Persistent Cystoid Macular Edema Research Articles

Dislocated 4-haptic intraocular lens rescue with Gore-tex suture scleral re-fixation

BackgroundDislocated IOL exchange conventionally involves manipulation within the anterior chamber which risks secondary injury to anterior chamber structures. We describe and evaluate a 4-haptic IOL rescue technique that avoids entering the anterior chamber and thus minimizes post operative inflammation, astigmatism and recovery time relative to conventional IOL explantation and replacement techniques.MethodsRetrospective, non-randomized, interventional study of all patients undergoing 4-haptic IOL rescue performed by two independent vitreoretinal surgeons at a single UK centre over two years. Surgical technique: A limited peritomy is performed with four 25-gauge scleral ports placed to enable use of two forceps, an infusion and a chandelier. A further four 27-gauge sclerotomies are symmetrically placed on the nasal and temporal sclera at 3 mm from the limbus with a 5 mm vertical separation on either side. A pars plana vitrectomy is performed followed by chandelier illuminated, bimanual cleaning of the dislocated IOL using 27-gauge serrated forceps. Gore-tex sutures are threaded through the IOL islets within the vitreous cavity and externalized through the sclerotomies for scleral re-fixation followed by conjunctival closure.ResultsSeven patients underwent IOL recycling with Gore-Tex suture scleral re-fixation. All procedures were successful in repositioning the IOLs, with all patients satisfied with post-operative outcome. Mean (standard deviation) time to IOL dislocation was 13 (3) years. Median visual acuity significantly improved post-operatively from 0.85 logMAR (Interquartile Range [IQR]: 0.2–2.1) to 0.07 (0.02–0.60) logMAR (p = 0.02). No significant post-operative complications were noted apart from persistent cystoid macular oedema in one patient non-compliant with post-operative treatment.ConclusionsTransscleral refixation using Gore-Tex suture is an effective, safe and practical approach in the management of dislocated 4-piece IOLs.

Fluocinolone intravitreal implant (Iluvien) for macular edema secondary to immune recovery uveitis in patient with acute myeloid leukemia

PurposeTo report the use of Fluocinolone intravitreal implant (Iluvien) for the treatment of persistent cystoid macular edema (CME) due to immune recovery uveitis syndrome in a patient with previous cytomegalovirus retinitis and acute myeloid leukemia.DesignCase report.MethodsThe clinical history of a patient who received an Iluvien implant in one eye for the treatment of cystoid macular edema due to immune recovery uveitis syndrome, previously treated with peribulbar Triamcinolone and intravitreal Dexamethasone injections, was reviewed.ResultsA 48-year-old woman presented with cystoid macular edema due to immune recovery uveitis syndrome. The patient had a history of cytomegalovirus retinitis 3.5 years prior, secondary to immunosuppressive treatment for an acute myeloid leukemia. Three periocular triamcinolone injections and two dexamethasone intravitreal implants were performed, but the edema recurred, so fluocinolone intravitreal implant was used, achieving a sustained control of the condition at one year of follow-up.ConclusionThe Fluocinolone intravitreal implant may be an effective treatment for persistent CME in patients with immune recovery uveitis syndrome.

Fluocinolone acetonide implant scleral fixation for cystoid macular edema in eyes with iris–lens diaphragm disruption

Abstract This is a two-center, case series of three patients with postoperative refractory cystoid macular edema (CME) and disruption of the iris–lens diaphragm, submitted to scleral fixation of fluocinolone acetonide implant. All patients achieved successful CME reduction with visual acuity improvement. The surgical procedure was uneventful in all cases; however, one patient developed hypotony with leakage from the scleral tunnel, which was successfully resolved with reinforcement of the suture and injection of viscoelastics in the anterior chamber. No case of implant migration was observed and patients did not report any visual field disturbances. Our results emphasize this surgical technique as an effective and safe procedure for patients with persistent CME and disruption of the iris–lens diaphragm.

