Treatment Of Cystoid Macular Edema Research Articles

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.

TOCILIZUMAB RESOLVES REFRACTORY MACULAR EDEMA ASSOCIATED TO RETINITIS PIGMENTOSA.

The aim of this report is to describe the resolution of refractory cystoid macular edema (CME) associated to retinitis pigmentosa (RP) with IV tocilizumab in three patients. Retrospective study of a series of consecutive cases of patients treated with off-label IV tocilizumab (anti IL6) for CME refractory to acetazolamide 250 mg for 3 months. Patients were diagnosed with RP by fundus appearance, electrophysiology, visual fields, and genetic testing. A complete ophthalmic examination including spectral-domain optical coherence tomography was performed. Three patients with RP and CME refractory to acetazolamide 250 mg for 3 months were treated with monthly IV tocilizumab for at least six months.All patients resolved CME and improved visual acuity after the third month of IV tocilizumab, resolving systemic and ocular adverse events related to previous treatments for CME. Tocilizumab was well tolerated with no other adverse events. CME causes visual impairment in RP, but current treatments are usually deficient. Tocilizumab has been successfully used as treatment for refractory CME in uveitis, retinal dystrophies, and autoimmune retinopathies. This article reports, for the first time, the long-term resolution of refractory CME in RP with IV tocilizumab.

Применение имплантата дексаметазона в комбинированном лечении кистозного макулярного отека на фоне окклюзии центральной вены сетчатки и ее ветвей.

Cystoid macular edema (cmE) is the main reason for decreased vision in case of retinal vein occlusions. Тhe purpose of the work is to determine optimal terms for the use of ozurdex implant in the combined algorithm of treatment of cystoid macular edema associated with occlusion of the central retinal vein (ocrV) and its tributaries (ocrVt). Аnalysis of the correlation of the eye treatment results with diagnosed cmE on the background of ocrV/ocrVt with ozurdex with the onset of the disease showed that the maximum apparent therapeutic effect is observed in patients who started treatment within 1-5 months from the onset of the disease. Keywords: cystoid macular edema, central retinal vein occlusion, Ozurdex

Oral minocycline for the treatment of retinitis pigmentosa-associated cystoid macular edema: results of a phase I/II clinical trial.

The etiology of retinitis pigmentosa (RP)-associated cystoid macular edema (CME) has been related to retinal neuroinflammation and microglial activation. Minocycline, a drug FDA-approved for anti-microbial indications, also inhibits microglial activation and expression of inflammatory mediators. This study investigates the safety and efficacy of oral minocycline as primary treatment for RP-associated CME. A single-center, prospective, open-label phase I/II clinical trial enrolled five participants with RP-associated CME. Participants had lead-in assessments prior to the initiation of oral minocycline 100mg twice daily for 12months. Main outcome variables included changes in best-corrected visual acuity (BCVA) and retinal central subfield thickness (CST) measured using spectral domain optical coherence tomography relative to mean of pre-treatment measurements. The study drug was well tolerated and not associated with any severe adverse events. No significant changes in mean BCVA from study baseline were noted in either the study eye (+ 0.7 ± 4.1 letters at 6months, - 1.1 ± 1.7 letters at 12months) or the qualifying fellow eye (- 0.3 ± 3.4 letters at 6months, - 0.3 ± 4.6 letters at 12months) (p > 0.05 for all comparisons). Mean percentage changes in CST from baseline however decreased progressively with treatment (decreases at 6 and 12months: study eyes 3.9 and 9.8%; qualifying fellow eyes 1.4 and 7.7%). Considering all eyes (n = 10), mean percentage CST decrease at 6 and 12months was 2.7 ± 9.5% (p = 0.39) and 8.7 ± 9.5% (p = 0.02) respectively. Oral minocycline administration over 12months was associated with no significant changes in mean BCVA and a small but progressive decrease in mean CST. NCT02140164 (05/2014).

