Evaluation of Functional Outcomes and OCT-Biomarkers after Intravitreal Dexamethasone Implant for Postoperative Cystoid Macular Edema in Vitrectomized Eyes.

Sigrid Freissinger,Wolfgang J. Mayer,Karsten U. Kortuem,Siegfried G. Priglinger,Tina Herold,Armin Wolf,Mehdi Shajari,Efstathios Vounotrypidis,Filippos Sakkias

doi:10.1155/2020/3946531

Sigrid Freissinger, Wolfgang J. Mayer + Show 7 more

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https://doi.org/10.1155/2020/3946531

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Abstract

Purpose To evaluate the efficacy of dexamethasone implant (DEX) for the treatment of postoperative cystoid macular edema (PCME) in vitrectomized eyes and to investigate visual and morphological OCT predictive factors. Methods In this retrospective study, eyes with PCME after vitrectomy were treated with at least one DEX injection and were observed over 12 months. Indications for surgery were epiretinal membrane (ERM) or rhegmatogenous retinal detachment (RRD) without macular involvement. Prior treatments, if any, were noted. Best corrected visual acuity (BCVA), central foveal thickness (CFT), and OCT morphology including the presence of intraretinal cysts/fluid or subretinal fluid (IRF/SRF) and ellipsoid zone (EZ) continuity were evaluated. Correlations between OCT measures and visual outcomes were analyzed by the generalized estimating equations procedure. Results Forty-six eyes with ERM and 15 eyes with RRD were enrolled. The ERM group was more likely to gain BCVA than RRD (odds ratio (OR), 1.168; 95% confidence interval (CI), 1.003–1.360; p=0.046). The absence of SRF (OR, 0.860; 95% CI, 0.743–0.995; p=0.043) was predictive of worse BCVA, whereas the integrity of EZ (OR, 1.094; 95% CI, 0.951–1.257; p=0.209) or naïve status (OR, 0.946; 95% CI, 0.871–1.137, p=0.853) was not. Eyes with a worse baseline BCVA were more likely to gain >1 line after 12 months (OR, 1.485; 95% CI, 1.171–1.884; p=0.001). Conclusion The efficacy of the treatment of PCME in vitrectomized eyes seems to be affected by baseline BCVA, the absence of SRF, and the indication for surgery. Naïve status appears not to play any significant role in the prediction of BCVA. This trial is registered with DRKS00018955.

Highlights

Postoperative cystoid macular edema (PCME) is one of the major reasons for visual impairment after cataract surgery, vitrectomy, or combined phacovitrectomy and usually occurs within 4 to 12 weeks [1]
Discussion e efficacy of dexamethasone implant (DEX) in the treatment of PCME has been shown in several studies after cataract surgery [13, 31, 34], in two large cohorts in vitrectomized eyes after surgery for various underlying pathologies [30, 31], and, recently, in a small cohort after surgery for rhegmatogenous retinal detachment (RRD) with macular involvement [33]
Most of these studies have focused on the development of central retinal thickness (CRT) and Best corrected visual acuity (BCVA) after DEX injection and its adverse effects. e EPISODIC-2 investigation was the first study that evaluated predictive factors, such as preoperative existing risk factors, naıve status, and age, with regard to a better visual outcome after DEX treatment

Summary

Introduction

Postoperative cystoid macular edema (PCME) is one of the major reasons for visual impairment after cataract surgery, vitrectomy, or combined phacovitrectomy and usually occurs within 4 to 12 weeks [1]. Topical eye drops are applied as the initial treatment, followed by periocular and intravitreal corticosteroids [6], as they offer several advantages compared with systemic corticosteroids [9, 10]. Their disadvantage is their short-lasting effect [11]. Their disadvantage is their short-lasting effect [11]. e faster clearance in vitrectomized eyes reduces the effect of intravitreal steroids in comparison with nonvitrectomized eyes [12].

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