractory pseudophakic cystoid macular edema (CME). METHODS Seven eyes of six patients (age range: 50-74) with pseudophakic CME resistant to standard treatment received intravitreal injections of 4 mg of TAAC with all vehicle. Mean preinjection duration of CME was 18.3 months. A mean of 2.1+/-1.2 (range 1 to 4) treatments were performed in four eyes (57.1 %) when visual acuity deteriorated towards baseline levels. Visual acuity assessment, optical coherence tomography (OCT), and fluorescein angiography (FFA) were performed pre- and postoperatively to evaluate results of TAAC injections. Intraocular pressure (IOP) and complications related to treatment were assessed. RESULTS After 11.1+/-3.9 months, mean best-corrected visual acuity (BCVA) increased (p =0.019) from 20/132 to a best value of 20/38. Mean macular thickness decreased from 517.29+/-146.98 mm to a best value of 263.71+/-83.13 mm (p=0.0018). Area of fluorescein leakage decreased (p<0.0001) from 11.84+/-0.93 mm2 at baseline to a minimal value of 3.86+/-0.98 mm2. The anatomic and functional improvement appeared after 1 month from the intravitreal injection and persisted through at least 3 months of follow-up. At the end of follow-up BCVA, macular thickness, and area of fluorescein leakage did not differ from baseline. Four eyes (57.1 %) developed IOP values higher than 21 mmHg, controlled by topical treatment. Two patients developed an endophthalmitis-like reaction. CONCLUSIONS Intravitreal TAAC was relatively safe and effective in resistant cases of pseudophakic CME with a temporary beneficial effect on visual acuity and macular edema.
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Affiliation(s)
- F Boscia
- Department of Ophthalmology and Otorhinolaryngology, University of Bari, Bari - Italy.
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Tewari HK, Sony P, Chawla R, Garg SP, Venkatesh P. Prospective Evaluation of Intravitreal Triamcinolone Acetonide Injection in Macular Edema Associated with Retinal Vascular Disorders. Eur J Ophthalmol 2018; 15:619-26. [PMID: 16167293 DOI: 10.1177/112067210501500513] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. Methods This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. Results Mean preinjection central macular thickness was 531.84±132 μm in Group I, 458.4±149 μm in Group II, and 750.81±148 μm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7±119 μM in Group I, 218.2±99 μm in Group II, and 210.5 ±56 μm in Group III) and 3 months (253.19±109 μm in Group I, 187±47 μm in Group II, and 182±50 μm in Group III) after injection (p<0.05). Mean follow-up was 22±2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2±0.4 logMAR units; Group II, 1.24±0.5 logMAR units; Group III, 1.1 ±0.4 logMAR units; 1 month postinjection in Group I, 0.88±0.3 logMAR units; Group II, 0.67±0.3 logMAR units; Group III, 0.86±0.4 logMAR units; 3 months postinjection in Group I, 0.84±0.4 logMAR units; Group II, 0.59±0.3 logMAR units; Group III, 0.82±0.5 logMAR units) (p<0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. Conclusions Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.
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Affiliation(s)
- H K Tewari
- Retina Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Perioperative Topical Nonsteroidal Anti-inflammatory Drugs for Macular Edema Prophylaxis Following Cataract Surgery. Am J Ophthalmol 2017; 176:174-182. [PMID: 28104415 DOI: 10.1016/j.ajo.2017.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe the effect of routine use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) on the incidence of postoperative macular edema (PME) after cataract surgery. The role of diabetic retinopathy on the relationship between NSAID use and PME was further analyzed. DESIGN Retrospective matched cohort study. METHODS Patients undergoing cataract surgery between January 2007 and June 2014 were included in this study. A total of 108 093 Kaiser Permanente Southern California patients underwent cataract surgery and 89 731 met inclusion criteria. Cataract surgery patients who had a perioperative prescription of topical NSAIDs filled in addition to topical steroids were compared to those taking topical steroids only. The main outcome measure was the diagnosis of macular edema within 90 days of cataract surgery. RESULTS A prescription for an NSAID was filled by 56.4% of patients. The prevalence of PME was 1.3% among those prescribed and 1.7% among those not prescribed NSAIDs. The number needed to treat was 320 patients to prevent 1 case of PME. A matched cohort analysis was performed to account for confounders. NSAID use was associated with a lower incidence of PME in patients without diabetes [relative risk (RR) 0.68, 95% confidence interval (CI) 0.58-0.72] and diabetics without retinopathy (RR 0.51, 95% CI 0.32-0.82). NSAID use was not associated with a change in the incidence of PME among patients with diabetic retinopathy (RR 1.06, 95% 0.81-1.38). CONCLUSION Topical NSAIDs were associated with a modest reduction of PME incidence in patients undergoing cataract surgery; however, this relationship was not seen among those with diabetic retinopathy. The risk for PME is low and the number of patients benefiting from treatment is small.
