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J. Boysen, J. Zastrocky, E. Margalit; The Use of Intraocular Acular PF® for the Treatment of Chronic Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2707.
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To test the safety of an intravitreal injection of Acular PF (preservative free ketorolac tromethamine) for the treatment of chronic pseudophakic cystoid macular edema that was refractory to at least 4 months of conventional therapy with topical ophthalmic corticosteroids and/or topical ophthalmic non-steroidal anti-inflammatory drugs.
Two patients with a history of mild non-neovascular age related macular degeneration and a diagnosis of chronic cystoid macular edema related to a single uncomplicated cataract extraction by phacoemulsification with implantation of a posterior chamber intraocular lens received a single 0.1 cc intravitreal injection of preservative free Acular 0.5% (Acular PF). The patients underwent pre-injection fluorescein angiography (FA), optical coherence tomography (OCT), and standard scotopic and photopic electroretinogram (ERG). ERG was repeated at one week, one month, three months, and six months post-injection. OCT and FA, in addition to a complete ophthalmic examination including dilated fundus exam, were repeated at one month, three months, six months, and nine months post injection.
Patient 1 showed a slight improvement in visual acuity and central foveal thickness on OCT at the 3 month follow-up visit but returned to his pre-injection visual acuity with thickening of the central fovea on OCT at subsequent visits. Patient 2 showed an increasing central foveal thickness on OCT at all visits with a visual acuity that remained stable when compared to pre-injection values. There were, however, no changes noted on ERG or evidence of toxicity on clinical exam. Since both patients had persistent cystic swelling at three months after the injection of Acular PF, both patients were offered and elected to undergo intravitreal injection of 0.1cc of triamcinolone acetonide (TA) 40mg/cc.
The study confirmed previous observations of intravitrael Acular PF safety. Although both patients showed no sustained improvement in visual acuity, angiographic evidence of CME, or central foveal thickness from a single intravitreal injection of Acular PF they did not show any evidence of toxicity on clinical exam or any observable difference in peak amplitude or latency at any follow-up visit on serial ERGs. It is possible that repeat injections or sustained release of preservative free ketorolac tromethamine are required to maintain any beneficial effect. Further study is warranted to define the efficacy of intravitreal ketorolac tromethamine.
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