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

Abstract

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.

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

“…Before the dexamethasone implant was introduced, triamcinolone acetonide was tested in a few larger and smaller studies, proving its efficacy in improving macular morphology and function in IGS [33,35,[65][66][67]. Later studies show significant improvements after IVD administration without serious side effects [27,[29][30][31][32]34]. The most recent large retrospective study from 2020 highlighted the benefits of early intervention and reported significantly larger visual gains when IVD was administered within 4 weeks of diagnosis [27].…”

Cystoid Macular Edema after Extracapsular Cataract Extraction Performed by Residents

“…They are considered primary treatment in many instances. Steroid are administered topically, systemically, intravitreally 15 . They can also be given in posterior subtenon space.…”

Clinical Course of Pseudophakic Cystoid Macular Edema Treated with Nepafenac

“…Barone et al identified a positive effect with intravitreal bevacizumab [14], while Splitzer et al illustrated the effect to be nonexistent [15]. In studies of bevacizumab-resistant cases, the use of a dexamethasone intravitreal implant improved corrected distance visual acuity (CDVA) and reduced central foveal thickness (CFT) [16,17]. Triamcinolone acetonide (TA) was shown to mediate similar effects compared to the dexamethasone implant [18][19][20], while other studies have recognized the need for more frequent injections due to the more temporary effect than with the dexamethasone implant [21,22].…”