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Agnes Lavaud, Romain Nicolau, Antoine P Brezin; Subtenon Injection of Triamcinolone Acetonide as first-line treatment of postoperative clinically significant pseudophakic cystoid macular edema. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):173.
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Pseudophakic cystoid macular edema (PCME) or Irvine-Gass syndrome can be treated in different ways. We have performed a retrospective monocenter study to assess the effect of subtenon (ST) injections of Triamcinolone Acetonide (TA).
Consecutive patients with idiopathic clinically significant PCME seen between January 2012 and October 2013 were treated with at least one ST injection of TA (40mg). Clinically significant PCME was defined as being the cause of complaints of blurred or imperfect vision. The link between symptoms and PCME was assessed by OCT Imaging (Heidelberg, HRA2 Spectralis) of the macula. The main outcome measure was the comparison of central macular thickness (CMT) before and 1 month after the injections. The Best Corrected Visual Acuity (BCVA) was also studied, as well as the effect of the injections on Intraocular Pressure (IOP).
Of 3690 cataract surgeries, clinically significant PCME was identified in 72 eyes (1.9 %) of 60 patients. Forty eyes (35 patients) with non-idiopathic causes of CME were excluded and 32 eyes (25 patients) were included in the study. There were 9 (36%) women and 16 (64%) men and the mean age of patients was 76.1± 8,2 years (range 58-91 years). The mean delay between cataract surgery and the diagnosis of PCME was 48.4±29.4 days (median 40, range 6-163 days). The mean CMT at the time of the diagnosis was 495.6 ± 74.0 μm (range 376-710 μm). One month after the injection the CMT decreased to a mean of 326.9±56.2 µm (range 195-475 µm). Overall, the average CMT decrease was -168.7 μm, 95% CI [132.5-204.9 μm] (p<0.001). Of 32 eyes, 3 were treated with a repeat injection because of a persistent PCME. The mean LogMAR BCVA was 0.28±0.17 at the time of diagnosis and 0.11± 0.12 one month after the injection. Overall, the average improvement in BCVA was -0.18 LogMAR, 95% CI [-0.13; -0.23 logMAR] (p<0.001). One month after the injections, the mean IOP was 15.3 ± 4.5 mmHg (range 8-34 mmHg) and all cases of ocular hypertension were managed with topical pressure-lowering medication.
Our results suggest the efficacy of subtenon triamcinolone injections as first line treatment in patients with clinically significant PCME.
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