Topical NSAIDs, intravitreal dexamethasone and peribulbar triamcinolone for pseudophakic macular edema

Abstract

Background The purpose of this study is to assess the effectiveness of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (intravitreal dexamethasone and peribulbar triamcinolone) in treating pseudophakic macular edema (PME). Methods Retrospective study of 33 eyes. Variables included best corrected visual acuity (BCVA; logMAR scale) and central retinal thickness (CRT) and central choroidal thickness (CCT) assessed with swept-source OCT. All patients were initially prescribed topical NSAIDs and reevaluated after 2 months. If improvement in BCVA or CRT was noted, topical NSAIDs were continued until resolution. If no improvement was observed at 2 months or subsequent visits, intravitreal dexamethasone implant was performed. Patients who refused intravitreal treatment were offered peribulbar triamcinolone. Results After treatment with topical NSAIDs for a median of 2 months, BCVA increased significantly from 0.5 to 0.3 while CRT decreased significantly from 435 to 316 μm. PME resolved in 19 of the 33 eyes (57.6%). Of the 14 recalcitrant cases, 13 were treated with corticosteroids. Of these 13 cases, 9 (69.2%) resolved. BCVA increased non-significantly from 0.7 to 0.4. CRT and CCT decreased significantly from 492 to 317 μm and from 204 to 182 μm respectively. Conclusions The overall success rate of the treatment algorithm was greater than 80%, a remarkable finding considering that no randomized study has yet been conducted to determine the optimal therapeutic protocol for PME. This is the first study to evaluate choroidal thickness in PME using SS-OCT, which could play a key role in its pathophysiology and provide useful information to improve the management of PME.

Topical NSAIDs and Oral Acetazolamide for Macular Edema after Uncomplicated Phacoemulsification: Outcome and Predictors of Non-Response

“…A recent study has examined the use of topical NSAIDs and intravitreal or peribulbar steroids in 33 eyes [ 20 ]. PCME occurred after 4 weeks postoperatively.…”

“…Topical NSAIDs eye drops were solely used as first-line therapy and resulted in complete regression of PCME in 19 of the 33 eyes studied (57%). A Dexamethasone implant was the second-line therapy and was performed in only 7 eyes, as the remaining 6 eyes refused this therapy and received peribulbar triamcinolone instead [ 20 ].…”

Akute Visusminderung nach parabulbärer Triamcinolonacetonid-Injektion

“…Die Behandlung des postoperativen Makulaödems umfasst zunächst die lokale Therapie mit nicht steroidalen antiinflammatorischen Augentropfen (NSAIDs) allein oder in Kombination mit steroidalen Augentropfen oder oralem Acetazolamid 2 . Bleibt die Erstlinientherapie erfolglos, kommen vor allem Kortikosteroide wie subtenonales oder peribuläres TA oder intravitreales Dexamethason zum Einsatz 3 , 4 . Da in unserem Fall die Erstlinientherapie über mehrere Monate nicht erfolgreich war, entschieden wir uns gemeinsam mit dem Patienten für die parabulbäre Injektion, da diese im Gegensatz zur intravitrealen Injektion weniger Risiken bez.…”

Safety and Efficacy of Prostaglandin Analogues in the Immediate Postoperative Period after Uneventful Phacoemulsification

“…Non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment for PME due to their excellent efficacy. Since their topical application results in greater penetration of the aqueous and consequently the vitreous and retina, this is the preferred route for NSAID use [ 10 ]. Usually, topical NSAIDs are combined with topical steroids.…”

“…Other treatment options include oral acetazolamide, triamcinolone delivered in the sub-tenon, the peribulbar or intravitreal route, as well as intravitreal dexamethasone implant. In refractory cases, intravitreal anti-vascular endothelial growth factor injections and tumor necrosis factor alpha inhibitors have rarely been employed [ 10 ].…”