Intravitreal Dexamethasone Implant at the Time of Silicone Oil Removal to Treat Persistent Macular Edema after Rhegmatogenous Retinal Detachment Repair

An intravitreal dexamethasone implant (DEX-I) was found to be effective and safe for the treatment of cystoid macular edema (CME) after vitrectomy for rhegmatogenous retinal detachment (RRD) and in silicone oil (SO)-filled eyes. We aimed to investigate the efficacy and safety of DEX-I at the time of SO removal for the treatment of recalcitrant CME after successful RRD repair. A retrospective review of the medical records was performed on 24 consecutive patients (24 eyes) with recalcitrant CME after RRD repair who were treated with a single 0.7-mg DEX-I at the time of SO removal. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A regression model was performed to assess the relationship between BCVA and CMT at 6 months and independent variables. In all 24 patients, CME occurred after RRD repair and remained despite topical therapy. The mean time of CME onset was 27.4 ± 7.7 days after vitrectomy. The mean time between vitrectomy and DEX-I was 106.8 ± 10.1 days. The mean CMT was significantly decreased from 429.6 ± 59.1 µm at baseline to 294 ± 46.4 µm at month 6 (p < 0.0001). The mean BCVA significantly improved from 0.99 ± 0.3 at baseline to 0.60 ± 0.3 at month 6 (p < 0.0001). An elevation of intraocular pressure was observed in one (4.1%) eye, which was medically managed. A univariate regression model revealed a relationship between month-6 BCVA after DEX-I and gender (β = -0.27; p = 0.03) and macular status (β = -0.45; p = 0.001) when RRD occurred. No relationship between month-6 CMT and independent variables was found. DEX-I at the time of SO removal had an acceptable safety profile and achieved favorable outcomes in eyes affected by recalcitrant CME that occurred after RRD repair. RRD-related macular status is significantly associated with visual acuity after DEX-I.

Non-steroidal anti-inflammatory agents for treating cystoid macular edema following cataract surgery.

Non-steroidal anti-inflammatory agents for treating cystoid macular edema following cataract surgery.

History of diagnosis and treatment of cystoid macular edema

AbstractFollowing the introduction of the ophthalmoscope by Helmholtz in 1851, very early descriptions of macular edema were reported by Jaeger in 1856 and Nettleship in 1872. Macular disease following cataract surgery was described by Hruby in 1950, Irvine in 1953, Chandler in 1954, Nicholls in 1954, and Maumenee in 1957, among others. The introduction of fluorescein angiography by Novotny and Alvis in 1961, with subsequent modifications by David, Sever and Justice, greatly facilitated the diagnosis of this condition. Using fluorescein angiography, Gass and Norton reported 44 patients with “cystoid macular edema” (CME) in 1966, which appears to be the first use of this term. The eponym “Irvine‐Gass syndrome” appears to have been published first in 1971. In 1991, Puliafito and colleagues reported the first use of optical coherence tomography, and published one case of postoperative CME in 1995.Treatments for CME developed as the pathophysiology became better understood. Early reported treatments included oral vasodilators (Laws, 1964), oral prednisone (Gehring, 1968), and pulsed ruby photocoagulation (Zweng and colleagues, 1968). Alternatively, other investigators recommended observation for at least 12 months, including Gass and Norton in 1969 and Jacobson and Dellaporta in 1974. Miyake reported good results with topical indomethacin prophylaxis in 1977; other investigators subsequently reported benefit with topical or oral indomethacin, including Yannuzzi and colleagues in 1979 and Kraff and colleagues in 1982. Various surgical factors, including posterior (rather than anterior) chamber intraocular lenses, were found to be beneficial during the 1980s. Multiple topical medications, including prednisolone acetate, flurbiprofen, ketorolac, diclofenac, and others, were investigated in the 1990s and 2000s. Gaudric and colleagues published treatment of CME with intravitreal triamcinolone acetonide in 2003.At the present time, the use of topical corticosteroids and nonsteroidal anti‐inflammatory agents is widely used in the prophylaxis and treatment of CME, but there is relatively little evidence from randomized clinical trials to support this practice. In both the US and Europe, no agent has achieved regulatory approval for the treatment of postoperative CME; all agents are used “off‐label”.

