Pseudophakic Cystoid Macular Edema Research Articles

Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives.

Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent evidence suggests that prophylaxis is unnecessary in patients without risk factors. Diabetes mellitus is generally considered as a risk factor for the development of PCME after cataract surgery since it causes breakdown of the blood–retinal barrier. Diabetic retinopathy (DR) increases the risk even further. Therefore, prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered in diabetic patients, especially if they have DR. NSAIDs block the cyclooxygenase enzymes responsible for prostaglandin production and reduce the incidence of PCME after cataract surgery. Nepafenac seems superior to other NSAIDs in terms of ocular penetration allowing higher and sustained therapeutic levels in retina and choroid. Topical steroids are less effective and may cause intraocular pressure increase limiting their long-term use. Nepafenac is cost effective, when the burden of PCME prevention is compared with the burden of treatment. Prevention is much cheaper and less harmful than invasive treatments like periocular or intravitreal injections. Overall, both nepafenac 0.1% and nepafenac 0.3% are well tolerated. They should be used carefully in patients with compromised corneas such as those with severe dry eye or penetrating grafts. If otherwise healthy cataract patients have ≥2 risk factors, like PCME in the other eye or posterior capsule rupture during surgery, treatment should be considered. Once-daily nepafenac 0.3% dosing may improve postoperative outcomes through increased patient compliance and may reduce treatment burden further. Every patient should be assessed in terms of risks/benefits of the treatment, in individual basis, before cataract surgery.

Comparison of the Efficacy of Dexamethasone, Nepafenac, and Bromfenac for Preventing Pseudophakic Cystoid Macular Edema: an Open-label, Prospective, Randomized Controlled Trial

ABSTRACTPurpose: To evaluate the incidence of pseudophakic cystoid macular edema (PCMO) in patients treated with corticosteroids alone or in combination with bromfenac or nepafenac eyedrops after uneventful cataract surgery.Materials and Methods: Prospective, randomized, open-label, placebo-controlled clinical trial. Patients who underwent routine cataract surgery with intraocular lens (IOL) implant were randomly divided into three groups receiving either bromfenac or nepafenac in association with dexamethasone or dexamethasone alone (control group) postoperatively. Best-corrected visual acuity (BCVA) measurement, slit lamp and fundus examination and optical coherence tomography (OCT) were performed preoperatively, 1 and 5 weeks after surgery. Primary outcome was defined as patients (%) in whom macular edema developed within 5 weeks after cataract surgery; secondary end points were patients (%) with BCVA improvement from pre-op through 5 weeks after surgery and corneal toxicity.Results: A total of 144 patients completed the study, 48 for each group. In all groups, mean central subfield thickness at OCT increased significantly 5 weeks after surgery (p < 0.01). However, at this time point, four patients (8.3%) of the control group and none in nepafenac and bromfenac groups developed PCMO (p = 0.016). Compared with baseline, mean BCVA significantly improved both at 1 and 5 weeks in all groups (p < 0.01). At 1 week, the nepafenac group showed a mean BCVA significantly lower compared with both the control (p = 0.038) and bromfenac group (p = 0.002).Conclusions: Co-administration of nepafenac or bromfenac and steroids in patients who underwent routine cataract surgery is associated with a lower incidence of PCMO compared with steroid monotherapy.

Poor glycemic control as a risk factor for pseudophakic cystoid macular edema in patients with diabetes

