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Marissa Genduso Bucci, Mark Dacey, Jesse M Smith; Dexamethasone intravitreal implant in the treatment of recurrent uveitic macular edema in the post-operative cataract setting: a case series. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3118.
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Cystoid macular edema (CME) is an important cause of decreased vision after cataract surgery and can prove especially challenging in patients with known uveitis and prior CME. We performed a retrospective, clinical study to examine the efficacy of the dexamethasone (DEX) intravitreal implant (Ozurdex®; Allergan, Inc., Irvine, CA) in the treatment of recurrent uveitic macular edema in the postoperative period following cataract surgery (post-CE/IOL).
We performed a retrospective chart review of patients >18 years of age with known uveitic macular edema previously treated with DEX. Eight patients (8 eyes) were included who underwent cataract surgery within 1-4 months from their last DEX. These patients then developed post-operative macular edema and were subsequently treated with a repeat DEX implant. The main outcome assessed was the central macular thickness (CMT) measured by optical coherence tomography (OCT) in the pre-operative, post-operative and post-DEX period. All patients who received the DEX implantation prior to cataract surgery met FDA-approved indications for Ozurdex® for treatment of non-infectious intermediate or posterior uveitis and had no active inflammation at the time of surgery.
Eight eyes were included in the study. There was a statistically significant increase in mean CMT from pre-operative (mean, 270 ± 45 μm) to post-CE/IOL (mean, 352 ± 87 μm) (p = 0.01). There was subsequently a statistically significant reduction in mean CMT after treatment with DEX in the post-operative period (mean, 264 ± 53 μm) (p = 0.03). Although not statistically significant, there was a trend towards less increase in CMT post-CE/IOL in eyes that received DEX closer to time of surgery in the pre-operative period.
Intravitreal dexamethasone implant was shown to be effective in treating cystoid macular edema in the post-cataract surgery setting in patients with uveitis and prior uveitic CME. It may be beneficial to treat uveitics with a history of CME with DEX in the immediate pre-operative period to prevent or control CME after cataract surgery, although further studies would be needed to confirm this.
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