Prevalence and associated factors of cystoid macular edema in children with early onset inherited retinal dystrophies.

To assess the prevalence of Cystoid macular edema (CME) in children with early onset retinal dystrophies (EORD) and to evaluate if there are associated factors and/or response to early treatment. Consecutive, retrospective case series. Medical records of patients, 18 years or younger, diagnosed with EORD were included in the study. Optic coherence tomography (OCT) scans, clinical and genetic characteristics as well as other associated factors were analyzed. Main outcome was the presence of CME on OCT scans. One hundred and two children with EORD (aged 1-18 years, mean 9.7 ± 4.2) were recruited. OCT was performed in 60/102 and among them, 19/60 had CME (31.7%). The disease-causing gene was identified in 13 children with CME; autosomal-recessive inheritance was found in 88.3% of those with an identified genotype. Children with Usher syndrome had CME in 44.4% of the cases. Early treatment of CME resulted in variable response. Our results show that 31.7% of children with EORD who underwent OCT have macular edema. CME prevalence was found to be relatively higher in children with Usher syndrome. Autosomal recessive was the most prevalent inheritance identified in the EORD group as well as in the CME group. Additional prospective research is needed to assess the efficacy of early CME treatment in pediatric EORD patients.

Case Report: Intravitreal dexamethasone implant as adjuvant treatment for taxane-related cystoid macular edema

Taxane-related cystoid macular edema (CME) is a rare complication of the taxoid medication, a chemotherapeutic drug. We report a 47-year-old Han Chinese man referred to our Eye Center for decreased vision with visual distortion in both eyes for two weeks. Two weeks prior, he received the last cycle of his six-monthly chemotherapy, including paclitaxel for hypopharyngeal malignancy. The best-corrected visual acuity (BCVA) was 0.4 OD and 0.1 OS. Macular optical coherence tomography showed significant bilateral CME, and fluorescein angiography (FA) revealed the fluorescein pooling at the late phase without leakage. Intravitreal 700 μg dexamethasone (DEX) implant was applied to the left eye and 13 days after to the right eye. Two months later, the macular morphology recovered to normal. One year after the first visit, the BCVA was 1.0 OD and 0.8 OS with standard macula on OCT. In conclusion, the intravitreal DEX implant might be an effective adjuvant treatment for taxane-related CME.

Macular oedema after uncomplicated phacoemulsification

Background: Recent development of cataract surgery has led to the improvement of visual outcomes. However, pseudophakic cystoid macular oedema (CME), which is also known as Irvine–Gass syndrome, remains a usual cause of unexpected visual disturbance after both complicated and uncomplicated cataract surgeries. Optical coherence tomography is an important method in detecting changes prior to clinical presentation.Aim: To assess macular thickness changes after uncomplicated phacoemulsification using spectral domain optical coherence tomography (SD-OCT).Setting: The study assessed healthy patients who had uneventful phacoemulsification and changes in macular thickness in Ibn Al Haitham Teaching Eye Hospital (tertiary eye center), Baghdad, Iraq.Methods: Macular thickness of 86 eyes with uncomplicated phacoemulsification were measured by using four OCT examinations: one preoperatively, which was used as a control, and three in the first week and first and second months. Incidence of macular thickness changes was evaluated in the central and para and perifoveal areas to detect which areas of the macular map will be affected more. Significance was tested by using paired t-test and p 0.05 was considered significant.Results: Significant increase in macular thickness postoperatively during the 2-month period reaching the maximum level in the second month; early significant changes were noticed in paracentral area in the first week whilst significant increase in the central and pericentral area was recorded in the first month. Cystoid macular oedema (CME) was detected in six eyes (7%) in the second month.Conclusion: Significant variation in macular thickness can occur after uneventful phacoemulsification surgery in healthy patients. Cystoid macular oedema was detected in 7% of our patients using SD-OCT. It is rare after uncomplicated phacoemulsification in healthy individuals but should be kept in mind in the follow-up period. A detailed fundus examination with OCT imaging is thus recommended in the first or second month postoperatively for the early detection and treatment of CME.