Noninfectious Outcomes of Intravitreal Antibiotic Steroid Injection and Topical Nonsteroidal Antiinflammatory Drugs Versus Triple Drop Therapy After Cataract Surgery

To compare noninfectious outcomes of intravitreal antibiotic steroid (IVAS) injection (moxifloxacin-triamcinolone) and postoperative topical nonsteroidal antiinflammatory drugs (NSAID) with a standard 3-drop therapy (TDT) regimen (topical antibiotic, steroid, and NSAID) in patients after cataract surgery. Retrospective comparative clinical cohort study. In 3 study centers in the United States, a total of 2143 eyes (N = 2143 patients) underwent cataract surgery with IVAS-NSAID or TDT between 2017 and 2022. Preoperative data were included, including patients' age, iris color, medical history, and ocular history. Postoperative data, including best-corrected visual acuity, intraocular pressure (IOP), and the need for IOP-lowering medications, were recorded at 1-week, 1-month, and 6-month time points. The primary outcome measures were postoperative complications, defined as persistent anterior chamber inflammation, persistent corneal edema (PCE), rebound inflammation, and cystoid macular edema, were compared between the 2 groups. There were 1079 eyes in the IVAS-NSAID group and 1064 eyes in the TDT group. Best-corrected visual acuity and IOP were similar between IVAS-NSAID and TDT eyes at all time points. A portion (11.6%) of TDT eyes experienced postoperative complications compared with 6.5% in IVAS-NSAID eyes (P < .001). Femtosecond laser-assisted cataract surgery was associated with increased rates of PCE in IVAS-NSAID eyes, and eyes with dark irides had a higher incidence of cystoid macular edema, PCE, and rebound inflammation in the IVAS-NSAID group. The IVAS-NSAID regimen overall had similar postoperative outcomes and fewer complications compared with the TDT regimen. IVAS-NSAID may be considered a safe alternative to topical regimens in non-femtosecond laser-assisted cataract surgery and patients with light irides.

Clinical Outcome of Cystoid Macular Edema in Silicone Oil-Filled Eyes.

Purpose: To investigate the clinical outcome of cystoid macular edema (CME) in eyes undergoing silicone oil (SO) tamponade with subsequent SO removal (SOR). Methods: A retrospective case series of adult patients with CME treated with SO tamponade and SOR was conducted between January 2015 and January 2021. Exclusion criteria included eyes with a prior SO tamponade, those that did not undergo SOR, or those with infectious/inflammatory diagnoses. The primary outcomes were the incidence and resolution rates of CME in eyes with SO tamponade that had undergone SOR. The secondary outcomes included changes in best-corrected visual acuity (BCVA) and central field thickness (CFT). Results: Nineteen eyes of 19 patients (58% men) aged 52 years (interquartile range [IQR], 45-66 years) met the study inclusion criteria. The median (IQR) follow-up duration post SOR was 22 (8-35) months. The mean CFT decline for the CME-resolved cases was 13.1 µm/mo (P = .257). CME resolved in only 10 eyes (53%), 7 (67%) of which occurred after SOR. The median (IQR) BCVA was 20/400 (20/200 to 20/1262) at CME diagnosis and 20/796 (20/252 to hand motions) after SOR, with 0.184 worsening in logMAR BCVA (P = .340). Medical treatment was not associated with CME resolution compared with observation (50% vs 89%, respectively; P = .069). Eyes with proliferative vitreoretinopathy (PVR) had a higher rate of persistent CME compared with eyes with other diagnoses (78% vs 10%, respectively; P = .005). Conclusions: Nearly half had nonresolution of CME after SO was removed. The VA at the last follow-up was unaffected by CME resolution. Preoperative PVR may be a risk factor for unresolved CME.

To Evaluate the Surgical Outcome of Epiretinal Membrane Retrospective Study

The epiretinal membrane (ERM) is a common vitreoretinal intersurface disorder in elderly individuals. The objective of the study was to evaluate the outcome of vitreoretinal surgery in patients with epiretinal membrane. We retrospectively reviewed the medical records of thirteen eyes of 12 patients with ERM with mean age group of 63 ± 6.07 (53 – 73) years who underwent vitreoretinal surgery in Tilganga Institute of Ophthalmology and completed at least 3 month postoperative follow up from April 2018 to March 2019. The patients’ pre- and post-operative best corrected visual acuity, slit-lamp examination findings, and optical coherence tomography (OCT) images were evaluated. Three cases were pseudophakic. Out of 10 phakic eyes, 7 had combined surgery and 3 had consecutive surgery (Pars Plana Vitrectomy followed by cataract surgery). The median baseline best corrected visual acuity in Log MAR was was 0.7 (0.6-1.00) which improved to 0.30 (0.25-0.60) in 3 month follow up which was statistically significant (p-0.04).OCT parameters showed decrease in mean CMT from 411.15± 94.52 µm to 318.61 ±118.87µm (p - 0.002). One eye developed inferior retinal detachment at 6 weeks follow up, two eyes had postoperative IOP &gt;30mmHg which was managed with topical anti-glaucoma medication and two had persistent cystoid macular edema. Pars plana vitrectomy with membrane peeling is safe and effective in restoring visual acuity in patients with ERM. Though the study population was small with short duration of follow up, results are encouraging, so need further prospective large multi-centered study to determine the effectiveness of ERM surgery

