Korean J Ophthalmol.  2019 Jun;33(3):259-266. 10.3341/kjo.2018.0106.

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

• Altintas A
• Ilhan C

• KMID: 2448865
• DOI: http://doi.org/10.3341/kjo.2018.0106

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.

Keyword

Bevacizumab; Dexamethasone; Macular edema; Pseudophakic cystoid macular edema

MeSH Terms

Bevacizumab*
Cataract
Dexamethasone*
Follow-Up Studies
Lens Implantation, Intraocular
Macular Edema*
Methods
Phacoemulsification
Visual Acuity
Bevacizumab
Dexamethasone

Figure

• 

  Fig. 1 An example of the progression in central macular thickness examined by optical coherence tomography (OCT). ILM = internal limiting membrane; BM = Bruch membrane; IR = infrared; HS = high speed; ART = automatic realtime tracking; Q = quality factor.

• 

  Fig. 2 Central macular thickness values before intravitreal dexamethasone implantation and at the end of the follow-up period.

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