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A.J. Pfaff, W.J. Wirosko; Management of cystoid macular edema resistant to topical medications . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1994.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To describe our experience with managing pseudophakic cystoid macular edema (CME) refractory to topical therapy. Methods: A retrospective chart review of all eyes with pseudophakic CME refractory to topical therapy between 2000 and 2003 at the Zablocki Veterans Administration Hospital was performed. Results: Eleven patients were identified. Mean duration of treatment with topical therapy before further intervention was 4 months (range, 0 – 11 months). Initial treatment for all eyes involved posterior subtenon (PST) injection with triamcinolone acetonide(20 mg). Mean visual acuity improved from 20/77 to 20/53 (p<0.05, two–tailed paired student’s t–test) with a mean follow–up of 13.5 months(range, 1–36 months). Three eyes with persistent CME after one PST injection received a second injection and demonstrated a mean visual acuity improvement from 20/68 to 20/50. Two eyes received a third PST injection and displayed a mean visual acuity improvement from 20/56 to 20/54. Complications included increased intraocular pressure in 1 eye, which was controlled with topical medication. No eyes suffered ocular perforation. Three eyes (27%) demonstrated persistent CME at last exam despite repeat PST injections, and deferred any further treatment. Conclusions: Pseudophakic cystoid macular edema refractory to topical therapy is uncommon. Treatment with posterior subtenon corticosteroid injection appears safe and can be associated with a significant improvement in visual acuity. Repeat PST injections can produce further visual improvements. Repeat PST corticosteroid injection may fail to resolve CME refractory to topical medications in up to 27% of eyes.
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