Дифференцированный подход в хирургическом лечении кистозного макулярного отека

Cystoid macular edema (CME) is the accumulation of fluid in the retina between the outer plexiform layer and the inner nuclear layer, which leads to the formation of cysts. Treatment of CME depends on the cause, for example, with AMD – anti-VGEF, with thrombosis – a combination with a laser, with uveitis, unfortunately, often – corticosteroids. Significant vision loss in patients with intraocular inflammation is most often a consequence of cystoid macular edema. CME with epiretinal fibrosis was observed in 33% of all patients with uveitis. Material and methods. We examined 12 patients diagnosed with CME with a diagnosis of uveitis of various genesis. Of these, 8 patients underwent treatment courses in different institutions in the past, using traditional methods (eye drops, anti-VGEF and ozurdex implants) with little success. Results. Out of 12 patients, all had identified sources of endogenous infection. All patients underwent OCT-angio and it is noteworthy that in 11 out of 12 patients (91.66 %), CME was detected with the presence of epiretinal fibrosis with macular traction syndrome. Within the background of the preparation, a vitrectomy was performed with the removal of the fibrosis. Subsequently, additional therapy was prescribed according to the scheme. According to OCT data, edema regression was observed in 10 out of 11 patients without the need for repeated intravitreal intervention. Conclusions. With CME of uveal genesis, there is a high risk of detecting epiretinal fibrosis with a traction component in the macular zone. The best result of surgical treatment in CME of uveal genesis is achieved by vitrectomy with removal of membranes in combination with efferent therapy. Keywords: CME, uveitis, epiretinal fibrosis, vitrectomy.

Efficacy of intravitreal conbercept injection on short- and long-term macular edema in branch retinal vein occlusion

To observe the best-corrected visual acuity (BCVA) and central foveal thickness (CFT) repeatedly after the intravitreal injection of conbercept (IVC) for treating cystoid macular edema (CME) in branch retinal vein occlusion (BRVO) and explore the relationship between the duration of CME and visual outcome. Subgroup analysis was performed to compare short-term (within 90d of CME onset) and long-term (over 90d of CME onset) macular edema in BRVO. After an initial IVC, a pro re nata (PRN) strategy was performed according to the recurrence of CFT or decrease of BCVA. Analysis of variance using repeated measurements, statistical analysis following indicators including BCVA and CFT collected at baseline and 1, 3, and 6mo after IVC. Among the 60 cases included in this retrospective study, 36 were short-term CME, and 24 were long-term CME. There were statistical significances between and within groups of the BCVAs at different time points (P<0.001). The interaction was found between group and time (P=0.006), indicating the difference in the speed of BCVA improvement between groups. In particular, the improvement speed of BCVA in the short-term CME group was faster than that in the long-term CME group. There were significant differences between and with groups of the CFT at different time points (P<0.001). However, the interaction between group and time in relation to CFT had no significant differences (P=0.59). IVC treatment for CME following BRVO is effective and safe. The duration of CME before treatment is a significant predictor of the visual outcomes of patients with BRVO. The improvement of vision might be faster with early IVC treatment than with delayed treatment.

Aggravation of retinal hard exudates after intravitreal anti-vascular endothelial growth factor therapy for cystoid macular edema and the risk factors: a retrospective study

