Chronic Pseudophakic Cystoid Macular Edema Research Articles

Management of Irvine-Gass syndrome with a scleral intraocular lens

Pseudophakic cystoid macular edema is a common complication when placing an intraocular lens (IOL) in the sulcus (8%). The vitrectomy with implantation of a new scleral-fixated IOL with self-blocking plugs permits to resolve the chronic pseudophakic cystoid macular edema resulting from the implantation of a 3-piece acrylic IOL placed in the sulcus. This new type of IOL seems to have multiple potential advantages compared with glued IOL or iris-claw IOL in the management of Irvine-Gass syndrome secondary to the placement of IOL in the sulcus.

Longstanding refractory pseudophakic cystoid macular edema resolved using intravitreal 0.7 mg dexamethasone implants

BackgroundRefractory pseudophakic cystoid macular edema (PCME) following cataract surgery has long posed a challenge to clinicians, but intravitreal injections with a sustained delivery 0.7 mg dexamethasone implant has emerged as a promising therapy for this condition.ObjectiveTo present a case of longstanding and refractory PCME with complete remission through 189 days of follow-up after two successive injections with intravitreal dexamethasone implants.Case reportA 59-year-old male had experienced metamorphopsia for approximately 4 years and had been diagnosed with PCME 15 months earlier. Since the time of the diagnosis, the condition had been refractory to both subtenon triamcinolone acetonide and a total of five injections with intravitreal ranibizumab. After the last injection with ranibizumab, central subfield mean thickness was 640 μm, and the best corrected visual acuity was 78 Early Treatment Diabetic Retinopathy Study letters. Following an intravitreal injection with a dexamethasone implant, the macular edema resolved at the next follow-up. The macular edema returned 187 days after the first injection and was treated with another intravitreal dexamethasone implant. Again, the macular edema subsided completely, and best corrected visual acuity improved to 84 Early Treatment Diabetic Retinopathy Study letters, a condition which was maintained through an additional 189 days of follow-up.ConclusionChronic PCME is traditionally a difficult condition to treat, but we are encouraged by the optimal response experienced with intravitreal sustained release dexamethasone implants in our patient whose longstanding PCME had been refractory to previous treatments with both subtenon triamcinolone and intravitreal ranibizumab. In this case, the condition appeared to be fully reversible once inflammation was controlled, but the need for monitoring and repeated injections remains an issue of concern.

Intravitreal Triamcinolone Acetonide Versus Pars Plana Vitrectomy for Pseudophakic Cystoid Macular Edema

Purpose: To compare the efficacy of intravitreal triamcinolone acetonide injection versus 23-gauge pars plana vitrectomy with internal limiting membrane peeling for the treatment of chronic pseudophakic cystoid macular edema (CME) after uncomplicated cataract surgery.Methods: This retrospective, comparative, consecutive case series study included 39 patients with chronic pseudophakic CME. Twenty eyes in 20 patients were treated with intravitreal triamcinolone acetonide injection (IVT group), and 19 eyes in 19 patients were treated with pars plana vitrectomy with internal limiting membrane peeling (PPV group). In both groups, complete ophthalmologic examinations were performed before and after procedures. Findings were compared between the groups.Results: Both groups experienced a significant improvement in visual acuity and macular thickness after 12 months follow-up. At months 1 and 2, the IVT group showed a significant improvement in visual acuity and a significant reduction in macular thickness compared with the PPV group (p < 0.05), but these differences were not statistically significant between the groups after the 12-month period.Conclusion: Both intravitreal steroid injection and pars plana vitrectomy with internal limiting membrane peeling had a favorable effect on visual and anatomic results in patients with chronic pseudophakic CME. However, surgical treatment had no advantage over intravitreal triamcinolone acetonide injection after 12-months follow-up.

Pseudophakic Cystoid Macular Edema Associated with Extrafoveal Vitreoretinal Traction

Purpose: To describe an association between extrafoveal vitreoretinal traction and intractable chronic pseudophakic cystoid macular edema (CME) by the use of optical coherence tomography (OCT).Methods: In a retrospective case series study, charts and OCT findings of patients who had postoperative recalcitrant pseudophakic CME for at least 6 months and vitreoretinal traction membranes were analyzed. Excluded were eyes that either had another vitreoretinopathy that could affect the analysis or had undergone an intravitreal intervention.Results: Three eyes (three patients) with macular edema following uneventful cataract surgery were detected to be associated with multifocal extrafoveal vitreoretinal traction sites in each. Retinal edema that was underlying each of the traction sites in all eyes was in continuum in at least one site per eye with the central macular edema, thus manifesting as diffuse macular edema.Conclusion: Chronic pseudophakic macular edema may be related to extrafoveal vitreoretinal traction.

