Frequent Topical Prednisolone for Treatment of Cystoid Macular Edema

Abstract

Purpose:: Intravitreal triamcinolone (IVT) has been widely used for treatment of cystoid macular edema (CME) of various causes with excellent results. However, some patients are very reluctant to receive intraocular injection because of anxiety, etc. To evaluate if frequent topical prednisolone is an effective alternative treatment for cystoid macular edema (CME), patients who had CME and could not accept IVT were treated with very frequent topical prednisolone solution.

Methods:: A retrospective chart review of six patients with CME secondary to pars planitis, long-term pseudophakia not responsive to topical ketarolac, and radiation retinopathy, was performed. All patients demonstrated CME on OCT. Patients were not intravitreal triamcinolone (IVT) candidates secondary to age, anxiety, or personal decision to defer IVT treatment. Each patient was treated with topical 1% prednisolone acetate ophthalmic solution (Pred Forte®, Allergan Inc) every 30 to 60 minutes while awake for 7 to 16 days. Topical prednisolone was then tapered slowly. Patients’ visual acuity (Snellen chart) and foveal retinal thickness on optical coherence tomography (OCT) were documented pre- and post-treatment. Intraocular pressure (IOP) was also carefully followed, and topical anti-glaucoma agents were used for IOP elevation secondary to topical steroid treatment. Follow up duration ranged from 7 to 242 weeks with an average duration of 49 weeks.

Results:: The average pre-treatment visual acuity was 20/123. Post treatment visual acuity was 20/55 approximately 12.3 days after initiation of topical prednisolone. Average visual acuity at the conclusion of our study was 20/60 (an average of 11 months after treatment). Two patients had no improvement in long-term visual acuity following treatment. OCT showed a significant improvement of CME in 5 of 6 patients. The maximal foveal thickness was 490 microns pre-treatment and 305 microns post-treatment. Due to one patient with significant IOP elevation of 40, the average IOP increase was 9.5.

Conclusions:: Our study showed marked improvement in both visual acuity and foveal thickness on OCT following frequent topical prednisonlone for treatment of CME. In some patients with CME who are not able to tolerate IVT, frequent topical prednisolone can be an effective treatment. More patients need to be recruited for this alternative treatment of CME to confirm efficacy of this therapy.

Keywords: macula/fovea • edema