Topical NSAIDs, intravitreal dexamethasone and peribulbar triamcinolone for pseudophakic macular edema.
Anti-Inflammatory Agents, Non-Steroidal
/ therapeutic use
Dexamethasone
/ therapeutic use
Drug Implants
Glucocorticoids
/ therapeutic use
Humans
Intravitreal Injections
Macular Edema
/ drug therapy
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome
Triamcinolone
/ therapeutic use
Visual Acuity
Central choroidal thickness
Central retinal thickness
Intravitreal dexamethasone
Peribulbar triamcinolone
Pseudophakic macular edema / Irvine Gass syndrome
Topical NSAIDs
Journal
BMC ophthalmology
ISSN: 1471-2415
Titre abrégé: BMC Ophthalmol
Pays: England
ID NLM: 100967802
Informations de publication
Date de publication:
05 Nov 2021
05 Nov 2021
Historique:
received:
09
05
2021
accepted:
28
09
2021
entrez:
6
11
2021
pubmed:
7
11
2021
medline:
10
11
2021
Statut:
epublish
Résumé
The purpose of this study is to assess the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (intravitreal dexamethasone and peribulbar triamcinolone) in treating pseudophakic macular edema (PME). Retrospective study of 33 eyes. Variables included best corrected visual acuity (BCVA; logMAR scale) and central retinal thickness (CRT) and central choroidal thickness (CCT) assessed with swept-source OCT. All patients were initially prescribed topical NSAIDs and reevaluated after 2 months. If improvement in BCVA or CRT was noted, topical NSAIDs were continued until resolution. If no improvement was observed at 2 months or subsequent visits, intravitreal dexamethasone implant was performed. Patients who refused intravitreal treatment were offered peribulbar triamcinolone. After treatment with topical NSAIDs for a median of 2 months, BCVA increased significantly from 0.5 to 0.3 while CRT decreased significantly from 435 to 316 μm. PME resolved in 19 of the 33 eyes (57.6%). Of the 14 recalcitrant cases, 13 were treated with corticosteroids. Of these 13 cases, 9 (69.2%) resolved. BCVA increased non-significantly from 0.7 to 0.4. CRT and CCT decreased significantly from 492 to 317 μm and from 204 to 182 μm respectively. The overall success rate of the treatment algorithm was greater than 80%, a remarkable finding considering that no randomized study has yet been conducted to determine the optimal therapeutic protocol for PME. This is the first study to evaluate choroidal thickness in PME using SS-OCT, which could play a key role in its pathophysiology and provide useful information to improve the management of PME.
Sections du résumé
BACKGROUND
BACKGROUND
The purpose of this study is to assess the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (intravitreal dexamethasone and peribulbar triamcinolone) in treating pseudophakic macular edema (PME).
METHODS
METHODS
Retrospective study of 33 eyes. Variables included best corrected visual acuity (BCVA; logMAR scale) and central retinal thickness (CRT) and central choroidal thickness (CCT) assessed with swept-source OCT. All patients were initially prescribed topical NSAIDs and reevaluated after 2 months. If improvement in BCVA or CRT was noted, topical NSAIDs were continued until resolution. If no improvement was observed at 2 months or subsequent visits, intravitreal dexamethasone implant was performed. Patients who refused intravitreal treatment were offered peribulbar triamcinolone.
RESULTS
RESULTS
After treatment with topical NSAIDs for a median of 2 months, BCVA increased significantly from 0.5 to 0.3 while CRT decreased significantly from 435 to 316 μm. PME resolved in 19 of the 33 eyes (57.6%). Of the 14 recalcitrant cases, 13 were treated with corticosteroids. Of these 13 cases, 9 (69.2%) resolved. BCVA increased non-significantly from 0.7 to 0.4. CRT and CCT decreased significantly from 492 to 317 μm and from 204 to 182 μm respectively.
CONCLUSIONS
CONCLUSIONS
The overall success rate of the treatment algorithm was greater than 80%, a remarkable finding considering that no randomized study has yet been conducted to determine the optimal therapeutic protocol for PME. This is the first study to evaluate choroidal thickness in PME using SS-OCT, which could play a key role in its pathophysiology and provide useful information to improve the management of PME.
Identifiants
pubmed: 34740334
doi: 10.1186/s12886-021-02132-w
pii: 10.1186/s12886-021-02132-w
pmc: PMC8570006
doi:
Substances chimiques
Anti-Inflammatory Agents, Non-Steroidal
0
Drug Implants
0
Glucocorticoids
0
Triamcinolone
1ZK20VI6TY
Dexamethasone
7S5I7G3JQL
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
387Informations de copyright
© 2021. The Author(s).
Références
Trans Am Ophthalmol Soc. 1966;64:232-49
pubmed: 5964923
J Cataract Refract Surg. 2008 Jan;34(1):70-5
pubmed: 18165084
Trans Am Ophthalmol Soc. 1998;96:557-634
pubmed: 10360304
Br J Ophthalmol. 2014 Mar;98(3):334-8
pubmed: 24288394
J Cataract Refract Surg. 2015 Sep;41(9):1954-61
pubmed: 26603404
Int Ophthalmol. 2012 Jun;32(3):235-43
pubmed: 22484726
Ophthalmic Res. 2017;58(2):67-73
pubmed: 28376478
Invest Ophthalmol Vis Sci. 2011 Jan 05;52(1):249-55
pubmed: 20720227
Surv Ophthalmol. 2015 Mar-Apr;60(2):123-37
pubmed: 25438734
Arq Bras Oftalmol. 2020 Jan-Feb;83(1):19-27
pubmed: 31664335
Curr Eye Res. 2021 Feb;46(2):239-247
pubmed: 32663050
Eye (Lond). 2019 Jan;33(1):14-33
pubmed: 29995841
Biomed Res Int. 2015;2015:362564
pubmed: 26509151
Retina. 2015 Jan;35(1):136-40
pubmed: 25170855
Ocul Immunol Inflamm. 2019;27(8):1224-1231
pubmed: 31414913
Br J Ophthalmol. 2015 Jul;99(7):979-83
pubmed: 25583283
Br J Ophthalmol. 2017 Mar;101(3):333-341
pubmed: 27190126
Eur J Ophthalmol. 2014 May-Jun;24(3):387-91
pubmed: 24170523
Ophthalmology. 2009 Aug;116(8):1481-7, 1487.e1
pubmed: 19545901
Am J Ophthalmol. 2009 Jun;147(6):1048-54, 1054.e1-2
pubmed: 19268890
Curr Eye Res. 2012 Apr;37(4):327-33
pubmed: 22440164
Int J Ophthalmol. 2019 Feb 18;12(2):258-267
pubmed: 30809482
J Fr Ophtalmol. 2017 Nov;40(9):788-792
pubmed: 28987449
Retina. 2010 Jan;30(1):71-80
pubmed: 19996827
Can J Ophthalmol. 2019 Oct;54(5):540-547
pubmed: 31564342
Ocul Immunol Inflamm. 2019;27(8):1235-1241
pubmed: 31411519
Ophthalmic Res. 2018;60(4):243-249
pubmed: 29045946
J Cataract Refract Surg. 2007 Sep;33(9):1550-8
pubmed: 17720069
Ocul Immunol Inflamm. 2017 Aug;25(4):513-519
pubmed: 27015572
Retina. 2018 Aug;38(8):1629-1635
pubmed: 28654631
Invest Ophthalmol Vis Sci. 2014 Jul 22;55(8):4967-74
pubmed: 25052991
Am J Ophthalmol. 1953 May;36(5):599-619
pubmed: 13040458