Abstract
Purpose
To 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 methods
This 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.
Results
About 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.
Conclusion
The implant is safe and effective for the treatment of recurrent CME due to IGS.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Lobo C . Pseudophakic cystoid macular edema. Ophthalmologica 2012; 227: 61–67.
Joussen A, Wolfensberger T . Mechanisms of macular edema and therapeutic approaches In Ryan SJ (ed) Retina, 5th edn. Elsevier: New York, NY, USA, 2013, pp 590–594.
Bhattacherjee P . The role of arachidonate metabolites in ocular inflammation. Prog Clin Biol Res 1989; 312: 211–227.
Flach AJ . The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery. Trans Am Ophthalmol Soc 1998; 96: 557–634.
Bergman M, Laatikainen L . Cystoid macular oedema after complicated cataract surgery and implantation of an anterior chamber lens. Acta Ophthalmol (Copenh) 1994; 72: 178–180.
Frost NA, Sparrow JM, Strong NP, Rosenthal AR . Vitreous loss in planned extracapsular cataract extraction does lead to a poorer visual outcome. Eye 1995; 9: 446–451.
Yilmaz T, Cordero-Coma M, Gallagher MJ . Ketorolac therapy for the prevention of acute pseudophakic cystoid macular edema: a systematic review. Eye 2012; 26: 252–258.
Kosker M, Sungur G, Celik T, Unlu N, Simsek S . Phacoemulsification with intraocular lens implantation in patients with anterior uveitis. J Cataract Refract Surg 2013; 39: 1002–1007.
Lara Smalling A, Cakiner-Egilmez T . Diabetes and cataract surgery: preoperative risk factors and positive nursing interventions. Insight 2014; 39: 18–20.
Elsawy MF, Badawi N, Khairy HA . Prophylactic postoperative ketorolac improves outcomes in diabetic patients assigned for cataract surgery. Clin Ophthalmol 2013; 7: 1245–1249.
Sehelsta H, Jampol L . Pharmacologic therapy of pseudophakic cystoid macular edema: 2010 update. Retina 2011; 31: 4–12.
Lafranco Dafflon M, Tran VT, Guex-Crosier Y, Herbort CP . Posterior sub-tenon’s steroid injections for the treatment of posterior ocular inflammation: indications, efficacy and side effects. Graefes Arch Clin Exp Ophthalmol 1999; 237: 289–295.
Jonas JB, Kreissing I, Segenring RF . Intravitreal triamcinolone acetonide for pseudophakic cystoid macular edema. Am J Ophthalmol 2003; 136: 384–386.
Spitzer MS, Ziemssen F, Yoeruek E, Petermeier K, Aisenbrey S, Szurman P . Efficacy of intravitreal bevacizumab in treating postoperative pseudophakic cystoid macular edema. J Cataract Refract Surg 2008; 34: 70–75.
Deuter CM, Gelisken F, Stublger N, Zierhut M, Doycheva D . Successful treatment of chronic pseudophakic macular edema (Irvine-Gass syndrome) with interferon alpha: a report of three cases. Ocul Immunol Inflamm 2011; 19: 216–218.
Wu L, Arevalo JF, Hernandez-Bogantes E, Roca JA . Intravitreal infliximab for refractory pseudophakic cystoid macular edema: results of the Pan-American Collaborative Retina Study Group. Int Opthalmol 2012; 32: 235–243.
Steinert RF, Wasson P . Neodynium:YAG laser anterior vitreolysis for Irvine-Gass cystoid macular edema. J Cataract Refract Surg 1989; 15: 304–307.
Harbour JW, Smiddy WE, Rubsamen PE, Murray TG, Davis JL, Flynn HW Jr . Pars plana vitrectomy for chronic pseudophakic cystoid macular edema. Am J Ophthalmol 1995; 120: 302–307.
Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C et al. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol 2007; 125: 309–317.
Boyer D, Yoon Y, Belfort R, Bandello F, Maturi RK, Augustin AJ et al. MEAD Study Group. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 2014; 121 (10): 1904–1914.
Taylor SR, Isa H, Joshi L, Lightman S . New developments in corticosteroid therapy for uveitis. Ophthalmologica 2010; 224 (Suppl 1): 46–53.
Medeiros M, Navarro R, Arumí J, Mateo C, Corcóstegui B . Dexamethasone intravitreal implant for treatment of patients with recalcitrant macular edema resulting from Irvine-Gass syndrome. Inv Ophthalmol Vis Sci 2013; 54 (5): 3320–3324.
Al Zamil W . Short-term safety and efficacy of intravitreal 0.7-mg dexamethasone implants for pseudophakic cystoid macular edema. Saudi J Ophthalmol 2015; 29 (2): 130–134.
Meyer L, Schönfeld C . Cystoid macular edema after complicated cataract surgery resolved by an intravitreal dexamethasone 0.7-mg implant. Case Rep Ophthalmol 2011; 2 (3): 319–322.
Brynskov T, Laugesen CS, Halborg J, Kemp H, Sorenson TL . Longstanding refractory pseudophakic cystoid macular edema resolved using intravitreal 0.7mg dexamethasone implants. Clin Ophthalmol 2013; 7: 1171–1174.
Williams GA, Haller JA, Kuppermann BD, Blumenkranz MS, Weinberg DV, Chou C et al. Dexamethasone DDS Phase II Study Group. Dexamethasone posterior-segment drug delivery system in the treatment of macular edema resulting from uveitis or Irvine-Gass syndrome. Am J Ophthalmol 2009; 147: 1048–1054, 1054.e1–e2.
Thach AB, Dugel PU, Flindall RJ, Sipperley JO, Sneed SR . A comparison of retrobulbar versus sub-Tenon’s corticosteroid therapy for cystoid macular edema refractory to topical medications. Ophthalmology 1997; 104 (12): 2003–2008.
Mueller AJ, Jian G, Banker AS, Rahhal FM, Capparelli E, Freeman WR . The effect of deep posterior subtenon injection of corticosteroids on intraocular pressure. Am J Ophthalmol 1998; 125 (2): 158–163.
Hirano Y, Ito T, Nozaki M, Yasukawa T, Sakurai E, Yoshida M et al. Intraocular pressure elevation following triamcinolone acetonide administration as related to administration routes. Jpn J Ophthalmol 2009; 53 (5): 519–522.
Bucolo C, Grosso G, Drago V, Gagliano C . Intravitreal triamcinolone acetonide in the treatment of ophthalmic inflammatory diseases with macular edema: a meta-analysis study. J Ocul Pharmacol Ther 2015; 31 (4): 228–240.
Errera M . Dexamethasone implant versus posterior sub-tenon triamcinolone acetonide for treatment of macular edema and/or vitritis in intraocular inflammatory diseases. Retrospective case series. Acta Ophthalmologica 2014; 92 (S253): 1–3.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Additional information
Presented as a free paper at the ASCRS Meet April 2015, San Diego, CA, USA.
Rights and permissions
About this article
Cite this article
Sudhalkar, A., Chhablani, J., Vasavada, A. et al. Intravitreal dexamethasone implant for recurrent cystoid macular edema due to Irvine–Gass syndrome: a prospective case series. Eye 30, 1549–1557 (2016). https://doi.org/10.1038/eye.2016.205
Received:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/eye.2016.205
This article is cited by
-
Pseudophakic macular edema in nondiabetic and diabetic patients without diabetic retinopathy treated with intravitreal dexamethasone implant
International Journal of Retina and Vitreous (2023)