Clinical variations and therapeutic challenges in the management of symptomatic retinal artery macroaneurysm: a tertiary center experience.

To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46years ± 14.89 (SD) fulfilled the inclusion criteria. Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29(±0.35) to 0.75(±0.15) p value 0.66 in Nd: Yag laser group, 2.67(±0.58) to 0.46(±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.

Case Report: Retained Lens Fragment in the Anterior Chamber 32 Years after Cataract Surgery

A 73-year-old Asian male presented to the eye clinic reporting a sudden onset of redness, irritation, and light sensitivity of the right eye 32 years after cataract surgery. While retained lens fragment in the anterior segment is an uncommon complication of cataract surgery, this case highlights a unique complication that should be considered as a differential diagnosis for cases of post-operational cataract surgery. It is important to consider a retained lens fragment as a differential when examining pseudophakic patients. Retained lens fragments can present weeks to years after cataract surgery with the more chronic cases secondary to nuclear fragments. Topical medications such as corticosteroids, non-steroidal anti- inflammatories, and cycloplegics can be used in treatment of the acute antiinflammatory event. If persistent inflammation and/or cystoid macular edema becomes an issue, management with subspecialty ophthalmology to remove the lens fragment is warranted. This case represents the longest time in literature between cataract surgery and the appearance of the retained lens fragment. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/case-report-retained-lens-fragment-in-the-anterior-chamber-32-years-after-cataract-surgery) Please check COPE course expiry dates prior to enrollment. The COPE course test must be taken before the course expiry date.

Patient-reported outcomes from a phase IV study of aflibercept in patients with refractory retinal vein occlusions.

PURPOSE:To determine the patient-centered effectiveness of switching patients with persistent macular edema due to retinal vein occlusion (RVO) to aflibercept using the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25).MATERIALS AND METHODS:Prospective study of eyes with persistent cystoid macular edema due to RVO despite regular treatment with bevacizumab or ranibizumab switched to aflibercept. Three loading doses of intravitreal aflibercept were administered every 4 weeks and thereafter every 8 weeks until week 48. Vision-related quality of life (VRQoL) using NEI-VFQ-25 was measured at baseline, 24 weeks, and 48 weeks following the switch. Baseline scores were compared to week 24 and 48 using paired t-test. Relationship between best-corrected visual acuity (BCVA) in the study eye and the NEI-VFQ-25 composite and subscale scores was investigated.RESULTS:Eighteen patients with RVO were enrolled in the study with a mean age of 70.3 ± 8.6 years. The mean change in BCVA and central macular thickness (CMT) from baseline to 48 weeks was +20.6 ± 5.2 Early Treatment of Diabetic Retinopathy Score letters and −109.2 ± 82.8 µm, respectively. VRQoL improved significantly, with an increase of mean NEI-VFQ composite score of 11.5 ± 9.5; the corresponding improvements in near and distant activities were 13.3 ± 19.4 and 8.4 ± 10.4, respectively (P < 0.001 for both). Logistic regression analysis demonstrated that BCVA gain of >15 letters and CMT < 300 µm at the end of the study predicted a higher change in VFQ-25.CONCLUSION:Switching eyes with persistent macular edema due to RVO to aflibercept resulted in significant improvement in visual function and patient satisfaction.

