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Ian D Kirchner, Ruby Parikh, Corey Waldman, Olga Shif, Philip H. Scharper; In office gas-fluid exchange and face-down positioning for treatment of refractory macular edema in post-vitrectomy patients. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5835.
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To determine the efficacy of an in-office complete gas-fluid exchange (GFX) and face-down positioning for treatment of refractory diabetic and cystoid macular edema (ME) in post-vitrectomy patients.
We performed a retrospective review of 10 eyes from 9 patients who underwent an in-office complete GFX and face-down positioning for persistent ME. One eye was excluded for a simultaneous diagnosis of serous retinal detachment at the time of the procedure. Patients were treated between November 2011 and November 2015 at the Krieger Eye Institute in Baltimore, Maryland. A complete GFX was performed with a non-expansile concentration of C3F8 gas. Patients were asked to maintain face-down positioning for one week. Outcome measures included post-GFX visual acuity (Va), measured using Snellen acuity and converted to logMAR notation, as well as post-GFX central subfield thickness (CST) determined by ocular coherence tomography (OCT) (Cirrus, Zeiss). Finally, OCTs were obtained during the post-GFX period to determine whether complete resolution of ME was achieved and maintained.
9/9 eyes had improvement in Va, with a mean logMAR acuity of 0.958 (20/182) pre-GFX improving to 0.449 (20/56) post-GFX. Mean CST improved from 375 uM pre-GFX to 336 uM post-GFX. While 9/9 of eyes also demonstrated improvement on OCT, only 2/9 (22%) achieved complete resolution of CME. Follow-up ranged from 5 weeks to 12 months, with a mean of 4.4 months. No patients had significant complications from the procedure.
An in-office complete GFX and face-down positioning was effective in improving Va and CST in post-vitrectomy patients with refractory ME. Additional studies are needed to determine its overall efficacy as a novel approach for providing complete and permanent resolution.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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