Suprachoroidal Implantation of Corticosteroid Slow Release Implants for the Treatment of Cystoid Macular Edema

Abstract

Purpose : In case of an instable iris-lens diaphragm, intravitreal corticosteroid slow-release implants (CSRI) may occidentally migrate into the anterior chamber, leading to irreversible damage of the corneal endothelium with consecutive corneal edema. A suprachoroidal application of these implants might overcome this problem. The purpose of this retrospective case series was to assess the efficacy and safety of a suprachoroidal application of dexamethasone and (Ozurdex®) and fluocinolon acetonide (Illuvien®) intravitreal implants for the treatment of chronic cystoid macular edema.

Methods : This retrospective case series included patients that recieved suprachoroidal administration of dexamethasone and fluocinolon acetonideimplants due to treatment-resistant (unsuccessful intravitreal or para-/retrobulbar triamcinolone) cystoid macular edema and instability of the iris-lens diaphragm (aphakia, scleral or iris fixated IOL, large iridectomy) . The suprachoroidal implant was placed at the level of the pars plana at the transition to the retina. Reduction of macular edema, incidence of secondary intraocular pressure increases and surgery related complications were evaluated.

Results : In total, 10 patients (9 dexamethasone and 1 fluocinolon acetonide) were treated. Mean follow up was 3 months. The procedure was well tolerated with no serious side effects. Mean central retinal thickness (CRT) decreased significantly from 578.9 µm to 336.3 µm (p=0.035). There was no statistically significant difference between mean preoperative (15.5 mmHg) and postoperative (15.0 mmHg, p=0.82) intraocular pressure. Mean best corrected visual acuity (BCVA) improved from 1.13 logMAR to 0.62 logMAR. No patient developed a steroid induced glaucoma in this small case series.

Conclusions : Suprachoroidal implantation of corticosteroid slow release implants proves to be a safe and feasible alternative for complex eyes with therapy-resistant cystoid macular edema and a disruption of the anterior-posterior segment border. A larger case series with longer follow-up for further evaluation of efficacy and safety of this novel procedure is needed.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.