Contemporary Outcomes and Prognostic Factors of 23-Gauge Vitrectomy for Retained Lens Fragments After Phacoemulsification

To provide data on visual acuity (VA) outcomes and prognostic factors of microincision (23-gauge) vitrectomy surgery (MIVS) for retained lens fragments after complicated cataract surgery. Retrospective, interventional case series from 2012 to 2017. Precataract surgery and intraoperative (vitrectomy) parameters, postvitrectomy complications, and best-corrected visual acuities (BCVAs) were identified. Vitrectomy was performed as early as corneal clarity permitted. Univariate and multivariate logistic regression were used to characterize factors associated with achieving VA better than 20/40, or worse than 20/200 at 6months. This study included 291 consecutive eyes (291 patients). LogMAR BCVA improved from 0.73 ± 0.70 before cataract surgery to 0.46 ± 0.63 (P < .001) after vitrectomy. The previtrectomy VA was 1.43 ± 0.79. At 6months, 183 (62.9%) and 45 patients (15.5%) achieved BCVAs better than 20/40 and worse than 20/200, respectively. Most frequent complications were de novo ocular hypertension (29 eyes, 10%) and transient cystoid macular edema (25 eyes, 8.6%). Postvitrectomy retinal detachment occurred in 9 eyes (3.1%). Final VA of 20/40 or better was independently associated only with better precataract surgery VA, age <75 years, absence of preexisting diabetic macular edema (DME) or postvitrectomy persistent cystoid macular edema (P < .05). Only poorer precataract surgery VA, delaying vitrectomy to later than 2weeks, and final aphakic status were independently predictive of 20/200 or worse VA (P < .05). Contemporary VA outcomes of 23-gauge vitrectomy for retained lens fragments are comparable with that of prior predominantly non-MIVS cohorts, but fall short of benchmarks for uncomplicated cataract surgery. IOL type or timing of placement do not impact final VA.

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery-a Scottish Ophthalmological Surveillance Unit study.

PurposePost-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients.MethodsA Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation.ResultsFourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44–86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2–0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270–788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1–0.3) with average mean CRT of 327microns (245–488).ConclusionsWe identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.

Scleral Fixation of the Fluocinolone Acetonide Implant in Eyes with Severe Iris-Lens Diaphragm Disruption and Recalcitrant CME: The Fluocinolone-Loop-Anchoring Technique (FLAT).

IntroductionWhile proven to be an effective treatment for cystoid macular edema (CME) and diabetic macular edema, intravitreal steroid implants (IVSI) may cause undesirable side effects, including steroid-related glaucoma or migration into the anterior chamber in the case of iris–lens diaphragm disruption. Here we present a new surgical technique that allows for the easy implantation and subsequent fixation of the fluocinolone acetonide intravitreal implant without the risk of migration as a feasible and possibly reversible approach in the treatment of persistent CME in severely damaged eyes.MethodsIn this single-center, prospective off-label, proof of principle, scleral fixation of the fluocinolone implant was performed in two eyes with disrupted anterior–posterior segment border and persistent CME. Both eyes were then followed monthly in accordance to a detailed protocol.ResultsThe procedure was overall well tolerated without severe side effects. There was no migration of the implant in the anterior chamber in either eye.ConclusionScleral fixation of the fluocinolone implant proved to be a safe and feasible approach in eyes with persistent CME and disrupted anterior–posterior segment border. This new technique also allows for the possible removal of the implant and may therefore be suitable even for eyes at higher risk for side effects, such as glaucoma.Electronic supplementary materialThe online version of this article (10.1007/s40123-020-00232-2) contains supplementary material, which is available to authorized users.

Effects of Switching to Aflibercept in Treatment Resistant Macular Edema Secondary to Retinal Vein Occlusion.

Purpose:The aim of this study was to examine 12-month outcomes of eyes switched from intravitreal ranibizumab or bevacizumab to aflibercept for cystoid macular edema due to retinal vein occlusion (RVO).Design:Retrospective, observation, case series.Methods:A retrospective study was performed assessing eyes with RVO switched to aflibercept for at least 12 months. To be included in the study, eyes had to have macular edema despite treatment for at least 6 months with bevacizumab and/or ranibizumab before the switch, central foveal thickness (CFT) ≥300 μm at time of switch, and visual acuity (VA) ≤60 early treatment of diabetic retinopathy score (ETDRS) letters (20/40 Snellen equivalent). Outcome measures included change in VA (in ETDRS letters), CFT, and interval between intravitreal injections.Results:27 eyes of 27 patients were included in the analysis: 13 with branch RVO, and 14 with central RVO. Mean VA before switch was 54.2 ± 23.7 letters (20/80 Snellen equivalent) and mean CFT was 460.4 ± 178.2 μm. Mean number of previous anti-vascular endothelial growth factor (VEGF) injections was 29.5 ± 19.2. At 12 months, mean VA improved by 8.7 ± 13.2 letters (P < 0.01) and mean CFT decreased by 180.9 ± 207.7 μm compared with baseline (P < 0.01). Mean injection interval increased by 1.6 ± 2.0 weeks to 6.9 ± 1.2 weeks, but this was not statistically significant (P = 0.18).Conclusions:In our small retrospective study, eyes switched to intravitreal aflibercept for persistent cystoid macular edema (CME) due to RVO improved vision and macular thickness; however, larger prospective studies are required to validate our findings.

