Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine–Gass Syndrome

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Abstract

Background

Cystoid macular edema (CME) due to Irvine–Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized.

Objective

To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN ^®) in the off-label treatment of recurrent CME due to IGS.

Methods

Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine–Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded.

Results

Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median – interquartile range), best-corrected visual acuity was 0.3–0.3; central macular thickness was 492.0–38.0; and intraocular pressure was 16.0–0. By Month 36, best-corrected visual acuity was 0.4 −0.3; central macular thickness was reduced to 369.0–324.0 and intraocular pressure was 17.0–3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops.

Conclusion

We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine–Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.

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Most cited references 11

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Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema.

Peter A Campochiaro, David M Brown, Andrew Pearson … (2012)

To assess long-term efficacy and safety of intravitreal inserts releasing 0.2 μg/d (low dose) or 0.5 μg/d (high dose) fluocinolone acetonide (FAc) in patients with diabetic macular edema (DME). Two randomized, sham injection-controlled, double-masked, multicenter clinical trials. Subjects with persistent DME despite ≥1 macular laser treatment were randomized 1:2:2 to sham injection (n = 185), low-dose insert (n = 375), or high-dose insert (n = 393). Subjects received study drug or sham injection and after 6 weeks were eligible for rescue laser. Based on retreatment criteria, additional study drug or sham injections could be given after 1 year. Percentage of patients with improvement of ≥15 letters from baseline. Secondary outcomes included other parameters of visual function and foveal thickness. At month 36, the percentage of patients who gained ≥15 in letter score using the last observation carried forward method was 28.7% (low dose) and 27.8% (high dose) in the FAc insert groups compared with 18.9% (P = 0.018) in the sham group, and considering only those patients still in the trial at month 36, it was 33.0% (low dose) and 31.9% (high dose) compared with 21.4% in the sham group (P = 0.030). Preplanned subgroup analysis demonstrated a doubling of benefit compared with sham injections in patients who reported duration of DME ≥3 years at baseline; the percentage who gained ≥15 in letter score at month 36 was 34.0% (low dose; P<0.001) or 28.8% (high dose; P = 0.002) compared with 13.4% (sham). An improvement ≥2 steps in the Early Treatment Diabetic Retinopathy Study retinopathy scale occurred in 13.7% (low dose) and 10.1% (high dose) compared with 8.9% in the sham group. Almost all phakic patients in the FAc insert groups developed cataract, but their visual benefit after cataract surgery was similar to that in pseudophakic patients. The incidence of incisional glaucoma surgery at month 36 was 4.8% in the low-dose group and 8.1% in the high-dose insert group. In patients with DME FAc inserts provide substantial visual benefit for up to 3 years and would provide a valuable addition to the options available for patients with DME. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Management of pseudophakic cystoid macular edema.

Suqin Guo, Shriji Patel, Ben Baumrind … (2014)

Pseudophakic cystoid macular edema (PCME) is a common complication following cataract surgery. Acute PCME may resolve spontaneously, but some patients will develop chronic macular edema that affects vision and is difficult to treat. This disease was described more than 50 years ago, and there are multiple options for clinical management. We discuss mechanisms, clinical efficacy, and adverse effects of these treatment modalities. Topical non-steroidal anti-inflammatory agents and corticosteroids are widely used and, when combined, may have a synergistic effect. Intravitreal corticosteroids and anti-vascular endothelial growth factor (anti-VEGF) agents have shown promise when topical medications either fail or have had limited effects. Randomized clinical studies evaluating anti-VEGF agents are needed to fully evaluate benefits and risks. When PCME is either refractory to medical therapy or is associated with significant vitreous involvement, pars plana vitrectomy has been shown to improve outcomes, though it is associated with additional risks.

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Pharmacologic therapy of pseudophakic cystoid macular edema: 2010 update.

Heather Shelsta, Lee Jampol (2010)

To review the current management and pharmacologic treatment of pseudophakic cystoid macular edema. Systematic review of currently accepted treatment modalities for pseudophakic cystoid macular edema. Main outcome measures include visual acuity and retinal thickness measurement by optical coherence tomography. Optical coherence tomography is used to diagnose and monitor response to therapy. New topical nonsteroidal antiinflammatory drugs have been approved by the Food and Drug Administration for ophthalmic use, and some show promise in the treatment of pseudophakic cystoid macular edema. Other areas of clinical research include the use of anti-vascular endothelial growth factor agents and the addition of intravitreal routes of administration (e.g., corticosteroids, nonsteroidal antiinflammatory drugs, and anti-vascular endothelial growth factor agents). Surgical therapeutic options include Nd:YAG laser for anterior vitreolysis and pars plana vitrectomy for chronic refractory cases. Surprisingly, few changes have occurred in recent years in the treatment of pseudophakic cystoid macular edema. Placebo-controlled, double-masked, randomized, clinical trials are largely lacking.

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Author and article information

Journal

Journal ID (nlm-ta): Int Med Case Rep J

Journal ID (iso-abbrev): Int Med Case Rep J

Journal ID (publisher-id): imcrj

Journal ID (pmc): imcrj

Title: International Medical Case Reports Journal

Publisher: Dove

ISSN (Electronic): 1179-142X

Publication date (Electronic): 26 February 2021

Publication date Collection: 2021

Volume: 14

Pages: 127-132

Affiliations

[1 ]Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto , Porto, Portugal

[2 ]Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto , Porto, Portugal

Author notes

Correspondence: João Heitor Marques Centro Hospitalar Universitário do Porto, Serviço de Oftalmologia , Largo do Prof. Abel Salazar, Porto, 4099-001, PortugalTel +351913680726 Email joaoheitormarques@gmail.com

Author information

João Heitor Marques http://orcid.org/0000-0001-6487-7950

Ana Carolina Abreu http://orcid.org/0000-0003-4842-8623

Angelina Meireles http://orcid.org/0000-0001-9148-2786

Bernardete Pessoa http://orcid.org/0000-0002-5673-1561

Article

Publisher ID: 295045

DOI: 10.2147/IMCRJ.S295045

PMC ID: 7924132

PubMed ID: 33664598

SO-VID: f14f1ed9-9cd9-4dfc-b4a7-4c6008f8c8d6

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 01 December 2020

Date accepted : 13 January 2021

Page count

Figures: 4, Tables: 2, References: 11, Pages: 6

Funding

Funded by: did not receive any funding;

The authors declare that this work did not receive any funding.

Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine–Gass Syndrome

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Most cited references 11

Sustained delivery fluocinolone acetonide vitreous inserts provide benefit for at least 3 years in patients with diabetic macular edema.

Management of pseudophakic cystoid macular edema.

Pharmacologic therapy of pseudophakic cystoid macular edema: 2010 update.

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