Current Management Options in Irvine–Gass Syndrome: A Systemized Review

Abstract

Irvine–Gass syndrome (IGS) remains one of the most common complications following uneventful cataract surgery. In most cases, macular edema (ME) in IGS is benign, self-limiting, and resolves spontaneously without visual impairment; however, persistent edema and refractory cases may occur and potentially deteriorate visual function. Despite the relatively high prevalence of IGS, no solid management guidelines exist. We searched the PUBMED database for randomized clinical trials (RCT) or case series of at least 10 cases published since 2000 evaluating different treatment strategies in patients with cystoid macular edema (CME). The search revealed 28 papers that fulfilled the inclusion criteria with only seven RCTs. The scarceness of material makes it impossible to formulate strong recommendations for the treatment of IGS. Clinical practice and theoretical background support topical non-steroidal anti-inflammatory drugs (NSAIDs) as the first-line therapy. Invasive procedures, such as periocular steroids, intravitreal corticosteroids, and anti-vascular endothelial growth factor (anti-VEGF), are usually applied in prolonged or refractory cases. Results of novel applications of subthreshold micropulse laser (SML) are also promising and should be studied carefully in terms of the safety profile and cost effectiveness. Early initiation of invasive treatment for providing better functional results must be examined in further research.

Pseudophakes zystoides Makulaödem

“…Wenn es nach lokaler Kombinationstherapie mit NSAID- und Steroidaugentropfen zu keiner Besserung gekommen ist, können parabulbäre Steroide eine wirksame Alternative sein 1 , 4 , 29 , 30 .…”

“…Steroide parabulbärWenn es nach lokaler Kombinationstherapie mit NSAID-und Steroidaugentropfen zu keiner Besserung gekommen ist, können parabulbäre Steroide eine wirksame Alternative sein[1, 4,29,30].TherapieempfehlungAcetazolamid (beginnend mit 2-mal 250 mg/Tag oral) sollte unter Beachtung der Kontraindikationen mit Kaliumsubstitution und unter Kaliumkontrolle verordnet werden. Die Therapie sollte je nach Verträglichkeit 2 bis 4 Wochen, bei Visusanstieg bis 3 Monate gegeben werden, bei Erfolg eventuell auch länger und unter "Ausschleichen" abgesetzt werden.…”

Management of inflammation after the cataract surgery

“…PCME or Irvine-Gass syndrome is defined as a presence of intraretinal fluid spaces or central macular thickening, and it remains the most common cause of decreased visual acuity after uneventful cataract surgery [29,30]. It is proven that macular thickness increases after uncomplicated phacoemulsification when compared with healthy contralateral eyes, usually without visual acuity deterioration, and after 6-8 weeks from the operation it gradually declines [31].…”

Is It Uveitis? Identifying and Managing Challenging Cases in Chronic Postsurgical Inflammation

“…Irvine-Gass syndrome refers to cystoid macular edema following otherwise uneventful cataract surgery. 14 Does this meet the SUN criteria for uveitis? Dr Grewal: The diagnosis of posterior uveitis, according to the SUN criteria, requires the presence of retinal or choroidal inflammatory lesions.…”