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Lauren Stephanie Taney, Caroline R Baumal, Jay S Duker; Sustained release dexamethasone implant for persistent macular edema after vitrectomy for epiretinal membrane. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1836.
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Persistent macular edema (ME) after removal of epiretinal membrane (ERM) with pars plana vitrectomy (PPV) may impair post-operative visual acuity (VA) improvement. The sustained release dexamethasone implant (DEX) was evaluated for treatment of unresolved ME after PPV for ERM.
A retrospective review of eyes treated with DEX from 2010 to present was performed. Only eyes that received DEX for treatment of persistent ME following PPV for ERM were included. VA, intraocular pressure (IOP), and optical coherence tomography (OCT) were utilized to assess eyes before and after DEX administration.
5 eyes were treated with DEX for persistent ME following PPV for ERM. Mean patient age at the time of DEX was 65 years. 1 patient had a remote history of sarcoid-related uveitis, which was inactive before and following PPV. 1 patient had well-controlled diabetes without any retinopathy. 3 eyes were phakic. Before DEX administration, all eyes were treated for ME with other agents including topical prednisolone (n=5), topical nonsteroidal anti-inflammatory (n=5), subtenons triamcinolone 40 mg (n=5), intravitreal triamcinolone 4 mg (n=1), intravitreal bevacizumab (n=3), and intravitreal ranibizumab (n=1). All eyes were treated with a combination of 3 of the above without improvement in VA or thickness on OCT before DEX. Mean number of days between PPV for ERM and DEX placement was 1045 (range 244-2387). Mean logMAR improvement in best corrected VA after DEX was 0.034. 4 of 5 eyes demonstrated reduction in macular thickness on OCT (mean decrease 76 um, range decrease of 56-155). There was no clinical response to DEX in 1 eye with residual ERM noted on OCT before and after DEX. For the 4 eyes with ME that responded to DEX, the duration of effect ranged from 3-8 months before ME recurred. Only 1 patient had an increase in IOP following DEX, which was controlled with topical drops.
Anti-inflammatory agents typically do not alter macular thickening prior to ERM surgery as the ERM exerts mechanical traction on the retina. However, inflammatory factors appear to play a role in unresolved anatomical changes and persistent retinal thickening after PPV for ERM. DEX was effective in improving VA and reducing ME in 4 of 5 vitrectomized eyes after other therapies had failed to do so. DEX may be considered as an adjunctive treatment when vision-limiting ME persists after PPV.
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