Systemic Steroids at the Forefront of New Protocols for the Treatment of Cystoid Macular Edema

Abstract

Purpose: : Developing a new delivery strategy by considering the natural barriers of the eye may offer a promising alternative for enhanced drug delivery and tissue targeting. The purpose of this investigation is to assess the potential of systemic steroid as an extra and alternative tool in treating CME unresponsive to the standard of care treatment.

Methods: : 13 eyes with confirmed idiopathic CME of at least 3 months duration and that previously failed conventional approach with steroidal/non-steroidal anti-inflammatory drops in combination with systemic diuretic agents and VEGF-inhibitors or triamcinolone intravitreal injections entered this investigation receiving a total oral dose of 1 mg/kg of prednisolone for 45 days. Before treatment, and at 2 weeks, month 1, 2, 3 and 6 and after treatment all patients underwent standardized color fundus photography (CFP), fluorescein angiography (FA), optical coherence tomography (CMT) and ophthalmic examinations, together with standardized assessments of best-corrected visual acuity, performed by masked visual acuity assessors using ETDRS protocols. Analysis was performed by Freidman test, Kruskal-Wallis test, and Mann-Whitney test P< 0.01.

Results: : At month 6, mean BCVA improved from baseline by 10.3 9.1 letters (P < 0.0001). Mean CMT reduction was 194.2_135.1_m (P < 0.0001). Gain of_10 letters BCVA from baseline occurred in 60.8% of the eyes (P<0.0001). There were no ocular adverse events and no serious collateral effects.

Conclusions: : Enabling therapeutic doses over a long period of time and equally targeting the anterior as well the posterior segment of the eye with a potentially lower rate of adverse events, systemic steroid emerge as promising new treatment tool for patients with persistent CME resulting from Irvine-Gass syndrome.

Keywords: retina • edema • corticosteroids