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Rino Frisina; Treatment Of Surgically Induced Cystoid Macular Edema By Intravitreal Implant Of Dexamethasone. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5805.
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© ARVO (1962-2015); The Authors (2016-present)
Surgically induced cystoid macular edema (SICME) is a post-operative complication that can occur after cataract surgery, commonly known as Irvine Gass syndrome. However, SICME can occur after pars plana vitrectomy (PPV) with or without cataract surgery. The pathogenesis of SICME is attributed to the breakdown of the blood-aqueous barrier due to an exaggerated inflammatory reaction and to the release of cytochines. The purpose of this study was to evaluate the efficacy and safety of the implant of Dexamethasone 0.7 mg (Ozurdex, Allergan, Irvine, Calif, USA) (IVO injection) for the treatment of SICME refractory to the most common topical anti-inflammatory therapy.
Prospective, non-comparative, open-label study. Six eyes of 5 patients affected by SICME for at least 3 months, had undergone treatment with IVO injection. The mean time of SICME was 19,3±20,1 months. Best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination were performed at baseline and every month after IVO injection. Fluorescein angiography (FA) was performed in all patients, prior to IVO injection, to exclude neovascular diseases. Central foveal thickness (CFT) and macular morphology (reduction or disappearance of intra-retinal cysts) were studied with optical coherence tomography (OCT) every month to the end of follow up.
Six eyes of five patients had undergone PPV for epi-retinal membrane (ERM). In two cases cataract surgery was also performed. SICME appeared between 1 and 3 months post-op. In the group of patients who underwent PPV without cataract surgery only one case was phakic. The pre-operative BCVA average was 0,62±0,35, range 0,70-1 (ETDRS). The pre-operative CFT average was 654,6±172,85, range 445-800, micron. The pre-operative IOP average was 13,8±1,48, 12-16, mmHg. The post-operative BCVA average was 0,4±0,37, 1-0 and the post-operative CFT average was 279,17±78,13, 180-350 micron, at the last control (follow up 49-189 days). In all cases there was an improvement of BCVA and the intra-retinal cysts disappeared. There were no side effects such as increased IOP.
IVO injection for the treatment of SICME was effective and safe. In our study, we noticed an improvement in BCVA, the disappearance of the cysts and the CFT reduction in all patients.
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