Intravitreal dexamethasone implant for recurrent CMO secondary to IGS
Reviewed by Sofia Rokerya

In this prospective study the authors present the data obtained on the efficacy and safety of the dexamethasone implant (0.7 mg) in the treatment of recurrent cystoid macular oedema (PCME) due to Irvine–Gass syndrome in patients with uncomplicated pseudophakia (off-label use). Recruitment criterion included, symptomatic PCME consistent with the diagnosis of Irvine–Gass syndrome that had recurred after at least one course of topical steroids with nonsteroidal anti-inflammatory drugs (NSAIDs) and one sub-Tenon triamcinolone acetonide injection. Additional therapy prior to inclusion was permissible and could consist of any of the following: (1) a repeat course of topical steroids combined with NSAIDS; (2) posterior sub-tenon or intravitreal triamcinolone acetonide; (3) a course of oral carbonic anhydrase inhibitors. The patients could only be included once at least three months had elapsed after the last corticosteroid injection. Resolution of cystoid macular oedema was defined as the complete disappearance of retinal cysts, retinal thickening, and subretinal fluid (if present) along with a restoration of the normal foveal contour and a reduction of central subfield thickness (CST) to 250 microns or less as seen on OCT and clinical examination, and associated with an improvement in corrected distance visual acuity (CDVA) to 20/25 (0.1 logMAR) or better. Recurrence was defined as the re-appearance of retinal thickening, cysts and / or subretinal fluid after complete resolution of the CME with therapy associated with a drop in CDVA to 20/40 (0.3 logMAR) or worse, with or without metamorphopsia. Twenty-seven patients (27 eyes) M:F 16:11 were included in the study. Median age: 63.24±5.62 years. At one month, the CDVA improved to 0.04±0.02 (20/25) logMAR from 0.52±0.12 logMAR (20/70) (P=0.001) with a reduction in CST from 454.2±45.3 to 218.32±38.15 microns (P=0.013). The CDVA was 0.04±0.03 logMAR(P<0.001) at month six and 0.05±0.02 logMAR(P<0.001) at month 12. The CST was 221±35.2 microns (P=0.013) at month six and 214±43.34 microns (P=0.0124) at month 12. All improvements were maintained for a year. Only one patient required a second injection. No complications were noted. The implant is effective in eliminating recurrences with a good safety profile in patients who have had at least two recurrences using current treatment options. Limitations of the study: Lack of a comparative arm and a small sample size. 

Intravitreal dexamethasone implant for recurrent cystoid macular edema secondary to irvine gass syndrome (IGS).
Sudhalkar A, Chhablani J, Vasavada A, et al.
EYE
2016;30:1549-57.