The management of Irvine-Gass Syndrome in a patient using Inhaler Steroid

Abstract

Irvine-Gass syndrome, is one of the most common causes of painless decrease in vision following even uneventful cataract surgery. It usually responds well to medical therapy, but, there are no widely acceptedconsensus on the effi cacy of various therapeutic options for the treatment of Irvine-Gass syndrome. The patient presenting in this case report, has systemic hypertension and chronic obstructive pulmonary disease and he use oral anti-hypertension medication and inhaler steroid. He diagnosed as Irvine-Gass syndrome due to presence of decrease in visual acuity and macular edema with hyporefl ective cystic intraretinal spaces in optical coherence tomography (OCT) since4th weekcontrol visitfollowing uneventful cataract surgery. After the responsiveness of several medications including topical steroid and non-steroidal anti-infl ammatory drugs and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), intravitreal sustainedrelease dexamethasone implant was applied. The visual acuity improved to 0.00 logMAR at 1st month after intravitreal dexamethasone therapy and consecutive OCT images showed complete resolution of macular edema with a normalization of the foveal profi le.The visual acuity and foveal architecture remained stable in 2-year follow-up period and additional treatment was not needed. To the best of our knowledge, this is the fi rst reportthatmentions the increment of visual acuity after a single dexamethasone implant, even though it did not response anti-VEGF combined with topical steroid and non-steroidal anti-infl ammatory drugs.

Safety of intravitreal triamcinolone and its impact on optic nerve morphology in patients treated for diabetic macular edema

“…1–4 Triamcinolone acetonide (TA), used off-label and administered by intravitreal (4 mg/0.1 mL) or sub-tenon (40 mg/mL) injections, has been effectively used in clinical practice for over two decades. 2,3,5…”

“…[1][2][3][4] Triamcinolone acetonide (TA), used off-label and administered by intravitreal (4 mg/0.1 mL) or sub-tenon (40 mg/mL) injections, has been effectively used in clinical practice for over two decades. 2,3,5 All intraocular corticosteroids share the same main complications, which include cataract development and a variable and dose dependent increase in intraocular pressure (IOP), sometimes to a level compatible with ocular hypertension (OHT). [6][7][8][9][10][11][12][13] Nearly 35% of the general population respond to corticosteroids, developing some degree of IOP increase following local treatment with corticosteroids.…”

Alternative treatment methods in eyes with pseudophakic cystoid macular edema

“…Altintas et al [26], reported a signi icant reduction in macular thickness with a single Ozudex implantation from 733 u to 197 u in eyes with unresponsive to intravitreal Anti-VEGF who is using inhaler steroid. This report showed that PCME can be developed even under systemic steroid treatment and intravitreal Ozudex implantation can be effective in such a dif icult patient.…”