Background/aimsTo evaluate retinal hard exudates (HEs) progression in patients with cystoid macular edema (CME) secondary to diabetic retinopathy (DR) or branch retinal vascular occlusion (BRVO) after intravitreal injections of ranibizumab (IVR) treatment and identify the risk factors for the deterioration of HEs.MethodsThis retrospective study enrolled 288 eyes with center-involving CME secondary to DR or BRVO from 288 patients (one eye per patient). All patients were treated with three loading doses of ranibizumab intravitreally at a monthly interval. The morphologic features of HEs were observed, and the HEs areas were quantified using a semi-automatic method at baseline, 1 month after the first dose of IVR and 1 month after the third dose of IVR therapy. HEs progression was defined as having a > =2-grade increase in the HEs severity scale. The best-corrected vision acuity (BCVA) and alterations in HEs areas were compared between DR and BRVO groups. And logistic regression analyses were used to identify the risk factors for HEs exacerbation.ResultsMorphological changes of retinal HEs occurred in all eyes after IVR therapy, although HEs area was not significantly changed in some eyes. DR group has a higher percentage of eyes with progressed HEs area than the BRVO groups (34.9% vs. 21.8%, P = 0.019) 1 month after the first dose of IVR. Both DR and BRVO groups had a decreased percentage of enlarged HEs 1 month after the third injection, but the DR group is still higher than the BRVO group (17.1% vs. 8.4%, P = 0.027). At baseline, there was no correlation between VA and HEs areas. After the first and third doses of IVR, there still was no consistent correlation between HEs severity and change in VA over time. Furthermore, CME with subretinal fluid (SRF) is associated with a higher risk of HEs progression (P = 0.001). Long CME duration and high serum low-density lipoprotein cholesterol (LDL-C) level were identified as risk factors for HEs progression following IVR treatment in both univariable and multivariable regression analyses (Odds ratio (OR) = 1.88, P = 0.012 and OR = 1.14, P = 0.021, respectively).ConclusionsAlterations in the area of retinal HEs are widely observed after IVR treatment for CME. The eyes with CME secondary to DR have a higher percentage of progressed HEs than the BRVO eyes. DME with SRF, extended duration of CME, and high LDL-C level are potential risk factors of deteriorated HEs after IVR treatment.

Importance of careful clinical examination and multimodal imaging before injecting intravitreal steroid

Intravitreal injections have now become the most preferred treatment for retinal vascular diseases. Intravitreal steroids are associated with complications such as cataracts, glaucoma, and central serous chorioretinopathy (CSCR). We report a case who developed CSCR after a single injection of intravitreal triamcinolone, given for the treatment of cystoid macular edema (CME) secondary to branch retinal venous occlusion (BRVO). On careful retrospective examination, we found that pachychoroid and a pigment epithelial detachment was present even before the injection was given. Four months postinjection, there was a recurrence of CME due to BRVO while there was no sign of CSCR. We emphasize on the importance of a careful clinical examination and appropriate interpretation of multimodal imaging before injecting intravitreal steroids.

Anti VEGF for post op CME- Boon or Bane!

Cataract surgery has advanced in techniques and instrumentation over the years, but complications such as cystoid macular edema (CME) do occur even after uneventful surgery. The incidence of pseudophakic CME (detected by optical coherence tomography) is 30%–40% after uncomplicated phaco cataract surgeries. Risk factors for the development of CME include prolonged duration of surgery, iris handling and diabetes. Corticosteroids are the mainstay of treatment of postoperative inflammation and CME. In certain situations where steroids are contraindicated anti-vascular endothelial growth factor (VEGF) agents are used as the second line agents for the treatment of CME. Here, we describe a case of postoperative uveitis with CME which showed good response with single dose intravitreal anti-VEGF injection-Bevacizumab.

Ciclosporin A in bilateral auto-immune chronic posterior uveitis associated with macular oedema: a Long-term Observational Safety and Efficacy Study.

