Efficacy of intravitreal dexamethasone implant for prostaglandin-induced refractory pseudophakic cystoid macular edema: case report and review of the literature

Efficacy of intravitreal dexamethasone implant for prostaglandin-induced refractory pseudophakic cystoid macular edema: case report and review of the literature

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Matteo Sacchi, Edoardo Villani, Francesca Gilardoni, Paolo Nucci University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy Background: Macular edema is a known complication even after uneventful cataract surgery.The chronic use of prostaglandin analogs is a risk factor for the development of pseudophakic cystoid macular edema (CME).Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first-line therapy but refractory postsurgical CME represents a therapeutic challenge, as there is not an evidence-based treatment.

Objective: To report the use of click here a single implant of intravitreal dexamethasone for tafluprost-associated pseudophakic CME refractory to NSAIDs and to sub-Tenon’s corticosteroid injections.Case report: A 64-year-old female with ocular hypertension treated with tafluprost experienced decreased vision (visual acuity 20/60) and metamorphopsia 2 months after uneventful cataract extraction.Spectral domain optical coherence tomography (SD-OCT) revealed CME.

After 1 month of topical and oral NSAIDs, CME was still evident on SD-OCT (visual acuity 20/50).Two sub-Tenon’s betamethasone injections were performed at a 2-week interval.As CME was still present, 2 months after the diagnosis of CME (visual acuity 20/40), the patient underwent a single dexamethasone intravitreal implant.

One month later, macular appearance was normal, jerome brown jersey and visual acuity increased to 20/30.This result was maintained throughout the 6 months of follow-up.Conclusion: In this report, a single implant of intravitreal dexamethasone successfully treated pseudophakic CME associated with the use of prostaglandin analogs unresponsive to NSAIDs and sub-Tenon’s betamethasone.

The results of this report need to be corroborated by powered, prospective, randomized trials.The need for repeated treatments as well as the retreatment interval in patients requiring more than a single injection are issues still needing further investigations.Keywords: prostaglandin-induced refractory cystoid macular edema, intravitreal dexamethasone implant, tafluprost, cataract surgery, pseudophakic cystoid macular edema.