Intravitreal corticosteroids for persisting cystoid macular edema after cataract surgery

Session Details

Session Title: Presented Poster Session: Cataract Surgery Complications and Management

Session Date/Time: Saturday 05/09/2015 | 09:30-10:50

Paper Time: 10:30

Venue: Poster Village: Pod 1

First Author: : I.Casal PORTUGAL

Co Author(s): :    M. Furtado   M. Macedo   M. Gomes   M. Lume   A. Meireles   P. Meneres

Abstract Details

Purpose:

Cystoid macular edema (CME) is a major cause of visual loss after intraocular surgery. Surgery-induced inflammation is mediated by prostaglandins and cytokines. Standard treatment of CME includes topical nonsteroidal anti-inflammatory drugs(NSAID) alone or in combination with steroids. Intravitreal steroids injections are usually used in refractory cases. Our purpose is to analyze refractory cases of CME, assess the main risk factors for this condition and treatment response.

Setting:

Centro Hospitalar do Porto in Porto, Portugal

Methods:

Retrospective analysis of all patients who underwent intravitreal injections of steroids to treat refractory CME after cataract surgery, in our department, between July/2012 and February/2015. CME was classified as acute, with onset up to 2 months after surgery and chronic , with onset 2 months after surgery. We evaluated systemic and ocular medical history; initial visual acuity(VA) and foveal thickness(FT) measured by optical coherence tomography(OCT); topical treatment performed, type of intravitreal corticosteroid used(intravitreal triamcinolone acetonide injection-ITAI or dexamethasone implant–OZURDEX®), and number of injections required;adverse reactions; final VA and FT at the end of follow-up. Patients without follow-up were excluded.

Results:

12 eyes were included, mean age at diagnose was 67,5 years and 60% were males. Two patients had Rheumatoid Arthritis; 1 had Crohn disease(no known uveitis history);1 had a prior vitrectomy for retinal detachment, 2 with glaucoma under topical prostaglandin and 1 with known past recurrent anterior uveitis. All surgeries were uncomplicated, and CME was acute in 66,6%. Mean initial VA was 0,39(decimal scale) and mean FT 478,2 µm. 8 eyes were treated with ITAI alone and 4 eyes with ITAI followed by OZURDEX®, with a mean of 1,67 injections per patient. The mean final VA was 0,58 and mean FT was 312,5 µm. Increased intra-ocular pressure was found in 2 eyes.

Conclusions:

Pseudophakic CME is the most common cause of early unexpected visual loss after cataract surgery. The pathogenesis is multifactorial and history of uveitis, use of prostaglandin analogs and systemic inflammatory/auto immune condition appear to increase risk for CME. There was an association between systemic inflammatory/auto imune disease and the largest number of injections required. In this group we can see an improvement in VA and a significant reduction of mean foveal thickness, with few adverse effects. Intravitreal corticosteroids appear to be an effective second-line treatment in these patients, after failure of topical treatment.

Financial Interest:

NONE