To specify the risk factors for pseudophakic cystoid macular edema (CME) in patients with diabetes. Kymenlaakso Central Hospital, Unit of Ophthalmology, Kotka, Finland. Prospective case series. Patients with type 1 or type 2 diabetes having routine cataract surgery were evaluated. Spectral-domain optical coherence tomography imaging was performed before surgery and 1month postoperatively. The study comprised 93 patients (95 eyes). The central retinal thickness increase was 9.7μm±1.7 (SEM) in diabetic patients with no retinopathy, 22.7±8.6μm in those who had nonproliferative retinopathy, and 73.8±37.4μm in those who had proliferative retinopathy (P<.001). The central retinal thickness increase was greater in the eyes of diabetic patients with insulin dependence than in eyes of patients using noninsulin medication (21.9±5.9μm versus 8.3±1.8μm, P=.017). Serum hemoglobin A1c concentration and inversely, patient age, were associated with central retinal thickness increase, even after adjustment for confounding factors (r=0.607, P<.001 and r=0.417, P=.001, respectively). The central retinal thickness change was smaller in the eyes of patients who had a nonsteroidal antiinflammatory drug (NSAID) as their postoperative antiinflammatory medication than in eyes of patients who were not prescribed NSAID medication when retinopathy was analyzed as a covariant (8.2±3.6μm versus 13.6±2.9μm, P=.016). Young patient age and poor glycemic control were risk factors for postoperative central retinal thickness increase. This study showed it is necessary to identify, effectively treat, and follow-up with patients with diabetes who are at a greater risk for pseudophakic CME.

Prednisolone versus dexamethasone for prevention of pseudophakic cystoid macular edema

ObjectivePrevention of cystoid macular edema (CME) is important to achieve good surgical outcomes after cataract surgery. Although many options for management exist, control of postoperative inflammation with topical steroids is one of the most commonly employed. We evaluated the difference in incidence of pseudophakic CME in patients treated with prednisolone or dexamethasone topical steroids. MethodsThe study was a retrospective chart review of patients who had undergone phacoemulsification at the Cole Eye Institute of the Cleveland Clinic. Reviewable patient charts had to indicate the topical steroid used and whether or not an additional medication (e.g., nonsteroidal anti-inflammatory drugs [NSAIDs]) was used after surgery. Excluded were patients who underwent combination procedures (e.g., trabeculectomy), perioperative anti–vascular endothelial growth factor or intraocular steroid, eyes with epiretinal membrane or prior retinal vein occlusion, those who developed postoperative endophthalmitis, patients with less than 3 months of follow-up, and patients who received topical NSAIDs. Pseudophakic CME was defined as new or worsening macular edema on optical coherence tomography within the first 3 months after cataract extraction. ResultsIn total, 1135 patient charts were included in the analysis; 721 patients were treated with prednisolone acetate, and 414 were treated with dexamethasone. Patient characteristics were similar between the 2 treatment groups. No significant difference was found in the rate of postoperative CME for patients receiving prednisolone or dexamethasone (4.0% vs 4.1%, p = 0.94). ConclusionsThere was no significant difference in the rate of pseudophakic CME when either prednisolone acetate or dexamethasone sodium phosphate was used after cataract surgery.

Differential diagnosis of cystoid macular edema by optic disc thickness in optical coherence tomography

PurposeThe differential diagnosis between Irvine‐Gass Syndrome (IGS) and Diabetic Macular Edema (DME) is currently established by angiography, which is an invasive and time‐consuming tool. The aim of this study is to evaluate differences in optic disc's nerve fiber layer thickness (RNFL) in patients with macular edema associated with IGS and Diabetes Mellitus (DM).MethodsRetrospective case control study of 28 eyes of 28 patients with macular edema divided into 2 groups. Group 1 included 14 eyes with IGS diagnosed by clinical and angiographic criteria and group 2 included 14 eyes with cystoid diabetic macular edema (DME) without previous ocular surgery. A control group (group 3) of 14 eyes of 14 healthy patients paired by age and gender were also included. Ophthalmologic examinations included visual acuity (VA) measurements, slit‐lamp examination, Goldmann applanation tonometry, Spectral‐Domain Optic Coherence Tomography (SD‐OCT) and fluorescein angiography.ResultsForty two patients (21 females and 21 males), with a mean age of 66.57 ± 10.80 years were included in this study. Optic disc nasal and temporal RNFL thicknesses as well as central macular thickness were significantly higher in group 1 and 2 compared with control group (p &lt; 0.05). Nasal RNFL thickness was higher in IGS than in patients with DME (p &lt; 0.001). To detect IGS (Group 1), comparative to DME (Group 2), using Nasal RNFL thickness, the area under the curve was 0.842 p &lt; 0.002. A cut‐off criterion of 82.50 μm resulted in 92.9% sensitivity and 71.4% specificity.ConclusionsOptic disc SD‐ OCT imaging might be a useful diagnostic tool to differentiate IGS from DME.