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Abstract
Objective: This paper aimed to review the current literature on the surface modification of intraocular lenses (IOLs). Data Sources: All articles about surface modification of IOLs published up to 2015 were identified through a literature search on both PubMed and ScienceDirect. Study Selection: The articles on the surface modification of IOLs were included, but those on design modification and surface coating were excluded. Results: Technology of surface modification included plasma, ion beam, layer-by-layer self-assembly, ultraviolet radiation, and ozone. The main molecules introduced into IOLs surface were poly (ethylene glycol), polyhedral oligomeric silsesquioxane, 2-methacryloyloxyethyl phosphorylcholine, TiO2, heparin, F-heparin, titanium, titanium nitride, vinyl pyrrolidone, and inhibitors of cytokines. The surface modification either resulted in a more hydrophobic lens, a more hydrophilic lens, or a lens with a hydrophilic anterior and hydrophobic posterior surface. Advances in research regarding surface modification of IOLs had led to a better biocompatibility in both in vitro and animal experiments. Conclusion: The surface modification is an efficient, convenient, economic and promising method to improve the biocompatibility of IOLs.
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Affiliation(s)
| | | | | | - Gui-Qin Wang
- Department of Ophthalmology, Navy General Hospital of PLA, Beijing 100048; Department of Ophthalmilogy, Third Clinical Medical College of Southern Medical University, Guangzhou, Guangdong 510515, China
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Grzybowski A, Sikorski BL, Ascaso FJ, Huerva V. Pseudophakic cystoid macular edema: update 2016. Clin Interv Aging 2016; 11:1221-1229. [PMID: 27672316 PMCID: PMC5025006 DOI: 10.2147/cia.s111761] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery, leading in some cases to a decrease in vision. Although the pathogenesis of PCME is not completely understood, the contribution of postsurgical inflammation is generally accepted. Consequently, anti-inflammatory medicines, including steroids and nonsteroidal anti-inflammatory drugs, have been postulated as having a role in both the prophylaxis and treatment of PCME. However, the lack of a uniformly accepted PCME definition, conflicting data on some risk factors, and the scarcity of studies comparing the role of nonsteroidal anti-inflammatory drugs to steroids in PCME prevention make the problem of PCME one of the puzzles of ophthalmology. This paper presents an updated review on the pathogenesis, risk factors, and use of anti-inflammatory drugs in PCME that reflect current research and practice.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Department of Ophthalmology, Poznań City Hospital, Poznań, Poland
| | - Bartosz L Sikorski
- Department of Ophthalmology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario "Lozano Blesa", Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Valentín Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida, Spain; IRB Lleida, Lleida, Spain
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Mylonas G, Georgopoulos M, Malamos P, Georgalas I, Koutsandrea C, Brouzas D, Sacu S, Perisanidis C, Schmidt-Erfurth U. Comparison of Dexamethasone Intravitreal Implant with Conventional Triamcinolone in Patients with Postoperative Cystoid Macular Edema. Curr Eye Res 2016; 42:648-652. [PMID: 27612922 DOI: 10.1080/02713683.2016.1214968] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIMS To evaluate the efficacy of the treatment with intravitreal triamcinolone acetonide or dexamethasone intravitreal implant in patients with postoperative cystoid macular edema (PCME). MATERIALS AND METHODS Thirty eyes of 29 patients with PCME were randomized into two groups: one group initially received an injection of 4 mg triamcinolone; retreatment after 3 months was dependent on functional and anatomic outcome in a PRN regimen. The second group received a single injection of the dexamethasone intravitreal implant (Ozurdex). Patients were followed for 6 months. The main outcomes were best-corrected visual acuity (BCVA) and central millimeter retinal thickness (CMMT). RESULTS Mean BCVA improved significantly in both groups at 3 months (p ≤ 0.05) and 6 months (p ≤ 0.05) after treatment. There was no statistically significant difference between the two groups in visual acuity improvement at 3 months (p > 0.05) or 6 months (p > 0.05). Mean CMMT of both groups also decreased significantly after treatment at 3 and 6 months (both p ≤ 0.05) and the reduction