Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema

Garcia, José Maurício Botto de Barros; Isaac, David Leonardo Cruvinel; Ávila, Marcos Pereira de

doi:10.5935/0004-2749.20160033

Cited by 11 publications

(8 citation statements)

References 9 publications

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“… 18 , 19 Patients with diabetes, particularly those with DR, are at an increased risk of developing PCME. 6 Do et al reported the incidence of PCME as 25% in diabetic patients. 13 Chu et al reported an increased RR of ME after cataract surgery in patients with DR and that this RR rose proportionately with increasing severity of DR (DM without retinopathy 2.15, very mild nonproliferative DR [NPDR] 3.50, severe NPDR 7.69, proliferative DR [PDR] 12.07, panretinal laser and stable PDR 10.63, any DR 7.27).…”

Section: Increased Risk In Diabetic Patientsmentioning

confidence: 99%

“… 17 It seems more prudent to prevent PCME rather than treat it, since treatment usually involves more invasive methods like intravitreal NSAID, 25 subtenon triamcinolone, 26 or intravitreal dexamethasone implant injections. 6 Boscia et al suggested that all diabetic patients undergoing cataract surgery should be treated with topical NSAIDs to prevent PCME. Intravitreal anti-VEGF drugs and steroids, combined with cataract surgery, may be considered in patients with preexisting DME.…”

Section: Need For Prophylaxismentioning

confidence: 99%

“…Majority of patients remain asymptomatic without active inflammation on fundus examination and optical coherence tomography (OCT). However, subclinical PCME is detected in almost 30% of patients with postsurgical fluorescein angiography and a further 11%–41% of patients with OCT. 6 The incidence may be as high as 20% when cataract extraction is complicated by posterior capsule rupture with vitreous loss or severe iris trauma. 5 , 7 Macular changes are more likely to occur following cataract surgery in diabetic patients, especially those with preexisting retinopathies compared to nondiabetic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Increased vascular permeability may lead to fluid accumulation in the inner nuclear and outer plexiform layers of the retina, and CME will develop. 6 Most research studies have focused on the role of prostaglandins. Recent studies, however, have shown the importance of other inflammatory mediators such as vascular endothelial growth factor (VEGF) and various cytokines.…”

Section: Introductionmentioning

confidence: 99%

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Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Yüksel¹,

Kartı²,

Küsbeci³

2017

OPTH

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Since its first description, the prevention of pseudophakic cystoid macular edema (PCME) continues to pose challenges for ophthalmologists. Recent evidence suggests that prophylaxis is unnecessary in patients without risk factors. Diabetes mellitus is generally considered as a risk factor for the development of PCME after cataract surgery since it causes breakdown of the blood–retinal barrier. Diabetic retinopathy (DR) increases the risk even further. Therefore, prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered in diabetic patients, especially if they have DR. NSAIDs block the cyclooxygenase enzymes responsible for prostaglandin production and reduce the incidence of PCME after cataract surgery. Nepafenac seems superior to other NSAIDs in terms of ocular penetration allowing higher and sustained therapeutic levels in retina and choroid. Topical steroids are less effective and may cause intraocular pressure increase limiting their long-term use. Nepafenac is cost effective, when the burden of PCME prevention is compared with the burden of treatment. Prevention is much cheaper and less harmful than invasive treatments like periocular or intravitreal injections. Overall, both nepafenac 0.1% and nepafenac 0.3% are well tolerated. They should be used carefully in patients with compromised corneas such as those with severe dry eye or penetrating grafts. If otherwise healthy cataract patients have ≥2 risk factors, like PCME in the other eye or posterior capsule rupture during surgery, treatment should be considered. Once-daily nepafenac 0.3% dosing may improve postoperative outcomes through increased patient compliance and may reduce treatment burden further. Every patient should be assessed in terms of risks/benefits of the treatment, in individual basis, before cataract surgery.

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Section: Increased Risk In Diabetic Patientsmentioning

confidence: 99%

Section: Need For Prophylaxismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Yüksel¹,

Kartı²,

Küsbeci³

2017

OPTH

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“…Therefore, IVD implantation was suggested as a new treatment option in PCME cases [20]. Garcia et al [21] applied IVD implantation in a series of six patients and favorable anatomic outcomes via OCT were confirmed. Kakkassery et al [22] showed the efficacy of IVD implantation in PCME resistant to both several topical and oral medication combinations, including topical diclofenac, topical and oral prednisolone, and oral acetazolamide.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Dexamethasone Implantation in Intravitreal Bevacizumab Treatment-resistant Pseudophakic Cystoid Macular Edema

Altıntaş

İlhan²

2019

Korean J Ophthalmol

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Purpose To evaluate the changes in visual acuity (VA) and central macular thickness (CMT) after intravitreal dexamethasone (IVD) implantation in intravitreal bevacizumab (IVB) treatment-resistant cases with pseudophakic cystoid macular edema (PCME). Methods This study included 10 PCME cases who underwent uneventful phacoemulsification and intraocular lens implantation with similar methods and six PCME cases referred to our hospital for treatment of low VA after cataract surgery. Due to the persistence of PCME, both topical steroid and anti-inflammatory medication were administered first, followed by IVB injection. IVD implantation was performed for all IVB treatment-resistant cases. VA and CMT values were compared before and at three months after the first IVD implantation. Results The mean VA values before and at 3 months after the first IVD implantation were 0.69 ± 0.19 logarithm of the minimum angle of resolution (logMAR) (1.50 to 0.10 logMAR) and 0.26 ± 0.07 logMAR (1.00 to 0.00 logMAR), respectively ( p < 0.001). The mean CMT was 476.13 ± 135.13 mm (314 to 750 mm) and 294.06 ± 15.26 mm (222 to 480 mm), respectively ( p < 0.001). The mean number of implanted IVD was 1.44 ± 0.89 (1 to 4) and the mean follow-up time was 7.4 ± 4.6 months (6 to 24 months). After IVD implantation therapy, the mean VA and CMT values were 0.19 ± 0.05 logMAR (0.70 to 0.00 logMAR) and 268.38 ± 31.35 mm (217 to 351 mm), respectively. Conclusions To the best of our knowledge, this is the first report to show the efficacy of IVD implantation even after repeated IVB injections in treatment-resistant PCME. IVD implantation is both a safe and effective method for decreasing PCME after both uneventful and complicated cataract surgery.

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Pseudophakic Cystoid Macular Oedema

Ugarte

2021

Cataract Surgery

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Dexamethasone 0.7 mg implants in the management of pseudophakic cystoid macular edema

Cited by 11 publications

References 9 publications

Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Topical nepafenac for prevention of post-cataract surgery macular edema in diabetic patients: patient selection and perspectives

Intravitreal Dexamethasone Implantation in Intravitreal Bevacizumab Treatment-resistant Pseudophakic Cystoid Macular Edema

Pseudophakic Cystoid Macular Oedema

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