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Himanshu Banda, Bradley T Smith; Preoperative Intraocular Dexamethasone Implant for Treatment of Macular Edema Prior to Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):394.
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Macular edema (ME) is a cause of visual morbidity following cataract surgery. Treatment is challenging in eyes with ME due to diabetic retinopathy, retinal occlusive disease, or uveitis. Inflammation caused by cataract extraction (CE) may exacerbate ME of all causes. No study has assessed preoperative intravitreal dexamethasone implants for treatment of ME prior to CE. We performed a retrospective, observational chart review to understand outcomes of patients with ME undergoing CE pre-treated with implantation of intraocular dexamethasone.
A database search was completed for patients treated for macular edema of any cause prior to cataract surgery with an intravitreal dexamethasone implant. For each patient, age, gender, ocular diagnosis, visual acuity (VA), intraocular pressure, and central foveal thickness (CFT) on optical coherence tomography (OCT) were recorded at the time of the intravitreal treatment prior to CE, as well as visits following surgery.
Ten patients were identified who underwent CE following intravitreal dexamethasone implantation. No complications during CE were reported. 60% of patients were men, with a median age of 61.2 years (range 25 – 75). Eyes had a diagnosis of ME secondary to central or branched retinal vein occlusion (RVO) in 40% of cases, diabetic macular edema (DME) in 40% of cases, and cystoid macular edema (CME) associated with uveitis/inflammation in 20% of cases. The mean interval of dexamethasone implantation to CE was 30 days (+/- 20.3); mean follow up interval was 52 days (+/- 34 days). All patients showed decreased CFT on OCT on the post-operative visit, with a mean reduction of 162 um (+/- 144.5). All patients showed improved VA on the post-operative visit, with a mean gain of +0.5 log MAR (+/- 0.3) acuity. Two patients developed ocular hypertension in the post-operative period requiring treatment with topical agents.
Intravitreal dexamethasone implantation improves CFT in patients undergoing cataract surgery with ME related to RVO, DME, and CME secondary to uveitis/inflammation. This study demonstrates intravitreal dexamethasone implantation may be an important adjuvant to treat ME prior to CE. Prospective studies would be necessary confirm the efficacy and safety of intravitreal dexamethasone implants in such scenerios.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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