was significantly superior in the triamcinolone group compared to ozurdex group at 1 week and 6 months (p ≤ 0.05). All cases with intraocular hypertension were managed with IOP-lowering medication and no surgery was required during the study. One patient was excluded because of endophthalmitis in the triamcinolone group. CONCLUSION Intravitreal triamcinolone and dexamethasone implant are both equally effective in increasing visual acuity in patients with PCME at a 6-month follow-up. However, macular edema seems to respond more rapidly with intravitreal triamcinolone, and 3-monthly repetitive injections maintain the reduction in retinal thickness better than a single dexamethasone implant at the first 6 months of follow-up period.
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Affiliation(s)
- Georgios Mylonas
- a Department of Ophthalmology , Medical University of Vienna , Vienna , Austria
| | | | - Panagiotis Malamos
- b 1st Department of Ophthalmology , "G. Gennimatas" General Hospital of Athens, University of Athens , Athens , Greece
| | - Ilias Georgalas
- b 1st Department of Ophthalmology , "G. Gennimatas" General Hospital of Athens, University of Athens , Athens , Greece
| | - Chryssanthi Koutsandrea
- b 1st Department of Ophthalmology , "G. Gennimatas" General Hospital of Athens, University of Athens , Athens , Greece
| | - Dimitrios Brouzas
- b 1st Department of Ophthalmology , "G. Gennimatas" General Hospital of Athens, University of Athens , Athens , Greece
| | - Stefan Sacu
- a Department of Ophthalmology , Medical University of Vienna , Vienna , Austria
| | - Christos Perisanidis
- c Department of Cranio-, Maxillofacial and Oral Surgery , Medical University of Vienna , Vienna , Austria
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Banerjee PJ, Cornelius VR, Phillips R, Lo JW, Bunce C, Kelly J, Murphy C, Edwards RT, Robertson EL, Charteris DG. Adjunctive intraocular and peri-ocular steroid (triamcinolone acetonide) versus standard treatment in eyes undergoing vitreoretinal surgery for open globe trauma (ASCOT): study protocol for a phase III, multi-centre, double-masked randomised controlled trial. Trials 2016; 17:339. [PMID: 27449500 PMCID: PMC4957411 DOI: 10.1186/s13063-016-1445-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eyes sustaining open globe trauma are at high risk of severe visual impairment. Ocular injuries which result in visual loss invariably affect the posterior segment of the eye, and prevention of visual loss involves posterior segment (vitreoretinal) surgery. Despite improvements in vitreoretinal surgical techniques, outcomes in these patients remain unsatisfactory, and development of the intraocular scarring response proliferative vitreoretinopathy is the leading cause. Proliferative vitreoretinopathy is the most common cause of recurrent retinal detachment in these eyes; it is reported to occur in up to 45 % of cases. METHODS/DESIGN The Adjunctive Steroid Combination in Ocular Trauma (ASCOT) trial is a multi-centre, double-masked, parallel-arm randomised controlled trial with an internal pilot designed to investigate the effectiveness and cost-effectiveness of using intravitreal and sub-Tenon's triamcinolone acetonide peri-operatively in patients undergoing vitrectomy following open globe trauma. In total, 300 eyes of 300 patients will be recruited and randomly allocated to one of two treatment groups. Both groups will receive standard surgical treatment and routine pre-operative and post-operative treatment and care. The treatment group will receive an adjunctive peri-operative steroid combination (triamcinolone acetonide) consisting of 4 mg/0.1 ml into the vitreous cavity and 40 mg/1 ml into the sub-Tenon's space. The trial incorporates a two-stage internal pilot to examine projected recruitment and retention rates. Progression criteria from the internal pilot study will enable us to determine whether to undertake the main trial. Patients and primary outcome assessors will be masked to treatment allocation. The primary outcome will be an improvement from baseline to 6 months of at least 10 on the corrected visual acuity as measured by ETDRS letter score. Secondary outcomes will be development of scarring, retinal detachment, intraocular pressure abnormalities, quality of life and public sector service use. DISCUSSION This is the first powered, controlled clinical trial to investigate the use of adjunctive triamcinolone in patients undergoing vitrectomy following open globe trauma. TRIAL REGISTRATION EudraCT2014-002193-37 . Registered on 5 September 2014. ISRCTN30012492 . Registered on 5 September 2014.
