Intravitreal fluocinolone acetonide implant for the treatment of persistent post-surgical cystoid macular edema in vitrectomized eyes

Abstract

Cystoid macular edema (CME) is the most common cause of decreased visual acuity after both vitrectomy and cataract surgery. Various strategies have been used for its treatment, such as intravitreal corticosteroids. The intravitreal fluocinolone acetonide implant (Iluvien®) is approved for the treatment of persisting diabetic macular edema and for the prevention of recurrence of non-infectious uveitis affecting the posterior segment. There are very few reports about its off-label use for post-surgical CME. We present four clinical cases of post-surgical CME (three following vitrectomy and one following cataract surgery in a vitrectomized eye 2 years ago). All of them had been previously treated with an average of four injections of intravitreal dexamethasone implant (Ozurdex®), with repeated recurrence of CME. After treatment with Iluvien, three cases showed improvement of both visual acuity and macular anatomy, with resolution of the macular edema. One patient required additional treatment with Ozurdex during follow-up, further improving CME. Two of the cases required topical pressure lowering treatment, and none required filtering surgery. Iluvien could be an effective therapeutic option for persistent non-diabetic macular edema after vitrectomy or cataract surgery refractory to other intravitreal therapies, with the benefit of being able to provide longer recurrence-free periods.

Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy

“…Miguel-Escuder et al reported four cases of PCME treated with FAc implant. Only one patient showed a suboptimal response to the treatment [5]. However, this patient underwent ERM peeling and intraocular lens fixation surgery 1 month after FAc implantation, probably causing an increase in inflammation.…”

“…While most cases of PCME resolve spontaneously, an important portion can be difficult to manage and significatively affect visual outcomes of PPV and other ocular procedures. The following sequential management strategy was proposed [6] However, drug clearance of topical treatment and IV anti-VEGF agents is faster in vitrectomized eyes, resulting in lower concentrations and limited efficacy [5,23].…”

“…To our knowledge, eight cases of PCME in vitrectomized eyes treated with FAc have been published in the literature [5,18,21,22].…”

“…The incidence of postoperative CME (PCME) after pars plana vitrectomy (PPV) is not well established and its pathogenesis also remains unclear [5]. It is thought to result from multifactorial changes in the retinal microenvironment, secondary to inflammation, vitreous traction, and light damage [6].…”

“…Scarce reports with samples of 1-4 patients described the use of FAc implant in the treatment of PCME in vitrectomized eyes [5,18,21,22].…”