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Christoph Deuter, Faik Gelisken, Manfred Zierhut, Deshka Doycheva; Interferon Alpha in the Treatment of Chronic Cystoid Macular Edema Following Cataract Surgery (Irvine-Gass Syndrome). Invest. Ophthalmol. Vis. Sci. 2013;54(15):2916.
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Cystoid macular edema (CME) is a common cause of visual impairment after cataract surgery. The aim of this retrospective analysis was to evaluate the long-term effects of interferon (IFN) alpha in the treatment of chronic CME following cataract surgery (Irvine-Gass syndrome).
Treatment with IFN alpha-2a was started at an initial dose of 3 million IU per day subcutaneously for approximately four weeks. Afterwards, the dose of IFN alpha-2a was tapered stepwise to the lowest possible dose that keeps CME in remission, and was finally discontinued if possible. Treatment efficacy has been assessed by optical coherence tomography (OCT).
Seven patients (3 male, 4 female; mean age 67.7 years, range 49-76 years) with 8 affected eyes have been analyzed. Mean follow-up was 29.1 months (range 27-34 months). Mean duration of treatment with IFN alpha-2a was calculated for 23.3 months (range 4-34 months). Ineffective pre-treatment included systemic corticosteroids (6 patients), acetazolamide (3 patients), and intravitreal triamcinolone and/or bevacizumab (5 patients). In 7 eyes (87.5%), IFN alpha-2a led to complete resolution of CME. Within 3 months, mean central foveal thickness (CFT) decreased from 543.8 µm (range 340-920 µm) to 249.1 µm (range 110-690 µm). An improvement of visual acuity of at least two lines could be observed in 5 eyes (62.5 %). In 2 patients IFN alpha-2a could be discontinued after 21 and 24 months, respectively, in complete remission of CME. During further follow-up of 6 and 7 months, respectively, no recurrence of CME occurred in these two patients. Treatment with IFN alpha was generally well tolerated. Only 1 patient discontinued treatment after 21 months due to side effects (persistent fatigue; CME in remission).
For patients, in whom pseudophakic CME does not respond to conventional treatment, IFN alpha represents a promising therapeutic approach. It is our impression that the proportion of patients, in whom IFN alpha treatment could be discontinued without further relapses of CME, is higher in chronic pseudophakic CME compared with chronic uveitic CME. Further studies are necessary to define the role of IFN alpha in chronic CME following cataract surgery.
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