A non-interventional, longitudinal, retrospective follow-up study to assess CsA-induced nephrotoxicity (IN) and its reversibility after withdrawal in patients exhibiting a bilateral chronic posterior uveitis (CPU) associated with cystoid macular oedema (CMO) in at least one eye. Data from medical records between 1986 and 2013. Primary outcome was the renal tolerance during and after CsA treatment assessed by plasma creatinine concentration and glomerular filtration rate (GFR) estimated by Chronic Kidney Disease Epidemiology (CKD-Epi) formula. Secondary outcomes were CsA through concentration, occurrence of cancers and ophthalmologic efficacy assessed by three parameters including CMO, vitreous inflammation, and best-corrected visual acuity BVCA changes. One hundred forty-three patients were followed for renal tolerance. Underlying diseases were Birdshot retinochoroiditis (n = 67), Behçet disease (n = 9), probable sarcoidosis (n = 23), sympathetic ophthalmia (n = 3), idiopathic (n = 41). After CsA discontinuation in 115 patients (mean treatment duration of 5.9 ± 3.8 years) mean plasma creatinine concentration was 82.2 ± 14.2 µmol/L versus 82.1 ± 14.1 µmol/L at baseline, mean GFR was 79.4 ± 13.9 mL/min versus 82.5 ± 14.3 mL/min at baseline, with no significant difference (respectively p = 0.91 and p = 0.09). Blood pressure did not significantly change during follow-up. CMO was completely resorbed in at least one eye, in 70.8% patients (n = 72) at 6 months, in 71.4% patients (n = 49) at 10 years and in 54.2% patients (n = 24) at 20 years. BCVA did not statistically change over time. Early and long-term monitoring of renal tolerance and dual adjustment of CsA doses in inflammatory stages of CPU were associated with reversible CsA IN. CsA could be effective in the treatment of CMO in CPU patients.

Treatment of cystoid macular edema in a patient with primary open angle glaucoma and diabetic retinopathy by withdrawal of travoprost

To study the association of cystoid macular edema (CME) and Travoprost eye drops in a patient with diabetic retinopathy (DR).The study was carried out on a 65yr old patient on a regular follow up from 2009-2018.A 65yr old patient of a DR of both eyes who had received 3 sittings of pan retinal photocoagulation (PRP) laser in both eyes and grid laser to his right eye. He was on regular follow up since 2009 with a stable proliferative diabetic retinopathy (PDR). Patient was also on topical antiglaucoma medication and had prophylactic YAG-PI done both eyes. He was on regular follow up since 2009 with a stable proliferative diabetic retinopathy (PDR). Right eye showed macular edema (ME) in 2014 and underwent OCT and FFA. Patient refused for intravitreal injection and preferred laser treatment, so patient underwent micropulse laser treatment in 2014. His edema persisted even after micropulse treatment. His systemic control was good and patient continued to use Travoprost eye drops. So in 2017 suspected CME secondary to topical prostaglandin (PG) analogue as he had strict glycemic control and was no fluctuation in ME. Hence topical PG analogue was withdrawn and stopped. On subsequent follow up after 2 months CME had completely disappeared and the foveal contour returned to normal on OCT. LE was status quo. Patient was followed up for more than 1 year and continuously followed up, 15 days back in June 2018 had no evidence of CME and vision was 6/9 in both eyes.: Differentiation of DME and CME secondary to PG analogue should be made at the earliest.

Clinical characteristics of full thickness macular holes that closed without surgery

PurposeTo ascertain the anatomic factors that help achieve non-surgical sealing in full thickness macular hole (FTMH).MethodsRetrospective collaborative study of FTMH that closed without surgical intervention.ResultsA total of 78 patients (mean...

Twelve-month outcomes of ranibizumab versus aflibercept for macular oedema in branch retinal vein occlusion: data from the FRB! registry

Background/AimsTo compare the efficacy of ranibizumab (0.5 mg) with aflibercept (2 mg) in the treatment of cystoid macular oedema due to branch retinal vein occlusion (BRVO) over 12 months.MethodsA multicentre,...

Modified inexpensive needle for suprachoroidal triamcinolone acetonide injections in pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is one of the leading causes of reduced vision, after cataract surgery. Topical steroids and nonsteroidal anti-inflammatory drops are frequently used in the management; however, intravitreal injections may be required for chronic cases. Suprachoroidal injection of preservative free Triamcinolone acetonide is a recent addition to the therapeutic armamentarium of ophthalmologists for treatment of cystoid macular edema of varied etiology. Though the drug is commercially available at a reasonable cost, the microneedle is not commonly available. We modified a 26 G needle for safe and cost-effective delivery of preservative-free suprachoroidal triamcinolone acetonide (SCT). In the current series of three patients with non-resolving PCME, macular edema resolved and vision improved over 3 months.