NSAIDS IN COMBINATION THERAPY FOR THE TREATMENT OF CHRONIC PSEUDOPHAKIC CYSTOID MACULAR EDEMA

The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injections for the treatment of chronic cystoid macular edema. Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks. At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thickness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy. Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.

Therapie des zystoiden Makulaödems bei Pseudophakie

Pseudophakic cystoid macular edema (PCME) is the most common complication following cataract surgery. In 1-3% of cases it is associated with a decrease in visual acuity. However, PCME has a good prognosis, persisting in only 10% of the patients beyond 2 years. The prophylactic therapy of eyes without additional disease with non-steroidal antiphlogistic drugs or steroids does not influence the final visual acuity. Under certain circumstances, prophylaxis can be a reasonable option. Risk factors that promote the formation of PCME are discussed. The course of acute or chronic PCME can be influenced by drug treatment, but in general the level of evidence for the treatment of this widespread problem is low. We would therefore like to present the Freiburg treatment scheme for PCME for discussion.

Steroid Hypopyon Following Intravitreal Triamcinolone Acetonide Injection in a Pseudophakic Patient

Purpose: A 64-year-old woman presenting with the complaint of ‘white stuff’ in her left eye one day after intravitreal triamcinolone injection for chronic pseudophakic cystoid macular edema after cataract extraction and anterior chamber intraocular lens implant is presented. Methods: Differential diagnosis included post-injection endophthalmitis versus ‘steroid hypopyon.’ Results: The patient was observed closely and the hypopyon cleared in four days. Three weeks after the injection, her visual acuity had improved from 20/200 to 20/70 with complete resolution of the macular edema. Conclusion: Patients having no capsular barrier presenting with hypopyon one day after IVTA may be observed closely for a few days for resolution of hypopyon prior to being treated as endophthalmitis.

TRYPAN BLUE-ASSISTED VITRECTOMY

To evaluate the efficacy of trypan blue dye for the staining and removal of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid during pars plana vitrectomy. The authors retrospectively reviewed a consecutive series of 26 eyes of 26 patients in whom trypan blue 0.15% dye was used to stain intraocular tissues during vitrectomy surgery. The cases reviewed included the following diagnoses: epiretinal membrane (13), macular hole (9), proliferative vitreoretinopathy (2), chronic pseudophakic cystoid macular edema (1), and chronic diabetic macular edema (1). The application of trypan blue resulted in a useful and consistent bluish staining, facilitating the identification, delineation, and removal of the epiretinal membrane, internal limiting membrane, or posterior hyaloid in all patients. Six months after the surgery, visual acuity was better or the same in 21 of the 26 patients. There were no clinical signs of retinal toxicity in any patients. Trypan blue staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal.

The effect of internal limiting membrane peeling on chronic recalcitrant pseudophakic cystoid macular edema: a report of two cases

PURPOSE: To describe the effect of internal limiting membrane peeling in chronic recalcitrant pseudophakic cystoid macular edema. DESIGN: Two interventional case reports. METHODS: Two consecutive patients with chronic pseudophakic cystoid macular edema of 11–22 months duration, after uncomplicated cataract surgery, unresponsive to previous treatment, were enrolled. The surgical technique consisted of pars plana vitrectomy and internal limiting membrane peeling. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and perifoveal leakage on fluorescein angiography. Optical coherence tomography scans were performed postoperatively. RESULTS: Pars plana vitrectomy with internal limiting membrane peeling resulted in anatomical, angiographic, and functional improvement in both patients, for total follow-up periods of 8 and 11 months, respectively. CONCLUSION: To our knowledge, this is the first report of chronic pseudophakic cystoid macular edema that favorably responded to pars plana vitrectomy with internal limiting membrane peeling, as concluded after a MEDLINE search.

