A Single 700 μg Dexamethasone Intravitreal Implant (Ozurdex) Effectively Treats Complex Post-Operative Cystoid Macular Edema

Abstract

 

Purpose

 

Severe post-operative cystoid macular edema (CME) associated with posterior uveitis may occur after anterior (Irvine-Gass syndrome) or posterior segment intraocular surgery and may result in visual loss. There is no consensus on the efficacy of various topical, oral, peribulbar, retrobulbar or intravitreal therapeutic options compared to natural history, but patients with this condition are often referred to specialists for treatment consultation.

 

Methods

 

Consecutive, retrospective review of patients diagnosed and treated with this condition in a multi-specialty practice. All patients had optical coherence tomography (OCT) and fluorescein angiography (FA) at baseline, one week, one month and on most recent follow-up.

 

Results

 

Six pseudophakic patients with acute, post-operative (≤8 weeks post-surgery, 4 after anterior segment procedures and 2 after posterior segment procedures with vitrectomy) CME associated with posterior uveitis and decreased vision (average logMAR VA= .996, range 20/60 - 20/400) and edema on OCT (avg central subfoveal thickness [CST] = 640 μm, range 447 to >1000 μm) were treated with one 700 μg intravitreal dose of Ozurdex (Allergan Inc., Irvine CA). Within 1 week VA improved to an average of logMAR 0.619 (~20/80) and avg CST decreased to 389 μm. At 1 month avg logMAR VA= 0.309, range 20/25 - 20/50 (p= 0.017 compared to baseline), and avg CST = 291 μm, range 233-352 μm (p=0.016 compared with baseline). At the most recent visit (average total follow-up of 18.4 weeks, range 12-21 weeks), logMAR VA and CST were not statistically different than at the 1-month interval. No patients developed serious adverse events, including vitreous hemorrhage, ocular hypertension or endophthalmitis, or developed recurrent edema. FA demonstrated a progressive diminution of late leakage at all post-treatment time points compared to baseline.

 

Conclusions

 

A single intravitreal injection of Ozurdex may rapidly and permanently treat severe post-operative CME associated with posterior uveitis in in both vitrectomized and non-vitrectomized eyes. This therapy may result in faster and more definitive visual rehabilitation and macular edema resolution compared to observation or other treatment options.

 

 

Example of a patient within this series who had maximal visual recovery with macular edema and angiography leakage resolution after a single Ozurdex injection on Day 0.

 

Keywords: 688 retina • 505 edema • 557 inflammation