Author: Mário Lima Fontes (Portugal)
Co-authors: Mariana Leuzinger Dias, Ricardo Pereira, Vítor Fernandes, Manuel Falcão, Amândio Rocha Sousa, Pedro Alves Faria
Purpose
Cystoid macular edema (CME) is a well-known postoperative macular complication of several ocular procedures, including pars-plana vitrectomy, and its pathogenesis after surgery is attributed to the breakdown of the blood–aqueous barrier due to an exaggerated inflammatory reaction and to the release of cytokines. Recurrent CME is difficult to treat, and many strategies have been employed with varying degrees of success. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 μg/day; ILUVIEN®) in the treatment of refractory CME after successful pars-plana vitrectomy (PPV).
Setting/Venue
Retrospective observational case series, that evaluates the effectiveness and safety after fluocinolone acetonide implant in patients with recurrent CME that underwent PPV or PPV combined with phacoemulsification, at Centro Hospitalar Universitário São João, Porto, Portugal.
Methods
Retrospective case series with consecutive eyes of patients with recurrent cystoid macular edema after vitrectomy and treated with a single implant of fluocinolone acetonide. Mean follow up after FAc implant was 36.4 ± 17.6 months. Demographics, previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg) and IOP lowering medication needed before FAc implant were recorded at baseline. Highest BCVA and IOP values and lowest CMT values registered throughout study were recorded as well as time to edema recurrence and the need of hypotensive drops. Total macular edema resolution was defined as CMT < 300μm or reduction > 20% and partial macular edema resolution was defined with a reduction >10%.
Results
Nine eyes from 9 patients with mean age of 68.7 ± 10.8 years were included. Eight patients were female, 4 underwent phacoemulsification simultaneously with PPV, while the remaining were already pseudophakic previously to PPV. Prior to FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and Ozurdex®), that led to macular edema resolution but with quick relapse 1 to 5 months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6 μm and IOP was 15.4 ± 2.4 mmHg with 4 eyes under IOP lowering medication. After FAc implant, all eyes achieved edema resolution (8 total and 1 partial resolution) with a peak gain of 17.2 letters and a maximum decrease of 208.2 μm in CMT. During follow-up (36.4 ± 16.6 months), 66.7% of the eyes kept their macula dry and 3 showed recurrence after 11, 14 and 18 months post-FAc implant, respectively. Maximum IOP registered was 17.0 ± 6.0 mmHg (9.0 ± 11.2 months after FAc implant). From the 4 eyes under hypotensive drops at baseline, the IOP lowering strategy was increased in 1 and maintained in the remaining during follow-up. Other 2 eyes started IOP-lowering medication, and 3 remained without need of IOP-lowering drops.
Conlusions
Intravitreal corticosteroid injections have shown to be an effective treatment option for recurrent CME after PPV. This case series showed that FAc implant not only maintained an anatomical dry macula but also provided visual improvement. These results demonstrate that FAc implant is an effective treatment option, and it reduces the need for repeated treatments. Significant IOP increase was observed in one third of the patients and it was effectively managed with topical treatment.
Financial Disclosure
None.
Comments
-