Vitrectomy for chronic pseudophakic cystoid macular edema

PURPOSE: We report the results of pars plana vitrectomy for chronic pseudophakic cystoid macular edema unresponsive to medical treatment. METHODS: Retrospective analysis of 23 consecutive eyes of 23 patients with chronic pseudophakic cystoid macular edema was performed. Eyes with vitreous incarceration into the cataract wound or vitreous–cornea contact were excluded from the study. Preoperatively, all eyes had cystoid macular edema confirmed on fluorescein angiography and were unresponsive to medical treatment. Pars plana vitrectomy was performed using standard techniques and vitreous adhesions to the iris, intraocular lens, or both were lysed if present. RESULTS: The mean interval between cataract surgery and vitrectomy was 32.3 ± 30.9 months (median, 20 months; range, 3 to 110 months). The vitreous was adherent to the iris or intraocular lens in 12 eyes (52.2%) and was present in the anterior chamber with no evidence of adhesions in seven eyes (30.4%). In four eyes (17.4%) the vitreous was posterior to the iris plane with no adhesions to anterior segment structures. The median preoperative best-corrected visual acuity was 20/200, and the median final postoperative best-corrected visual acuity was 20/60 ( P < .0001) after a mean follow-up of 30.2 ± 31.2 months (median, 14 months; range, 2 to 109 months). Final best-corrected visual acuity improved by a mean of 3.3 ± 2.6 Snellen lines, with a median percent change of 70% (mean, 57.3%; range, 0% to 99%). In all 23 eyes the cystoid macular edema resolved postoperatively by biomicroscopic examination in a mean period of 3.3 months (median, 2 months; range, 1 to 12 months). CONCLUSIONS: In pseudophakic eyes with chronic cystoid macular edema unresponsive to medical treatment, vitrectomy resulted in resolution of the cystoid macular edema with improved visual acuity in some cases. Clinical improvement may occur in eyes with no apparent vitreous disturbance.

Ketorolac treatment of pseudophakic cystoid macular edema identified more than 24 months after cataract extraction

Objective To evaluate whether ketorolac ophthalmic drops prescribed four times a day can be associated with improved visual acuity and prompt resolution of edema for patients with pseudophakic cystoid macular edema identified more than 24 months after cataract surgery. Design Prospective, nonrandomized, comparative (subject self-controlled) trial. Participants The records of nine patients who had pseudophakic cystoid macular edema more than 24 months after cataract surgery at the time treatment commenced were identified at the Wilmer Retinal Vascular Center from September 1, 1996, through March 1, 1997. Main outcome measures Best-corrected visual acuities measured on a retroilluminated Bailey-Lovie chart approximately every 3 months, contact lens biomicroscopy, and fluorescein angiography following ketorolac. Intervention Commercially available ketorolac ophthalmic drops 0.5% were prescribed for the affected eye four times a day for at least 3 months and continued until edema resolved. Results Ten eyes of nine patients were identified more than 24 months after cataract extraction (median, 59 months). Seven eyes (70%) improved (mean, +3.2 lines; range, +1 to +13 lines), including six by 2 or more lines 3 months after treatment initiation. Two eyes (20%) were unchanged, and one eye (10%) was 1 line worse. All seven eyes that improved 1 line or more had some or complete angiographic resolution of fluorescein dye leakage. In these seven eyes, ketorolac was discontinued when dye leakage completely resolved or failed to continue to improve on periodic 3-month follow-up examinations. In all seven eyes, recurrence of edema was noted within 3 months after ketorolac was stopped. Conclusions Chronic pseudophakic cystoid macular edema identified more than 24 months after cataract surgery can improve with topical ketorolac but probably requires persistent use.

Pars Plana Vitrectomy for Chronic Pseudophakic Cystoid Macular Edema

We determined the efficacy of pars plana vitrectomy in a series of patients with chronic pseudophakic cystoid macular edema. Clinical records were reviewed on 24 consecutive patients who underwent pars plana vitrectomy in one eye for chronic pseudophakic cystoid macular edema. All 24 patients had failed to improve on medical therapy and had preoperative evidence of either vitreous adhesions to anterior segment structures (23 eyes) or iris capture of the intraocular lens (one eye). The mean, best-corrected Snellen visual acuity was 20/190 preoperatively (median, 20/200; range, 20/50 to 3/200) and 20/52 postoperatively (median, 20/40; range, 20/20 to 20/400 [P < .0001]). Visual acuity improved postoperatively in all 24 eyes, with a mean improvement of 4.7 Snellen lines (range, one to eight lines). There was no highly significant difference in preoperative visual acuity (P = .41) or postoperative visual improvement (P = .17) between patients with anterior as opposed to posterior chamber intraocular lenses. Longer time interval from cataract surgery to vitrectomy did not correlate with less postoperative visual improvement. In pseudophakic eyes with chronic cystoid macular edema, vitreous adhesions to anterior segment structures, and visual loss that is unresponsive to medical therapy, pars plana vitrectomy with removal of these vitreous adhesions may lead to improved visual acuity.