Treatment of Refractory Post–operative Cystoid Macular Edema (CME) With Intravitreal Triamcinolone

Abstract

Abstract: : Purpose: Cystoid macular edema (CME) can lead to significant visual loss after intraocular surgery and is often treated topically or with periocular steroids. We studied the efficacy of treating refractory post–operative CME with intravitreal triamcinolone acetonide (IVT). Methods: Eighty–six eyes of eighty–two patients presenting with post–operative CME were treated. Steroid treatment consisted of a single intravitreal injection of 2 or 4 mg of triamcinolone acetonide through the pars plana under sterile conditions. Results: Eighty–two (95.3%) eyes developed CME after cataract extraction. The additional 4 (4.7%) eyes developed CME after vitreoretinal or scleral buckling surgery. The number of eyes with prior periocular steroid treatment was 15 out of 86 (17%). At 3 months following initial IVT injection, 42.2% of eyes gained 2 or more lines of Snellen visual acuity, 37.5% were the same, and 20.3 % worsened by 2 or more lines of Snellen visual acuity. At 6 months following initial IVT injection, 38.6% of eyes gained 2 or more lines of Snellen visual acuity, 42.1% were the same, and 19.3 % worsened by 2 or more lines of Snellen visual acuity. At 3 months, macular edema completely resolved in 29% of eyes, improved in 34% of eyes, was unchanged in 20% of eyes, and worsened in 18% of eyes. At 6 months, macular edema resolved in 22% of eyes, improved in 33% of eyes, was unchanged in 24% of eyes, and worsened in 20% of eyes. The mean number of additional intravitreal triamcinolone injections during follow up was 0.4. The mean follow–up was 9 months. Conclusions: Intravitreal triamcinolone acetonide injection appears to be an effective treatment modality for refractory post–operative CME.

Keywords: injection • macula/fovea