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Affiliation(s)
- Philip J. Banerjee
- />Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD UK
- />National Institute for Health Research (NIHR) Clinical Research Facility at Moorfields Eye Hospital, London, UK
| | - Victoria R. Cornelius
- />Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Rachel Phillips
- />Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- />National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Jessica W. Lo
- />Department of Primary Care and Public Health Sciences, King’s College London, London, UK
- />National Institute for Health Research (NIHR) Biomedical Research Centre at Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Catey Bunce
- />NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, London, UK
- />University College London Institute of Ophthalmology, London, UK
| | - Joanna Kelly
- />King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Caroline Murphy
- />King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Elizabeth L. Robertson
- />Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD UK
- />National Institute for Health Research (NIHR) Clinical Research Facility at Moorfields Eye Hospital, London, UK
| | - David G. Charteris
- />Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD UK
- />National Institute for Health Research (NIHR) Clinical Research Facility at Moorfields Eye Hospital, London, UK
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Banerjee PJ, Xing W, Bunce C, Woodcock M, Chandra A, Scott RAH, Charteris DG. Triamcinolone during pars plana vitrectomy for open globe trauma: a pilot randomised controlled clinical trial. Br J Ophthalmol 2015; 100:949-955. [DOI: 10.1136/bjophthalmol-2015-307347] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/26/2015] [Accepted: 10/04/2015] [Indexed: 11/04/2022]
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Landré C, Zourdani A, Gastaud P, Baillif S. [Treatment of postoperative cystoid macular edema (Irvine-Gass syndrome) with dexamethasone 0.7 mg intravitreal implant]. J Fr Ophtalmol 2015; 39:5-11. [PMID: 26520410 DOI: 10.1016/j.jfo.2015.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the efficacy of dexamethasone 0.7 mg intravitreal implant in patients with postoperative cystoid macular edema. MATERIALS AND METHODS Fourteen patients' charts with postoperative cystoid macular edema were retrospectively reviewed. The main outcome measures were best-corrected visual acuity (BCVA) and mean central retinal thickness (CRT). RESULTS Patients' mean age was 72.1 years old. Five patients were diabetic. All patients had previously been treated with non-steroidal anti-inflammatory drops. Four patients had received a previous treatment with intravitreal ranibizumab. The mean follow-up period was 8.7 months. Mean BCVA before intravitreal dexamethasone was 0.72 logMAR. After injection, it improved to 0.50 at month 1, was 0.47 at month 3, and 0.60 logMAR at month 12. The pre-injection mean CRT was 598 μm. It improved to 286 μm at month 1, 338 μm at month 3, and was 441 μm at month 12. Eight patients received 2 intravitreal injections of dexamethasone. Five patients presented with elevated intraocular pressure during follow-up, which was treated with drops. CONCLUSIONS Intravitreal dexamethasone injection improved visual acuity and macular thickness at month 1 and month 3 in patients with postoperative cystoid macular edema. A second injection was necessary after a mean period of 5 months.
