Author: Tiago Morais Sarmento (Portugal)
Co-authors: João Garrido, Inês Passos, Ana Luisa Rebelo, António Ramalho, Augusto Candeias
Purpose
To report efficacy, safety and management of fluocinolone acetonide implant administration in central retinal vein occlusion induced macular edema (CRVO-ME) in an eye with glaucoma.
Setting/Venue
Hospital do Espírito Santo de Évora, Évora, Portugal
Methods
Case report of a 60-year-old patient with glaucoma followed in our department for unilateral CRVO-ME. Baseline best-corrected visual acuity (BCVA) was counting fingers (5.00 logMAR) with intraocular pressure (IOP) of 18mmHg under timolol+dorzolamide bid. SD-OCT registered central subfield thickness (CST) of 578mcm, cube volume (CV) of 12,1mm3 and mean cube thickness (MCT) of 337mcm.
Results
Patient was submitted to loading dose of 3 intra-vitreal administrations of ranibizumab 0.5mg with insufficient response in increasing BCVA (<+0.1), in reducing CST (reduction<20%) and intra-retinal fluid. The IOP value remained fluctuating between mild elevation and borderline values, under maximum therapy (timolol+dorzolamide and brimonidine bid). Faced with the dilemma of refractory CRVO-ME and borderline IOP values in glaucoma, we took the controversial decision of administering a fluocinolone implant. On 1st month, BCVA rised to 1.0, CST reduced to 243mcm (-48%), CV reduced to 8.9mm3 (-12%), MCT reduced to 248mcm (-12.5%) and there was no residual intraretinal or subretinal fluid. IOP climbed from 20 to 28mmHg and we took another controversial decision of adding travoprost. Follow-up appointments during 8 months showed stable BCVA values, maintained absence of intraretinal ou subretinal fluid and IOP reduction to 22-24mmHg without structural or functional glaucomatous progression. From the 8th month onwards, BCVA started to progressively decline due to cataract progression until 0.4 at 12 months . After uneventful cataract surgery, BCVA returned to 0.9 and IOP value lowered to 18 mmHg. Until 20 months of follow-up, BCVA has remained stable at 0.8, without any residual fluid and without any glaucomatous functional or structural progression.
Conlusions
Fluocinolone acetonide implant proved effective in reversing CRVO-ME and in restoring BCVA in an eye with glaucoma. However, the IOP rise was difficult to control with hypotensive drugs and requires more frequent monitoring for signs of structural or functional glaucoma progression. Despite this risk, after 20 months of follow-up, BCVA remains high and the eye has not suffered structural or functional glaucomatous progression.
Financial Disclosure
None
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