Effects of dexamethasone implant on macular morphology and visual function in patients with different diseases

PurposeTo evaluate the effects of dexamethasone implant in patients with different retina diseases.MethodsIn the study 194 eyes of patients treated with Dexamethasone implant were included restrospectively in the study. Best‐corrected visual acuity (BCVA) measurement, complete ophthalmic evaluation with Intraocular pressure (IOP), and spectral‐domain optical coherence tomography (OCT) were performed at baseline and 30 days after treatment.ResultsWe have analyzed the results of the administration of dexamethasone implant in 194 eyes, during the years 2015 and 2016. The main indications for the treatment with dexamethasone implant were central retinal oclusion (54.20%), diabetic macular edema (35.35%), Irvine Gass syndrome (4.71%), uveitis (3.03%), macular degeneration (2.02%), vitreous‐ macular traction syndromes (0.33%) and neovascularization of the anterior segment (0.33%). The best visual acuity and the IOP before the administration of dexamethasone implant were respectively 0.21(+/‐ 0.15) and 16 mmHg. After the treatment the best visual acuity improves to 0.27 (+/‐ 0.2) and the IOP was 18.9 mmHg (+/‐6.28). The macular thickness has been reduced to 519.72 micron (+/‐ 157.86) to 429.96 microns (+/‐153.98) after the dexamethasone implant.ConclusionsIntravitreal dexamethasone implant showed an early and fast effect in reducing CRT and moderatly improving BCVA. There are IOP variations, but it rarely exceeds normal limits.

Widening use of dexamethasone implant for the treatment of macular edema.

Sustained-release intravitreal 0.7 mg dexamethasone (DEX) implant is approved in Europe for the treatment of macular edema related to diabetic retinopathy, branch retinal vein occlusion, central retinal vein occlusion, and non-infectious uveitis. The implant is formulated in a biodegradable copolymer to release the active ingredient within the vitreous chamber for up to 6 months after an intravitreal injection, allowing a prolonged interval of efficacy between injections with a good safety profile. Various other ocular pathologies with inflammatory etiopathogeneses associated with macular edema have been treated by DEX implant, including neovascular age-related macular degeneration, Irvine–Gass syndrome, vasoproliferative retinal tumors, retinal telangiectasia, Coats’ disease, radiation maculopathy, retinitis pigmentosa, and macular edema secondary to scleral buckling and pars plana vitrectomy. We undertook a review to provide a comprehensive collection of all of the diseases that benefit from the use of the sustained-release DEX implant, alone or in combination with concomitant therapies. A MEDLINE search revealed lack of randomized controlled trials related to these indications. Therefore we included and analyzed all available studies (retrospective and prospective, comparative and non-comparative, randomized and nonrandomized, single center and multicenter, and case report). There are reports in the literature of the use of DEX implant across a range of macular edema-related pathologies, with their clinical experience supporting the use of DEX implant on a case-by-case basis with the aim of improving patient outcomes in many macular pathologies. As many of the reported macular pathologies are difficult to treat, a new treatment option that has a beneficial influence on the clinical course of the disease may be useful in clinical practice.

Ocriplasmin treatment for vitreomacular traction in real life: can the indication spectrum be expanded?

To evaluate the efficacy of intravitreal ocriplasmin for the resolution of vitreomacular traction (VMT) with or without a full thickness macular hole (FTMH) in the clinical setting and to assess whether the indication spectrum of this treatment modality can be expanded beyond that of the MIVI-TRUST trials. The records of patients with VMT with or without FTMH, who were treated with intravitreal ocriplasmin were reviewed. Patients were divided in two groups. In the first group, VMT with or without FTMH was present without any other macular pathology. In the second group, VMT with or without FTMH occurred alongside of other macular disease including age-related macular degeneration, diabetic maculopathy and post-operative pseudophakic cystoid macular edema. Release of the VMT was achieved in 12/20 patients (12/20 eyes) of the first group. 16 eyes in this group met 3 or more criteria known to be associated with favorable prognosis after intravitreal ocriplasmin treatment. No cases of release of the VMT were observed in the second group, which included 15 patients (15 eyes). Significant improvement of visual acuity and reduction of the central macular thickness was observed only in the subgroup of eyes which responded to treatment. Concomitant macular pathology was a significant factor for treatment failure and we suggest that ocriplasmin should be regarded with caution in these cases. Careful patient selection for treatment with ocriplasmin using specific criteria in the clinical setting can provide superior results to those reported in the MIVI-TRUST trials.