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Affiliation(s)
- C Landré
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - A Zourdani
- Cabinet Nice-Retina, 5, rue Eugène-Emmanuel, 06000 Nice, France
| | - P Gastaud
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France
| | - S Baillif
- Hôpital Pasteur 2, 30, avenue de la Voie-Romaine, 06000 Nice, France.
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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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Gewaily D, Muthuswamy K, Greenberg PB. Intravitreal steroids versus observation for macular edema secondary to central retinal vein occlusion. Cochrane Database Syst Rev 2015; 2015:CD007324. [PMID: 26352007 PMCID: PMC4733851 DOI: 10.1002/14651858.cd007324.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Central retinal vein occlusion (CRVO) is a common retinal vascular abnormality associated with conditions such as hypertension, diabetes, glaucoma, and a wide variety of hematologic disorders. Macular edema (ME) represents an important vision-threatening complication of CRVO. Intravitreal steroids (IVS), such as triamcinolone acetonide, have been utilized to treat macular edema stemming from a variety of etiologies and may be a treatment option for CRVO-ME. OBJECTIVES To explore the effectiveness and safety of intravitreal steroids in the treatment of CRVO-ME. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014 Issue 10), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2014), EMBASE (January 1980 to November 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 November 2014. For all included primary studies, we used The Science Citation Index (3 December 2014) and manually reviewed reference lists to identify other possible relevant trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) that compared intravitreal steroids, of any dosage and duration of treatment of at least six months, with observation for the treatment of CRVO-ME. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts identified from the electronic searches and assessed full-text articles from potentially eligible trials. Two review authors independently assessed trial characteristics, risk of bias, and extracted data from included trials. We contacted investigators of included trials for desired data not provided in the trial reports. MAIN RESULTS We included two RCTs that enrolled a total of 708 participants with CRVO-ME. SCORE compared triamcinolone acetonide intravitreal injections (n = 165) with observation (n = 72); GENEVA compared dexamethasone intravitreal implants (n = 290) with sham injections (n = 147). We observed characteristics indicative of high risk of bias due to incomplete outcome data in SCORE and selective outcome reporting in GENEVA. Loss to follow-up was high with 10% in the steroid groups and almost twice as much (17%) in the observation group. GENEVA enrolled participants with both branch and central retinal vein occlusion, but did not present subgroup data for the CRVO-ME population. A qualitative assessment of the results from GENEVA indicated that the dexamethasone implant was not associated with improvement in visual acuity after six months among participants with CRVO-ME. Although the SCORE investigators reported that participants treated with 1 mg (n = 82) or 4 mg (n = 83) triamcinolone intravitreal injections were five times more likely to have gained 15 letters or more in visual acuity compared with participants in the observation group (1 mg; risk ratio (RR): 5.27; 95% confidence interval (CI) 1.62 to 17.15; 4 mg RR 4.92; 95% CI 1.50 to 16.10) by the eighth-month follow-up examination, the average visual acuity decreased in all three groups. However, eyes treated with triamcinolone lost fewer letters than participants in the observation group at 8 months (1 mg mean difference (MD): 8.70 letters, 95% CI 1.86 to 15.54; 4 mg MD: 9.80 letters, 95% CI 3.32 to 16.28). A higher incidence of adverse events was noted with IVS therapy when compared with observation alone. As many as 20% to 35% of participants experienced an adverse event in the IVS groups compared with 8% of participants in the observation group of the SCORE study. The GENEVA investigators reported 63% in the treatment arm versus 43% in the observation arm experienced an adverse event. The most commonly encountered adverse events were elevated intraocular pressure, progression of cataracts, and retinal neovascularization. We graded the quality of evidence as low due to study limitations, imprecision of treatment estimates, and selective outcome reporting. AUTHORS' CONCLUSIONS The two RCTs reviewed herein provide insufficient evidence to determine the benefits of IVS for individuals with CRVO-ME. The improvement in visual acuity noted in the SCORE trial should be interpreted with caution as outcome data were missing for a large proportion of the observation group. Adverse events were observed more often with IVS treatment compared with observation/no treatment.
