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Bunjo LJ, Bacchi S, Pietris J, Chan WO. Current management options for the treatment of refractory postoperative cystoid macular edema: A systematic review. Surv Ophthalmol 2024; 69:606-621. [PMID: 38490455 DOI: 10.1016/j.survophthal.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
Post-operative cystoid macular edema (PCME) is an important complication following intraocular surgery that often resolves spontaneously without treatment. In some cases, PCME may persist despite initial medical therapy, which can adversely impact visual outcomes. Various topical, intraocular and systemic treatments exist for the prevention and management of cystoid macular edema; however, there is no consensus on treatment of refractory cases in the postoperative setting. In accordance with the PRISMA guidelines, we systematically reviewed 68 articles describing management options and their outcomes for treatment-resistant cases of PCME. The most commonly reported treatments included steroid (39 studies) and biological-based (17 studies) therapies. We provide an overview of the treatment options for refractory PCME.
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Affiliation(s)
- Layla J Bunjo
- The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
| | - Stephen Bacchi
- Lyell McEwin Hospital, Adelaide, South Australia, Australia; Flinders University, Adelaide, South Australia, Australia
| | - James Pietris
- University of Queensland, Herston, Queensland, Australia
| | - Weng Onn Chan
- Department of Ophthalmology, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Health and Medical Sciences Building, University of Adelaide, Adelaide, South Australia, Australia
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Bernal-Morales C, Navarro-Angulo MJ, Rodriguez-Maqueda M, Velazquez-Villoria D, Cubero-Parra JM, Marticorena J, Hernández-Martínez A, Ruiz-Miguel M, Adan A, Ruiz-Casas D, Zarranz-Ventura J. Predictive Factors and Management of Macular Edema after Retropupillary Iris-Claw Intraocular Lens Implantation in Aphakia: National Multicenter Audit-Report 2. J Clin Med 2023; 12:jcm12020436. [PMID: 36675364 PMCID: PMC9862359 DOI: 10.3390/jcm12020436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/16/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
The aim of this multicenter, national clinical audit is to evaluate the predictive factors and management of postoperative macular edema (ME) after retropupillary iris-claw intraocular lens (RICI) implantation and pars plana vitrectomy (PPV). Preoperative, surgical and postoperative data were collected. Number and type of intravitreal injections (IT) administered (anti-VEGF or dexamethasone implant), visual acuity (VA), intraocular pressure (IOP) and central retinal thickness (CRT) assessed by OCT were collected at 1, 3, 6 and 12 months. From 325 eyes (325 patients), 11.7% (38/325) developed postoperative ME. Previous complicated cataract surgery with no capsular support was the only significant predictive factor for developing postoperative ME (OR 2.27, 95% CI 1.38-4.52, p = 0.02) after RICI implant. Mean time to ME development was 11.4 ± 10.7 weeks, and mean CRT peaked at 3 months follow-up. Different treatment options were non-steroidal anti-inflammatory (NSAIDs) drops (31.6%, 12/38), dexamethasone (DEX) implant (50%, 19/38), anti-VEGF (7.9%, 3/38) or combined IT (10.5%, 4/38). Cumulative probability of ME resolution was higher in the group treated with IT than in the group treated with topical NSAIDs (85.2% vs. 58.3%, p = 0.9). Performing RICI implantation after complicated cataract surgery is a risk factor for the development of postoperative ME. DEX implants may be an effective treatment for postoperative ME in these cases.
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Affiliation(s)
- Carolina Bernal-Morales
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | | | | | | | | | - Joaquín Marticorena
- Instituto Oftalmológico La Esperanza, HM La Esperanza, 15705 Santiago de Compostela, Spain
- Servicio de Oftalmología, Complejo Hospitalario Universitario, 15006 A Coruña, Spain
| | | | | | - Alfredo Adan
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Diego Ruiz-Casas
- Servicio de Oftalmología, Hospital Ramon y Cajal, 28029 Madrid, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d’Oftalmologia (ICOF), Hospital Clínic, 08028 Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Correspondence:
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Sharpless M, Hogden M. Full-Thickness Macular Hole Closure Following a Single Intravitreal Injection of Aflibercept in an Eye With Diabetic Macular Edema. JOURNAL OF VITREORETINAL DISEASES 2022; 6:457-460. [PMID: 37009537 PMCID: PMC9954781 DOI: 10.1177/24741264221083415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: This work aims to discuss the case of a 32-year-old man with diabetic macular edema (DME) who underwent successful treatment of a full-thickness macular hole (FTMH) with a single dose of aflibercept. Methods: A case report is presented. Results: A 32-year-old man with reduced vision and DME in the right eye was found to have a FTMH. The patient was scheduled for pars plana vitrectomy; however, following a single dose of intravitreal aflibercept, the FTMH closed and the patient avoided surgical intervention. Conclusions: FTMH formation in DME is a rare complication that typically requires surgical intervention. We present a case of FTMH closure after a single dose of intravitreal aflibercept, which to our knowledge is the first of its kind. This report highlights the importance of considering conservative treatment initially to avoid surgery.
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Affiliation(s)
- Michael Sharpless
- Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Michael Hogden
- Department of Ophthalmology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
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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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