A cross sectional study for evaluation of intraoperative and postoperative posterior segment complications of cataract surgery

Introduction: There is always some risk of complications during or immediately after cataract surgery so regular collection of data helps to identify high-risk patients and to confirm that they are being managed appropriately. Monitoring of cataract surgical outcomes is associated with a reduction in the incidence of surgical complications. Materials and methods: After obtaining ethics committee clearance, this cross-sectional, observational study was conducted in 500 patients having visually significant cataract those underwent planned extracapsular cataract extraction by phacoemulsification with PCIOL implantation method to evaluate the posterior segment complications of cataract surgery between October 2015 and September 2016. Results and discussion: Complications evaluated were cystoid macular edema, nucleus drop, expulsive and delayed suprachoroidal hemorrhage, infectious post-operative endophthalmitis, retinal detachment following cataract extraction and any other complication which involving posterior segment of eye. Out of 500 patients, 6 had postoperative complications in the form of CME (1.2%). No incidence of any other posterior segment complications occurred in present study. Conclusion: Cataract surgery is a safe procedure with a high patient satisfaction rate. The occurrence of pseudophakic cystoid macular edema after cataract surgery is a well known complication. As in our study CME incidence was 1.2%.

OCT-Leakage Mapping: A New Automated Method of OCT Data Analysis to Identify and Locate Abnormal Fluid in Retinal Edema

To test OCT-Leakage, a new method of analyzing and mapping sites of lower optical reflectivity found on OCT, by examining eyes with various types of retinal edema to identify abnormal increases in retinal extracellular fluid. Prospective analysis of a cohort of cases. Healthy eyes and eyes with retinal edema in the setting of different retinal diseases. Prospective OCT-Leakage analysis of 12 eyes with various types of retinal edema, such as diabetic macular edema, branch retinal vein occlusion, idiopathic perifoveal telangiectasia, and Irvine-Gass syndrome, representing intraretinal edema and eyes with idiopathic central serous chorioretinopathy and neovascular age-related macular degeneration representing subretinal fluid accumulation, in order to compare with OCT-Leakage analysis of a series of 41 eyes of 24 healthy controls. Raw scan data from the OCT images were exported and used to calculate lower than normal optical reflectivity maps (low optical reflectivity [LOR] ratios). Optical reflectivity LOR maps (OCT-Leakage maps) were collected for the full retina A-scan and layer by layer after segmentation. Low optical reflectivity ratios from patients with the different conditions of retinal edema and controls were compared. Fluorescein angiography (FA) and OCT angiography (OCTA) were performed in all eyes. Identification of areas of abnormal retinal fluid accumulation. The OCT-Leakage maps based on sites of LOR (LOR ratios) delineated the location of intraretinal and subretinal fluid, always integrating the location of the sites on FA and the vascular abnormalities observed on OCTA. The areas of fluid outline in the OCT-Leakage maps were coincident and generally larger than those seen on FA. In all cases, the OCT-Leakage maps were able to identify the location of the fluid in the different segmented retinal layers. Mapping of lower reflectivity sites within the retina demonstrates the amount and location of retinal and subretinal fluid in different retinal diseases, showing potential to contribute to their management. Furthermore, thepossibility of complementarity between OCT-Leakage and OCTA is highly promising.

