Efficacy and Safety of Intravitreal Dexamethasone Implant for Recurrent Pseudophakic Cystoid Macular Edema

Monday, April 20, 2015: 3:56 PM
Room 1B (San Diego Convention Center)
Aditya Sudhalkar, MS, FLVPEI
Viraj A. Vasavada, MS
Shail A. Vasavada, DO, DNB, FICO
Abhay R. Vasavada, MS, FRCS

To provide preliminary data of the efficacy and safety of an intravitreal dexamethasone implant in recurrent/recalcitrant pseudophakic cystoid macular edema (CME).

Prospective observational study included 25 patients with cystoid macular edema following uneventful phacoemulsification with in-the-bag IOL implantation, not responding to conventional treatment. Patients with pre-existing diabetic retinopathy, uveitis or uncontrolled diabetes excluded. Diagnosis of Pseudophakic CME was confirmed by OCT and Fluorescein angiography. All patients received a trial of topical NSAIDS and steroids for at least 2 months. In recurrent/non-responding cases, Intravitreal Dexamethasone implant (Inj. Ozurdex, Allergan) was given using a standardized technique. Visual acuity and OCT scans measured on a monthly basis pre- and post-intravitreal injections. Minimum follow-up was 6 months. Outcome measures were change in visual acuity and central macular thickness on OCT.

Ongoing study: Early results (14 eyes). Median age 66.24±7.42 years. Median follow-up 10.4±2.5 months. 7 eyes had recurrent edema and 7 had recalcitrant edema. 3 eyes with recalcitrant edema had received posterior subtenon triamcinolone injection in addition to standard topical treatment. Mean baseline VA was 0.52±0.21 logMAR and improved to 0.12±0.07 logMAR at final follow-up (p<0.001).71% had 20/20, 93% had 20/40 or better vision at final follow-up. OCT central macular thickness; 408.24±31.2 microns at baseline and 210.2±21.24 microns at final follow up(p=0.012). No eye had rise in IOP. One eye had recurrent edema two months after injection. No other adverse events noted. Results will be updated at time of presentation.

Preliminary data shows that Intravitreal dexamethasone implant appears to be effective, long lasting and reasonably safe in the treatment of recurrent/recalcitrant CME post cataract surgery and can possibly reduce visual disability secondary to CME.