Outcomes after Epiretinal Membrane Surgery with or Without Internal Limiting Membrane Peeling.

IntroductionThe aim of this study was to assess the incidence of persistent postoperative cystoid macular edema (pCME) in patients undergoing pars plana vitrectomy with epiretinal membrane peel (ERM) only versus those with ERM peel combined with internal limiting membrane peel (ILM). Secondary endpoints of the study were to review both the central macular thickness (CMT) and visual acuity.MethodsThe patients were divided in two groups, one group in which only the ERM was peeled (n = 36 patients) and another group in which both the ERM and the ILM were removed (n = 62 patients). The results were analyzed retrospectively. Each patient received a complete ophthalmological examination, including best-corrected visual acuity (BCVA) using an ETDRS chart and spectral domain optical coherence tomography, at three time points: prior to surgery and 3 weeks and 3 months after surgery.ResultsA total 98 eyes of 98 patients were included in this study. The mean follow-up time was 7.7 months. CMT decreased significantly after surgery in all patients, and none of these changes differed significantly between the two groups. The BCVA increased significantly after surgery across all patients, and there were no significant changes between the two treatment groups. Postoperative pCME occurred in eight patients in each group, representing 22.2% of the 36 patients in the ERM only group and 12.9% of the 62 patients in the ERM/ILM peel group. However, this difference was not statistically significant.ConclusionsNo difference was found between the two groups in terms of incidence of pCME. Both groups experienced had similar decrease in the CMT and improvement in the BCVA postoperatively.

OLINiOAL AND MoRpHoLoGiOAL outcomes AND BENEFiT oF EARLY iDiopATHiO EpiRETiNAL MEMBRANES SURGERY

Surgical treatment of iERM improves or stabilizes visual acuity (VA), decreases metamorphopsia, and restores macular anatomy. Nevertheless patients with low preoperative VA do not enjoy complete recovery after membrane removal. Limited restoration of the VA in these patients can be due to chronic traction of retina, vascular leakage and persistent cystoid macular edema. All these factors restrict the restoration of macular anatomy and function. Objective. The purpose is to investigate the functional, structural and morphological outcomes of iERM surgical treatment in different proliferation phase. Materials and methods. 60 patients were divided into 3 groups: 1 group - patients with VA 0.7-0.9; 2 group - patients with VA 0.3-0.6; 3 group with VA 0.1-0.3. Idiopathic ERM/ILM samples from vitrectomy were analyzed for glial acidic fibrillary protein (GFAP), cellular retinaldehyde-binding protein (CRALBP), a-SMA, vimentin, CD65 and type II, IV, VI collagen using flat-mount immunohistochemistry. Results. We observed transdifferentiated retinal Muller cells and astrocytes in myofibroblast-like phenotype which induced tissue contraction. In the course of time membranes demonstrated rough extratrecellular matrix component combination. These membranes had strong adhesion to ILM and were removed in the unique block during vitrectomy. An improvement of postoperative best-corrected visual acuity (BCVA), as well as a decrement in central foveal thickness (CFT) was observed in all groups, maximum after 1 year of observation. Postoperative BCVA was better in patients with satisfactory preoperative VA. Comparative analysis of the three groups showed a significant improvement in BCVA and CFT in the first group. These patients have very little macular damage resulting in good recovery of the macular function. Conclusions. We conclude that vitrectomy for early symptomatic iERM is beneficial in preserving excellent vision. Early intervention may prevent the evolvement of non-reversible damage to the outer retina. It is a safe procedure associated with a lower chance of surgical difficulty during ERM/ILM peeling.

Usefulness of Intravitreal dexamethasone implant in treatment of persistent cystoid macular edema due to Irvine–Gass syndrome

Introduction: Pseudophakic cystoid macular edema (CME) is one of the commonest causes of visual impairment after uneventful cataract surgery. There is no standardized protocol for pseudophakic CME and cases with refractory or persistent CME remained therapeutic challenge.