The effect of intravitreal Ranibizumab for refractory cystoid macular edema after cataract surgery

Objective To evaluate the effect of intravitreal Ranibizumab for refractory pseudophakic cystoid macular edema (CME) after routine senile cataract surgery. Methods From April 2013 to May 2015, 5 patients with refractory pseudophakic CME were treated with intravitreal Ranibizumab injection. Followed up for 3-6 months, visual acuity, retinal morphology and thickness of macula were compared before and after treatment to evaluate the effect. Results After once treatment of intravitreal Ranibizumab, all patients showed better visual acuity and less macular edema without recurrence or complication. Conclusion Intravitreal Ranibizumab is safe and effective for refractory pseudophakic cystoid macular edema. Key words: Ranibizumab, intravitreal; Cataract , age-related; Cystoid macular edema, refractory, pseudophakic

Combined Ab Interno Glaucoma Surgery Does not Increase the Risk of Pseudophakic Cystoid Macular Edema in Uncomplicated Eyes.

To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction. In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME. In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687). Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.

Pseudophakic cystoid macular edema prevention and risk factors; prospective study with adjunctive once daily topical nepafenac 0.3% versus placebo

BackgroundDefine the effectiveness of a topical non-steroidal anti-inflammatory drug (NSAID) added to topical steroid use after uncomplicated phacoemulsification for the prevention of pseudophakic cystoid macular edema (PCME) using a prospective, randomized, double-masked, placebo-controlled clinical study.MethodsEyes (1000) were randomized to placebo (497) or nepafenac 0.3% (503) used once daily, post-operatively for 5 weeks at two ophthalmology clinics. Diagnosis of PCME was made by clinical, ocular coherence tomography (OCT), and with fluorescein angiography confirmation. Correlation of PCME to NSAID use and the presence of pre-operative risk factors for PCME were assessed including, contralateral PCME, diabetic retinopathy, retinal vein occlusion, macular hole, epiretinal membrane, macular degeneration, retinal detachment repair, and prostaglandin use.ResultsPCME was the most common complication associated with routine cataract surgery (4.2% with PCME risk factors, 2.0% with risk factors excluded). Topical nepafenac 0.3% significantly reduces the incidence of PCME compared to placebo when used after routine cataract surgery (p = .0001). When patients with pre-operative risk factors are excluded, the incidence of PCME between treatment and placebo groups is equivalent (p = 0.31). PCME relative risk (RR) was most significant in contralateral PCME (RR 19.5), diabetic retinopathy (RR 13.1), retinal vein occlusion (RR 12.9), macular hole (RR 7.7), and epiretinal membrane (RR 5.7). Prostaglandin use and previous retinal detachment were not shown to increase risk.ConclusionPseudophakic cystoid macular edema is common after phacoemulsification cataract surgery. Topical nepafenac 0.3% reduces PCME in patients with pre-operative risk factors for PCME compared to placebo but shows no benefit in patients without pre-operative risk factors.Trial registrationNIH ClincalTrials.gov retrospectively registered January 15, 2017, NCT03025945.

Risk factors for and diagnosis of pseudophakic cystoid macular edema after cataract surgery in diabetic patients

To evaluate the risk factors and potential diagnostic criteria for pseudophakic cystoid macular edema (CME) in diabetic patients after phacoemulsification. Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. Prospective nonrandomized study. Diabetic patients were followed for up to 6months after cataract surgery and examined to evaluate their foveal thickness, macular sensitivity, and corrected distance visual acuity. Multiple statistical analyses were performed to determine risk factors and diagnostic criteria for pseudophakic CME. The duration, type of diabetes, stage of diabetic retinopathy, nuclear opalescence grading, glycosylated hemoglobin A1c (HbA1c), and ultrasound time were correlated with the change in foveal thickness and macular sensitivity after cataract surgery. Unsupervised data analysis showed 3 groups of patientsas follows: nonpseudophakic CME, level 1 pseudophakic CME, and level 2 pseudophakic CME. Subclinical level 1 patients had a 30% to 40% increase in foveal thickness 1month postoperatively, while level 2 patients had at least a 40% increase in foveal thickness and a 20% decrease in macular sensitivity. The incidence of clinical pseudophakic CME was 3.2% in diabetic patients as per the diagnostic criteria. The change in macular sensitivity was more consistent and correlated with foveal thickness. The duration, severity, type of diabetes, hardness of the lens, and HbA1c were risks for pseudophakic CME in diabetic patients after cataract surgery. A 40% or more increase in foveal thickness and 20% or more decrease in macular sensitivity offer an objective and reliable diagnostic standard to report pseudophakic CME in diabetics.

