Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19 mg, ILUVIEN (R)) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy

Autores da FMUP

• Fernando Manuel Mendes Falcão Reis

  Autor

• Amândio António Rocha Dias De Sousa

  Autor

Participantes de fora da FMUP

• Lima-Fontes, M
• Leuzinger-Dias, M
• Barros-Pereira, R
• Fernandes, V
• Falc?o, M.
• Alves-Faria, P

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2 mu g/day; ILUVIEN (R)) in the treatment of refractory PCME after successful PPV. Methods This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitario de Sao Joao, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, mu m), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300 mu m or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. Results Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5 months later. At baseline, BCVA was 55.0 +/- 10.6 letters, CMT was 514.9 +/- 165.6 mu m, and IOP was 15.4 +/- 2.4 mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2 mu m in CMT. During follow-up (44.0 +/- 14.8 months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28 months, respectively. The maximum IOP registered was 17.0 +/- 6.0 mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. Conclusion FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.

Keywords

• Fluocinolone acetonide implant; Recurrent cystoid macular edema; Pars plana vitrectomy