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Affiliation(s)
- Dina Gewaily
- Deglin and Greene Retinal Center, Wynnewood, Pennsylvania, USA, 19096
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Khurana RN, Palmer JD, Porco TC, Wieland MR. Dexamethasone Intravitreal Implant for Pseudophakic Cystoid Macular Edema in Patients With Diabetes. Ophthalmic Surg Lasers Imaging Retina 2015; 46:56-61. [PMID: 25559510 DOI: 10.3928/23258160-20150101-09] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/20/2014] [Indexed: 11/20/2022]
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Akova-Budak B, Kıvanç SA, Baykara M. Inadvertent intracorneal triamcinolone injection during cataract extraction. J Cataract Refract Surg 2014; 40:1928-9. [PMID: 25442888 DOI: 10.1016/j.jcrs.2014.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Indexed: 10/24/2022]
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Al Zamil WM. Short-term safety and efficacy of intravitreal 0.7-mg dexamethasone implants for pseudophakic cystoid macular edema. Saudi J Ophthalmol 2014; 29:130-4. [PMID: 25892932 PMCID: PMC4398816 DOI: 10.1016/j.sjopt.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/07/2014] [Accepted: 10/21/2014] [Indexed: 11/19/2022] Open
Abstract
AIMS To determine the feasibility, safety, and clinical efficacy of intravitreal 0.7-mg dexamethasone implants (Ozurdex) in patients with refractory cystoid macular edema after uncomplicated cataract surgery. METHODS AND MATERIALS In this study, 11 eyes of 11 patients affected by pseudophakic cystoid macular edema refractory to medical treatment were treated with a single intravitreal injection of a dexamethasone implant. Follow-up visits involved Early Treatment Diabetic Retinopathy Study visual acuity testing, optical coherence tomography imaging, and ophthalmoscopic examination. RESULTS The follow-up period was six months. The mean duration of cystoid macular edema before treatment with Ozurdex was 7.7 months (range, 6-10 months). The baseline mean best corrected visual acuity (BCVA) was 0.58 ± 0.17 logarithm of the minimum angle of resolution (logMAR). The mean BCVA improved to 0.37 ± 0.16 logMAR (p = 0.008) and 0.20 ± 0.13 logMAR (p = 0.001) after 1 and 3 months, respectively. At the last follow-up visit (6-month follow-up), the mean BCVA was 0.21 ± 0.15 logMAR (p = 0.002). The mean foveal thickness at baseline (513.8 μm, range, 319-720 μm) decreased significantly (308.0 μm; range, 263-423 μm) by the end of the follow-up period (p < 0.0001). Final foveal thickness was significantly correlated with baseline BCVA (r = 0.57, p = 0.002). No ocular or systemic adverse events were observed. CONCLUSIONS Short-term results suggest that the intravitreal dexamethasone implant is safe and well tolerated in patients with pseudophakic cystoid macular edema. Treated eyes had revealed a significant improvement in BCVA and decrease in macular thickness by optical coherence tomography.
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Affiliation(s)
- Waseem M. Al Zamil
- Address: Department of Ophthalmology, P.O. Box 2208, Khobar 31952, Saudi Arabia. Tel.: +966 138966666; fax: +966 138966776.
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Guo S, Patel S, Baumrind B, Johnson K, Levinsohn D, Marcus E, Tannen B, Roy M, Bhagat N, Zarbin M. Management of pseudophakic cystoid macular edema. Surv Ophthalmol 2014; 60:123-37. [PMID: 25438734 DOI: 10.1016/j.survophthal.2014.08.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 08/24/2014] [Accepted: 08/26/2014] [Indexed: 01/08/2023]
Abstract
Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.
