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Pseudophakic cme vietnam Feb 2015
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Transcript of Pseudophakic cme vietnam Feb 2015
Aditya SudhalkarAbhay Vasavada
Viraj VasavadaVaishali Vasavada
Samaresh Srivastava
Financial Disclosure: None
60 year old male
No systemic complaints
Uncomplicated phacoemulsification with in the bag implantation of hydrophobic IOL(Acrysof IQ, Alcon Laboratories, Fort Worth, TX)
Presented 3 weeks post operatively with sudden, painless DOV-3 days
Patient Profile
Was on topical steroids at the time of presentation
CDVA: RE-20/80, LE-20/40
RE: Anterior Segment-Pseudophakia
LE: Anterior Segment- Nuclear and Posterior Subcapsular Cataract
IOP: RE-15 mm Hg, LE-12 mm Hg
RE Fundus Photograph
Cystoid macular edema
RE PS-OCT scan
ManagementAdvised(and received) a course of topical steroids,
cycloplegics and a NSAID
Asked to review in a month
Vision improved to 20/40(CDVA) after a month
Had a recurrence on tapering topical medication
RE OCT image
Further treatmentGiven posterior subtenon preservative free
triamcinolone acetonide(20mg in o.5ml) and was put on oral acetazolamide therapy(250mg 4 times/day) with potassium supplementation
Asked to review in a month
CME resolved, recurred at the end of month 2
Advised intravitreal dexamethasone implant
RE PS-OCT scan
Intravitreal dexamethasone implantTopical anesthesia
Infero-temporal quadrant
Post-operative topical antibiotics for a week
Asked to review in a week’s time
One week post operativelyVision: RE-20/20
IOP: RE-14 mm Hg
Posterior segment: No CME
RE PS-OCT scan
One year laterVision maintained at 20/20
No recurrences
No IOP spikes noted
IntroductionPseudophakic Cystoid Macular Edema: Clinically
significant in <2% population
Typically presents 4-12 weeks after surgery
Generally self resolving
Responds in most cases to topical ± systemic therapy
Some cases are resistant to therapy
PurposeTo determine the preliminary efficacy and safety of
intravitreal dexamethasone implant(Ozurdex, Allergan Inc) for the treatment of recalcitrant pseudophakic CME
MethodsProspective study
Inclusion Criteria:
Patients with pseudophakic CME
At least one course each of a.)topical steroids+NSAIDS b.)Oral CA inhibitors c.) Intravitreal/periocular steroids
Methods Exclusion Criteria:
Contraindication to ocular steroids
Complicated pseudophakia
Unwilling patient
MethodsInjections were administered using a standardized
technique by a single surgeon(AS).
Postoperative topical antibiotics for a week
Visual acuity testing every month for 6 months
IOP monitoring every month for 6 months
OCT analysis every month for 12 months
Statistical analysisDescriptive statistics, the paired and unpaired t test,
odds ratio were used, as appropriate
Primary outcome measure: Improvement in CDVA
Secondary outcome measure: Change in OCT thicknessRecurrenceComplications, if any
ResultsThirteen patients(13 eyes)
6 males, median age 64.42 ±5.76 years
Mean baseline CDVA: 0.54 ±0.14 logMAR
Median baseline IOP: 12.2 ± 4.3 mm Hg
None of the patients had systemic disease that could confound the results
Average number of topical treatments received: 1.6 ±0.4
Average systemic therapy received: one course of oral CA inhibitors
All patients received at least one subtenon triamcinolone injection
ResultsMedian duration of CME prior to inclusion: 8.6 ±
4.32 months
All patients followed up for a year
CDVA improved to 0.1 ± 0.04 logMAR
OCT thickness improved from 432.24 ±89.32 microns to 254 ± 47.24 microns
One patient developed a recurrence 1 month after injection, he required a second dexamethasone injection
None of the patients developed an IOP spike
DiscussionOur results are similar to a retrospective analysis
published recently
Safe and well tolerated
Only one patient required a second injection
Further trials are warranted
Medeiros et a;’ Dexamethasone Intravitreal Implant for Treatment of Patients With Recalcitrant Macular Edema Resulting From Irvine-Gass Syndrome Invest. Ophthalmol. Vis. Sci. 2013 : 54 (5) 3320-3324
Figure 1(A,B,C) shows the color fundus photograph, fundus fluorescein angiography (FFA) images and spectral-domain optical coherence tomography (SD-OCT) scans of a 27 year old man who presented with dimution of vision in left eye since 3 days. On examination is corrected distance visual acuity (CDVA) was 20/40. At baseline, the colour fundus photograph (A) shows a choroidal neovascular membrane (CNVM) (black arrow) and subretinal fluid. The FFA images show a classic CNVM (black arrow) with early hyperfluoresence (B) and late leakage (C). The SD-OCT scan shows choroidal neovascular complex (black arrow) above the retinal pigment epithelium. He was treated with two intravitreal bevacizumab injections with an interval of one month between injections. At 23-month followup his visual CDVA was 20/20. The color photograph shows scarred CNVM (E, black arrowhead). SD-OCT shows scar (E, black arrowhead) with recovery of foveal contour (F, black arrowhead).
Figure 1
LimitationsSmall number of patients
No comparative arm
ConclusionDexamethasone implant a viable treatment option for
recalcitrant pseudophakic CME
May be considered as primary therapy
Preliminary analysis suggests its safe and effective
References:Brysknov T et al; Longstanding refractory pseudophakic cystoid
macular edema resolved using intravitreal 0.7 mg dexamethasone implants2013 Volume 2013:7 Pages 1171—1174