Evaluation of pseudophakic cystoid macular edema using optical coherence tomography angiography.

To compare the optical coherence tomography angiography (OCT-A) findings of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) in eyes with pseudophakic cystoid macular edema (PCME) with those of fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) and to compare PCME vascular density values of the SCP and DCP with those of healthy eyes. In this retrospective observational study, 13 eyes (12 patients) with PCME underwent comprehensive ophthalmologic examinations including visual acuity, FA, SD-OCT, and OCT-A. The vascular density of the SCP and DCP were measured using AngioAnalytics software in all PCME eyes and compared with 46 healthy eyes of 25 subjects. In patients with PCME, at the level of SCP, the mean vascular density in the whole en face image was 44.48 ± 3.61% while it was 50.27 ± 5.30% at the level of the DCP. In contrast, the vascular density in the whole en face image was 50.35 ± 3.22 at the level of SCP while it was 56.15 ± 3.28 at the level of DCP in 46 healthy eyes of 25 subjects. The vascular density of patients with PCME was significantly lower than in healthy subjects at the SCP (p<0.0001) and at the DCP (p<0.0001). We report the OCT-A appearance of PCME and vascular density map with values that can be easily interpreted for quantitative evaluation of retina perfusion status using OCT-A. This approach might be the first step in helping us fully understand the pathophysiologic mechanisms underlying PCME.

Evaluation of Predictive Factors for Successful Intravitreal Dexamethasone in Pseudophakic Cystoid Macular Edema.

Purpose To determine the efficacy, safety, and predictive outcome factors for intravitreal dexamethasone implant (DEX) in pseudophakic cystoid macular edema (PCME). Methods Retrospective, interventional, controlled study. Patients included had to have clinically significant PCME and have been treated with the DEX between 2012 and 2015. Charts and one-year data were selected consecutively, and efficacy and safety were abstracted. Visual acuity (VA) and central foveal thickness (CFT) were analysed. Results Nineteen patient data sets were analysed. After treatment with DEX, mean VA increased significantly by 0.2 logMAR (p = 0.034), while the mean CFT was reduced significantly by 162.79 μm (p < 0.001). Five patients receiving a combination of DEX/bevacizumab have not experienced a higher mean VA gain or CFT reduction compared to fourteen patients receiving DEX alone. Decision rules, when to combine DEX with bevacizumab, have not been defined before the study. Only posttreatment VA gains in the nonhypertensive subgroup (n = 11) were significantly better (p = 0.026). Analysis of data from diabetes patients (n = 4) versus nondiabetics yielded no significant differences in efficacy. There have been no adverse events within follow-up time. Conclusion The use of DEX in PCME showed significant improvements in VA and CFT. The VA seems to show greater improvements in patients without hypertension.

Postsurgical Cystoid Macular Edema.

Cystoid macular edema (CME) is a primary cause of reduced vision following both cataract and successful vitreoretinal surgery. The incidence of clinical CME following modern cataract surgery is 0.1-2.35%. Preexisting conditions such as diabetes mellitus and uveitis as well as intraoperative complications can raise the risk of postsurgical CME. The etiology of CME is not completely understood. Prolapsed or incarcerated vitreous and postoperative inflammatory processes have been proposed as causative agents. Pseudophakic CME is characterized by poor postoperative visual acuity. Fluorescein angiography shows the classical perifoveal petaloid staining pattern and late leakage of the optic disk. Optical coherence tomography is a useful diagnostic tool, which displays cystic spaces in the outer nuclear layer. The most important differential diagnoses include age-related macular degeneration and other causes of CME such as diabetic macular edema. Most cases of pseudophakic CME resolve spontaneously. The value of prophylactic treatment is doubtful. First-line treatment of postsurgical CME should include topical nonsteroidal anti-inflammatory drugs and corticosteroids. Oral carbonic anhydrase inhibitors can be considered complementary. In cases of resistant CME, periocular or intraocular corticosteroids present an option. Antiangiogenic agents, though experimental, should be considered for nonresponsive persistent CME. Surgical options should be reserved for special indications.