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Affiliation(s)
- Suqin Guo
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA.
| | - Shriji Patel
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Ben Baumrind
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Keegan Johnson
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Daniel Levinsohn
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Edward Marcus
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Brad Tannen
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Monique Roy
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Neelakshi Bhagat
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Marco Zarbin
- Department of Ophthalmology, The Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
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Mitropoulos PG, Chatziralli IP, Peponis VG, Drakos E, Parikakis EA. Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm 2014; 23:225-31. [PMID: 24678790 DOI: 10.3109/09273948.2014.898775] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of our study was to evaluate the potential efficacy and safety of intravitreal ranibizumab in patients with pseudophakic cystoid macular edema (CME). METHODS This retrospective study comprised 7 eyes with CME treated with intravitreal ranibizumab. Patients were examined at 1 week and 1 month after injection and monthly thereafter. Main outcome measures included changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Safety was assessed by ophthalmic examination and report of systemic adverse effects. RESULTS There was a statistically significant difference on BCVA (p < 0.001) and CRT (p < 0.001) before and after the ranibizumab injection. One injection appeared to be sufficient for the resolution of CME, while recurrence was observed in 1 patient, in a long-term follow-up. No observable ocular or systemic side effects were found. CONCLUSIONS Intravitreal ranibizumab seems to be effective and safe for the treatment of pseudophakic CME, demonstrating a statistically significant difference in BCVA as well as CRT.
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Efficacy and safety of intracameral triamcinolone acetonide to control postoperative inflammation after phacotrabeculectomy. J Cataract Refract Surg 2013; 39:1691-7. [DOI: 10.1016/j.jcrs.2013.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/21/2013] [Accepted: 04/29/2013] [Indexed: 11/18/2022]
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Assessment of the differences in pharmacokinetics and pharmacodynamics between four distinct formulations of triamcinolone acetonide. Retina 2013; 33:522-31. [PMID: 22990317 DOI: 10.1097/iae.0b013e3182647f69] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the durability of Kenalog, Trivaris, Triesence, and compounding pharmacy preservative-free triamcinolone acetonide in pigmented rabbits with syneretic vitreous using direct visualization, pharmacodynamics, and pharmacokinetics. METHODS Twenty-five Dutch-belted rabbits were used. Pharmacokinetic experiment: Rabbits were intravitreally injected with one of four 4-mg triamcinolone acetonide formulations. Wide-field imaging was serially performed to document residual drug mass. Pharmacodynamics experiment: Four triamcinolone acetonide groups and one control group received intravitreal recombinant human vascular endothelial growth factor 165 every 2 weeks and were followed with fluorescein angiography to assess vascular endothelial growth factor retinal vasculopathy as a measure of residual steroid effect. Particle size of the formulations was measured with Mastersizer 2000. RESULTS Remaining triamcinolone acetonide mass after 19 weeks: 12,091 ± 2,512 pixels for the Kenalog group, 1,307.36 ± 695.57 for Trivaris, 5577 ± 1477 for Triesence, and 1,535 ± 329 for compounded preservative-free triamcinolone acetonide. Kenalog suppressed recombinant human vascular endothelial growth factor-induced retinopathy more effectively than the other triamcinolone acetonide groups at Week 39, the final time point assessed. Particle size (90th percentile) was 47 μm for Kenalog, 26 μm for Triesence, and 22 μm for both compounded preservative-free triamcinolone acetonide and Trivaris. CONCLUSION Triamcinolone acetonide formulations do not have the same pharmacokinetics/pharmacodynamics. Kenalog has the longest vitreous visibility and durability. Particle size appears to correlate with efficacy and durability.
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Paspulati A, Punjabi OS, Theodoropoulou S, Singh RP. Triamcinolone Acetonide as an Adjuvant to Membrane Peeling Surgery: A Pilot Study. Ophthalmic Surg Lasers Imaging Retina 2013; 44:41-5. [DOI: 10.3928/23258160-20121221-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 06/21/2012] [Indexed: 11/20/2022]
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Demirel S, Batioğlu F, Özmert E. Intravitreal Ranibizumab for the Treatment of Cystoid Macular Edema in Irvine-Gass Syndrome. J Ocul Pharmacol Ther 2012; 28:636-9. [DOI: 10.1089/jop.2012.0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sibel Demirel
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Figen Batioğlu
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Emin Özmert
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Sevim MS, Sanisoglu H, Turkyilmaz K. Intravitreal Triamcinolone Acetonide Versus Pars Plana Vitrectomy for Pseudophakic Cystoid Macular Edema. Curr Eye Res 2012; 37:1165-70. [DOI: 10.3109/02713683.2012.721444] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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