Longitudinal Follow-Up of Choroidal Thickness in Central Retinal Vein Occlusion With and Without Cystoid Macular Edema

Purpose: To investigate the longitudinal relationship between subfoveal choroidal thickness (CT) and central retinal vein occlusion (CRVO). Methods: Retrospective cohort of 104 subjects with enhanced-depth imaging optical coherence tomography for unilateral CRVO. Mean CT and best-corrected visual acuity (BCVA) were compared in eyes with and without CRVO and in eyes with CRVO with and without cystoid macular edema (CME). Results: CT was thicker in eyes with CRVO-related CME than uninvolved contralateral eyes at baseline (263.9 ± 86.9 versus 230.2 ± 87.9 µm; P &lt; .001) and final follow-up (261.1 ± 94.7 versus 222.3 ± 86.2 µm; P = .007). CRVO eyes treated with intravitreal antivascular endothelial growth factor with or without steroid therapy showed a significant reduction in CT at final follow-up (256.3 ± 90.7 versus 236.9 ± 85.9 µm; P = .004). Subjects with CRVO who were not treated with intravitreal injections also showed a significant but more modest decline in CT over time (234.4 ± 94.2 versus 221.5 ± 97.1 µm; N = 31; P = .02). However, contralateral uninvolved eyes without CRVO did not show a significant change in CT over time (233.3 ± 87.9 versus 219.5 ± 90.6 µm; N = 71; P = .40). Persistent CME at final follow-up was associated with thicker baseline (277.6 ± 96.4 versus 235.1 ± 86.5 µm; P = .02) and final CT (265.7 ± 93.4 versus 215.0 ± 82.1 µm; P = .005). Change in CT was not related to change in BCVA ( P &gt; .05). Conclusions: CT was greater in eyes with CRVO-related CME compared to eyes with CRVO but no CME and compared to uninvolved contralateral eyes. CT decreased in eyes with CRVO over time both among eyes that received intravitreal injections and among eyes that did not receive injections. CT may be a prognosticator of treatment response in CRVO-related CME.

Efficacy of additional topical betamethasone in persistent cystoid macular oedema after carbonic anhydrase inhibitor treatments in retinitis pigmentosa

ObjectiveWe investigated the efficacy of additional topical betamethasone in persistent cystoid macular oedema (CMO) after carbonic anhydrase inhibitors (CAIs) therapy.Methods and analysisThis retrospective cohort study included 16 eyes of 10...

Twenty-Four Months Follow-Up of Intravitreal Bevacizumab Injection Versus Intravitreal Triamcinolone Acetonide Injection for the Management of Persistent Non-Infectious Uveitic Cystoid Macular Edema

ABSTRACTPurpose: To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME).Methods: Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT.Results: Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group.Conclusions: Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.

PROSPECTIVE EVALUATION OF A SUSTAINED-RELEASE DEXAMETHASONE INTRAVITREAL IMPLANT FOR CYSTOID MACULAR EDEMA IN QUIESCENT UVEITIS.

To investigate dexamethasone intravitreal implant (DEX implant; OZURDEX, Allergan, Inc) in the treatment of uveitic cystoid macular edema that had persisted in the absence of intraocular inflammation. In this prospective interventional case series, 10 patients with uveitic cystoid macular edema and quiescent uveitis were treated with dexamethasone intravitreal implant at baseline and evaluated monthly for one year. Patients were retreated whenever cystoid macular edema recurred. The primary outcome measure was best-corrected visual acuity (BCVA) at day 90. At day 90, mean improvement from baseline BCVA was 14.4 letters (P = 0.0003), 70% of patients had a ≥10 letter BCVA improvement, 50% of patients had a ≥15 letter BCVA improvement, and the mean decrease from baseline central subfield retinal thickness was 140 μm (P = 0.008). Improvements were maintained through day 360 with retreatment as needed. At day 360, mean improvement in BCVA was 16.5 letters (P = 0.006) and the mean decrease in central subfield retinal thickness was 158 μm (P = 0.002). One patient experienced intraocular pressure >25 mmHg (managed with topical medication). Two phakic patients (2/8; 25%) had worsening of lens opacity requiring cataract extraction. Dexamethasone intravitreal implant may be an effective treatment for patients with persistent cystoid macular edema in quiescent uveitis.