Abstract
Purpose :
Some patients develop macular edema (ME) following intraocular surgery. Postoperative ME is generally inflammatory in nature and angiographically resembles uveitic macular edema (UME). There are now several FDA-approved steroid injections which are indicated for UME: Ozurdex (0.7mg dexamethasone intravitreal implant), Xipere (4mg/0.1mL triamcinolone acetate suprachoroidal suspension), and Yutiq (0.18mg flucinolone acetonide intravitreal implant). We sought to validate their initial anatomic and functional efficacy, as well as their effect on intraocular pressure (IOP), specifically in patients with postoperative UME.
Methods :
Consecutive case series of 91 patients treated with Ozurdex, Yutiq, and/or Xipere for postoperative UME. All patients had developed new onset ME following intraocular surgery. Patients with a preoperative history of uveitis or systemic inflammatory disease were excluded. Visual acuity (VA), IOP, and optical coherence tomography (OCT) scans were reviewed baseline, at 6 weeks, and 3 months following the initial administration of each agent. Snellen VA was converted to Early Treatment Diabetic Retinopathy Study (ETDRS) letter equivalents for computational purposes. The OCT outcome measures of interest to establish anatomic efficacy were macular volume (MV) and central subfield thickness (CST) on foveal OCT line scans.
Results :
A total of 146 injections (N=90 Ozurdex, =37 Yutiq, =19 Xipere) were analyzed. Visual acuity improved by 4.8 letters (p=7 x 10-5) at 6 weeks and 3.6 letters (p=0.003) at 3 months. Highly significant anatomic improvements in CST (-129 µm, p~10-13) and MV (-0.88 mm3, p~10-11) were observed at 6 weeks, with evidence of a persistent but waning treatment effect at 3 months (CST: -75 µm; p~10-6, MV: -0.59 mm3, p~10-7). Approximately 5.5% of patients had IOP elevation ≥25 mm Hg at 6 weeks (N=6/107) and 3 months (N=5/91). Overall, however, there was no significant rise in mean IOP at 6 weeks (+1.0 ETDRS letters, p>0.05) or at 3 months (-0.0 letters, p>0.05), after allowing for topical IOP management at the discretion of the treating physician.
Conclusions :
In this retrospective, real world study of 91 patients with postoperative ME, all three FDA-approved steroid injections for UME demonstrated both anatomic and functional efficacy. IOP-related complications were infrequent and adequately managed with topical antihypertensive therapy.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.