This is a retrospective review of 39 eyes of 37 patients treated with Ozurdex® (intravitreal dexamethasone implant) for persistent post-operative cystoid macular oedema (CMO) following vitrectomy and idiopathic epiretinal membrane (ERM) peeling. The 0.7mg implant was injected in each eye at least three months after the vitrectomy. The authors report a significant decrease in central retinal thickness (CRT) and improvement in best corrected visual acuity at 65 days follow-up. Recurrence of CMO occurred in 46.2% (18 eyes) after 130 days follow-up; 43.6% (17 eyes) needed at least one repeat injection and 7.7% (three eyes) needed fluocinolone acetonide (Iliuven®). This group had good anatomical and functional outcome (visual acuity improvement from 0.5 to 0.1 logMAR and CRT from 524 to 308µm). It is hypothesised that postoperative CMO following ERM peeling is a result of breakdown of the blood-retinal barrier at the level of the capillary endothelium, which leads to vascular leakage and increase in CRT. Anti-VEGF and triamcinolone is the mainstay of treatment, but drug clearance from the vitreous cavity is increased after vitrectomy. This paper suggests that sustained-release steroid implants (Ozurdex® and Iliuven®) may be effective alternatives. This study is limited by its retrospective nature and lack of control group. Prospective trials are needed to further look into this treatment.
Steroid implants in the treatment of post-epiretinal membrane peel macular oedema
Reviewed by Kurt Spiteri Cornish
Intravitreal sustained-release steroid implants for the treatment of macular edema following surgical removal of epiretinal membranes.
CONTRIBUTOR
Kurt Spiteri Cornish
Sheffield Teaching Hospitals NHS Trust, London, UK.
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