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Randee Miller, Kaitlyn Wallace, Joshua Hou, Clement Chow, Jose De la Cruz, Maria Cortina, Felix Chau; Treatment Outcomes of Cystoid Macular Edema in Patients with Boston Type I Keratoprosthesis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):263.
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© ARVO (1962-2015); The Authors (2016-present)
Cystoid macular edema (CME) is a common complication of Boston keratoprosthesis (Kpro) implantation, for which there is no standard treatment protocol. In this study we report our experience with several established therapies for CME.
Medical records of all patients who underwent implantation of Kpro at Illinois Eye and Ear Infirmary from Feb 2007- Nov 2012 were retrospectively reviewed. Eyes with CME as confirmed on spectral domain optical coherence tomography (SD-OCT) in the postoperative period were included. Outcome measures included visual acuity (VA), intraocular pressure, SD-OCT macular thickness, type, frequency, and duration of treatment including topical steroids and non-steroidals, posterior sub-tenon (PST) and intravitreal triamcinolone (IVT), intravitreal bevacizumab, and dexamethasone implant (Ozurdex). Structural outcomes were categorized into resolution (R), improvement (I), stable (S), or worsened (W).
105 Kpro were implanted into 91 eyes of 85 patients over a 5 year period. 19 of 91 eyes (21%) were diagnosed with CME postoperatively. The median time from Kpro to diagnosis of CME was 3 months. The median follow up time was 21.9 months. The median VA at time of CME diagnosis was 20/200 and the median initial OCT macular thickness was 519 µm. 10 eyes had topical treatment only (3R, 3I, 2S, 2W). 9 eyes had additional treatments with injections: 1 had intravitreal bevacizumab (S); 1 had PST and IVT (S); 1 had PST, IVT and bevacizumab (W); 3 had at least one Ozurdex (1R, 2I) and 3 had PST, IVT, and Ozurdex (3I). The 8 steroid injected eyes received a median of 3 treatments over a median of 24.7 months. Overall, the median final VA was 20/250 (p= 0.25) and median final OCT macular thickness was 413 µm (p= 0.005). 4 eyes with pre-existing glaucoma had a transient pressure spike >30 mmHg following steroid injection; 3 were treated successfully with topical medication (3/4) and one required a glaucoma shunt procedure (1/4). There were no other ocular complications.
Treatment of CME following Kpro can be challenging. Corticosteroids remain a mainstay of treatment and anatomic improvement may occur in the absence of visual acuity improvement. Twelve of 19 eyes exhibited resolution or improvement of CME, including all 6 eyes treated with Ozurdex; four of these 12 eyes had improved visual acuity. Ozurdex may be beneficial in treating chronic Kpro CME.
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