1. Aditya Sudhalkar
Abhay Vasavada
Viraj Vasavada
Vaishali Vasavada
Samaresh Srivastava
Financial Disclosure: None

2. 60 year old male
No systemic complaints
Uncomplicated phacoemulsification with in the bag
implantation of hydrophobic IOL(Acrysof IQ, Alcon
Laboratories, Fort Worth, TX)
Presented 3 weeks post operatively with sudden,
painless DOV-3 days
Patient Profile

3. Was on topical steroids at the time of presentation
CDVA: RE-20/80, LE-20/40
RE: Anterior Segment-Pseudophakia
LE: Anterior Segment- Nuclear and Posterior
Subcapsular Cataract
IOP: RE-15 mm Hg, LE-12 mm Hg

4. RE Fundus Photograph
Cystoid macular edema

5. RE PS-OCT scan

6. Management
Advised(and received) a course of topical steroids,
cycloplegics and a NSAID
Asked to review in a month
Vision improved to 20/40(CDVA) after a month
Had a recurrence on tapering topical medication

7. RE OCT image

8. Further treatment
Given posterior subtenon preservative free
triamcinolone acetonide(20mg in o.5ml) and was put
on oral acetazolamide therapy(250mg 4 times/day)
with potassium supplementation
Asked to review in a month
CME resolved, recurred at the end of month 2
Advised intravitreal dexamethasone implant

9. RE PS-OCT scan

10. Intravitreal dexamethasone
implant
Topical anesthesia
Infero-temporal quadrant
Post-operative topical antibiotics for a week
Asked to review in a week’s time

11. One week post operatively
Vision: RE-20/20
IOP: RE-14 mm Hg
Posterior segment: No CME

12. RE PS-OCT scan

13. One year later
Vision maintained at 20/20
No recurrences
No IOP spikes noted

14. Introduction
Pseudophakic Cystoid Macular Edema: Clinically
significant in <2% population
Typically presents 4-12 weeks after surgery
Generally self resolving
Responds in most cases to topical ± systemic therapy
Some cases are resistant to therapy

15. Purpose
To determine the preliminary efficacy and safety of
intravitreal dexamethasone implant(Ozurdex,
Allergan Inc) for the treatment of recalcitrant
pseudophakic CME

16. Methods
Prospective study
 Inclusion Criteria:
Patients with pseudophakic CME
At least one course each of a.)topical steroids+NSAIDS
b.)Oral CA inhibitors
c.) Intravitreal/periocular steroids

17. Methods
 Exclusion Criteria:
Contraindication to ocular steroids
Complicated pseudophakia
Unwilling patient

18. Methods
Injections were administered using a standardized
technique by a single surgeon(AS).
Postoperative topical antibiotics for a week
Visual acuity testing every month for 6 months
IOP monitoring every month for 6 months
OCT analysis every month for 12 months

19. Statistical analysis
Descriptive statistics, the paired and unpaired t test,
odds ratio were used, as appropriate
Primary outcome measure: Improvement in CDVA
Secondary outcome measure:
Change in OCT thickness
Recurrence
Complications, if any

20. Results
Thirteen patients(13 eyes)
6 males, median age 64.42 ±5.76 years
Mean baseline CDVA: 0.54 ±0.14 logMAR
Median baseline IOP: 12.2 ± 4.3 mm Hg

21. None of the patients had systemic disease that could
confound the results
Average number of topical treatments received: 1.6 ±0.4
Average systemic therapy received: one course of oral CA
inhibitors
All patients received at least one subtenon triamcinolone
injection

22. Results
Median duration of CME prior to inclusion: 8.6 ±
4.32 months
All patients followed up for a year
CDVA improved to 0.1 ± 0.04 logMAR

23. OCT thickness improved from 432.24 ±89.32
microns to 254 ± 47.24 microns
One patient developed a recurrence 1 month after
injection, he required a second dexamethasone
injection
None of the patients developed an IOP spike

24. Discussion
Our results are similar to a retrospective analysis
published recently
Safe and well tolerated
Only one patient required a second injection
Further trials are warranted
Medeiros et a;’ Dexamethasone Intravitreal Implant for Treatment of Patients With Recalcitrant Macular Edema Resulting From
Irvine-Gass Syndrome Invest. Ophthalmol. Vis. Sci. 2013 : 54 (5) 3320-3324

25. Figure 1(A,B,C) shows the color fundus photograph, fundus fluorescein angiography (FFA) images and spectral-domain optical
coherence tomography (SD-OCT) scans of a 27 year old man who presented with dimution of vision in left eye since 3 days. On
examination is corrected distance visual acuity (CDVA) was 20/40. At baseline, the colour fundus photograph (A) shows a choroidal
neovascular membrane (CNVM) (black arrow) and subretinal fluid. The FFA images show a classic CNVM (black arrow) with early
hyperfluoresence (B) and late leakage (C). The SD-OCT scan shows choroidal neovascular complex (black arrow) above the retinal
pigment epithelium. He was treated with two intravitreal bevacizumab injections with an interval of one month between injections. At
23-month follow
up his visual CDVA was 20/20. The color photograph shows scarred CNVM (E, black arrowhead). SD-OCT shows scar (E, black
Figure 1

26. Limitations
Small number of patients
No comparative arm

27. Conclusion
Dexamethasone implant a viable treatment option for
recalcitrant pseudophakic CME
May be considered as primary therapy
Preliminary analysis suggests its safe and effective

28. References:
Brysknov T et al; Longstanding refractory pseudophakic cystoid
macular edema resolved using intravitreal 0.7 mg
dexamethasone implants2013 Volume 2013:7 Pages 1171—1174