Subtenon triamcinolone injection for postoperative cystoid macular edema associated with tafluprost

Abstract

PurposeWe report the successful treatment of a case of cystoid macular edema (CME) associated with topical tafluprost, which was accompanied by serous retinal detachment (SRD).CaseA 78-year-old woman underwent intraocular lens suture surgery, including anterior vitreous cutting, for crystalline lens dislocation in the right eye. Tafluprost was initiated 12 weeks after surgery. Intraocular pressure (IOP) was controlled at 10–14 mmHg. Visual acuity remained at 20/40–30/40. However, the patient complained of blurred vision (20/200) 9 months after surgery. CME accompanied by SRD was identified by optical coherence tomography (OCT) and treated with subtenon triamcinolone injection. Visual acuity rapidly increased to 20/50, and the volume of SRD decreased in a few days. Discontinuation of tafluprost and initiation of diclofenac eye drops improved visual acuity to 20/40 and resulted in improved OCT findings within a few weeks. Three months after injection, tafluprost was resumed along with diclofenac. No recurrence of CME occurred over the following 3 months, and IOP was controlled at 10–15 mmHg.ConclusionSRD is considered to be a symptom of treatment-resistant CME, which may lead to poor visual acuity after recovery. In such cases, subtenon triamcinolone injection should be strongly considered at an early stage.

Efficacy of intravitreal dexamethasone implant for prostaglandin-induced refractory pseudophakic cystoid macular edema: case report and review of the literature

“…In addition, the effect of the intravitreal injection of the drug is transient, needing multiple procedures with increased risk of endophathalmitis 1. Although there are studies showing that a single sub-Tenon’s injection of triamcinolone successfully treated pseudophakic CME associated with tafluprost, travoprost, and latanoprost,3,12 in the current case and in a report by Brynskov et al11 sub-Tenon’s injections of corticosteroids were not effective in resolving prostaglandin-induced CME. Because our case was unresponsive to topical NSAIDs and sub-Tenon’s steroids, we opted for a dexamethasone implant.…”

“…Tafluprost, the most recent PGA commercially available, has shown similar efficacy compared to other PGAs and a safe profile 5. To the best of our knowledge, this is the first report of the use of a dexamethasone implant for prostaglandin-induced pseudophakic CME and the second case of pseudophakic CME associated with tafluprost 3. Several treatments have been described for pseudophakic CME, and although no standardized treatment exists, topical NSAIDs have become the mainstay of pseudophakic CME therapy and prophylaxis.…”

“…These patients represent a challenge for the clinicians, as for refractory CME there is no standardized treatment, and although many approaches have been described, available therapies have showed conflicting results 1,2. Matsuura et al recently reported a case of tafluprost-associated pseudophakic CME successfully treated with a single sub-Tenon’s triamcinolone injection 3. We present a case of tafluprost-associated pseudophakic CME refractory to NSAIDs and steroid sub-Tenon’s injections successfully treated with a single intravitreal dexamethasone implant.…”

“… 1 , 2 Matsuura et al recently reported a case of tafluprost-associated pseudophakic CME successfully treated with a single sub-Tenon’s triamcinolone injection. 3 We present a case of tafluprost-associated pseudophakic CME refractory to NSAIDs and steroid sub-Tenon’s injections successfully treated with a single intravitreal dexamethasone implant. This is the first report on the use of a dexamethasone implant for the treatment of prostaglandin-induced pseudophakic CME.…”

Cystoid macular edema related to cataract surgery and topical prostaglandin analogs: Mechanism, diagnosis, and management

“…Because the preserved formulation contains a low concentration of benzalkonium chloride (BAK) (0.001%, as opposed to 0.02% in BAK-preserved latanoprost), it seems likely that these rare cases were attributable to the PGA component of the treatment rather than the preservative. 66,89 The role of BAK in the development of CME is discussed later in this review.…”