Синдром Ирвина–Гасса после факоэмульсификации катаракты на глазах с авитрией

Синдром Ирвина–Гасса после факоэмульсификации катаракты на глазах с авитрией

Intravitreal Dexamethasone Implant for the Treatment of Postoperative Macular Edema

Introduction: Macular edema after cataract surgery (Irvine-Gass syndrome) or pars plana vitrectomy is a postoperative complication which can lead to permanent visual loss. Increased inflammatory substances, such as prostaglandins and cytokines, are discussed to be causative. Currently, there are no evidence-based guidelines for the treatment of postoperative macular edema. Intravitreal dexamethasone (DEX) could be effective by its anti-inflammatory effect. We examined the functional and morphological results of treatment with 0.7 mg intravitreal DEX implant (Ozurdex®). Methods: In an observational study, we analyzed visual acuity (logMAR), intraocular pressure (IOP), clinical findings, and the central macular thickness (CMT, optical coherence tomography [OCT] Spectralis®, Heidelberg Engineering, 30° macular scan, 19 scans) of 12 eyes before and 1 month after the last DEX implantation (off-label use, Ozurdex®, Allergan, Inc., Irvine, CA, USA) for macular edema after cataract surgery or vitrectomy. Re-implantation was performed when OCT showed new intraretinal fluid along with a decrease in the patient's visual acuity. The mean follow-up was 14.4 ± 10.6 months. Results: Twelve eyes of 12 patients (4 female, 8 male) with a mean age of 62.6 ± 11.9 years were treated with a mean of 2.5 ± 1.6 intravitreal DEX implant injections. Prior to injection, the visual acuity was 0.74 ± 0.34 logMAR and the CMT was 608 ± 129 µm. One month after the last injection (after a mean of 437 ± 322 days), the CMT normalized (300 ± 90 µm, p < 0.01) in all cases with a visual acuity of 0.49 ± 0.43 logMAR (p < 0.01). After 8.1 ± 5.3 months, recurring macular edema could be completely reduced by re-injection in 66% (8 patients). Four patients had no recurrence. Postinjection, the mean IOP was 17.4 ± 6.8 mm Hg. Postinjection, 7 patients required topical antiglaucomatous therapy. Conclusions: Treatment with an intravitreal DEX implant is an effective therapy for postoperative macular edema. Each injection leads to a complete resorption of the edema with a significant increase in visual acuity.

Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine-Gass syndrome: a prospective case series.

PurposeTo determine the preliminary efficacy and safety of off-label dexamethasone implant for treatment of recurrent cystoid macular edema (CME) secondary to Irvine-Gass syndrome (IGS).Patients and methodsThis study was set in Raghudeep Eye Clinic, Ahmedabad and LV Prasad Eye Institute, Hyderabad (India). It is a Prospective Case Series. Prospective case series comprising of patients with uncomplicated pseudophakia and CME due to IGS who recurred after one course of topical steroids with NSAIDS and a sub-Tenon corticosteroid injection. A complete ocular and systemic exam, fluorescein angiography, and central subfield thickness (CST) on optical coherence tomography scans were performed. Follow-up visits were on days 1, 15, and 30 and then monthly for a year. Appropriate statistical analysis was done. The primary outcome measure was the change in CDVA at months 1, 6, and 12. Secondary outcome measures were recurrence of CME and complications if any as noted at months 1, 2, 6, and 12.ResultsAbout 27 patients (27 eyes) with 16 males were included. Median age: 63.24±5.62 years. At 1 month, the CDVA improved to 0.04±0.02 (20/25) logMAR from 0.52±0.12 logMAR (20/70) (P=0.001) with a reduction in CST from 454.2±45.3 to 218.32±38.15 microns(P=0.013). The CDVA was 0.04±0.03 logMAR(P<0.001) at month 6 and 0.05±0.02 logMAR(P<0.001) at month 12. The CST was 221±35.2 microns (P=0.013) at month 6 and 214±43.34 microns (P=0.0124) at month 12. All improvements were maintained for a year. Only one patient required a second injection. No complications were noted.ConclusionThe implant is safe and effective for the treatment of recurrent CME due to IGS.