Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul;36(7):1244-51.
doi: 10.1097/IAE.0000000000000892.

RECALCITRANT CYSTOID MACULAR EDEMA AFTER PARS PLANA VITRECTOMY

Mostafa R Alam  1 , Cheryl A Arcinue, Nadia B Mendoza, William R Freeman
Affiliations

RECALCITRANT CYSTOID MACULAR EDEMA AFTER PARS PLANA VITRECTOMY

Mostafa R Alam et al. Retina. 2016 Jul.

Abstract

Purpose: To evaluate the outcomes of different types of treatment of chronic cystoid macular edema (CME) after pars plana vitrectomy.

Methods: Retrospective review of eyes that developed chronic CME after pars plana vitrectomy treated with intravitreal triamcinolone acetonide (TCA) with or without the addition of anti-vascular endothelial growth factor.

Results: Thirty-nine eyes of 37 patients were included, with a median duration between pars plana vitrectomy and onset of CME of 5 months (interquartile range, 3-12). In most eyes (66.7%), the main indication for surgery was for vitreomacular interface disorders, such as epiretinal membrane, vitreomacular traction, and macular hole. With intravitreal TCA, there was a significant decrease in central foveal thickness at 3, 6, and 12 months, compared with baseline (P = 0.0171, 0.0401, and 0.0024, respectively). A significant gain in vision was noted at 1 month compared with baseline (P = 0.0169), but this was not sustained at 3, 6, and 12 months (P = 0.4862, 0.9098, and 0.4312, respectively). The addition of bevacizumab to TCA did not provide any additional benefit for central foveal thickness and visual acuity. Thirty-two eyes (82.1%) were started on prophylactic antiglaucoma drops 2 weeks after a TCA injection, and no eye needed laser or surgery to control intraocular pressure.

Conclusion: Chronic CME after pars plana vitrectomy is recurrent and difficult to treat. Intravitreal TCA is effective in reducing CME, but there was only short-term visual acuity improvement even with continued reduction of central foveal thickness. Intraocular pressure did not significantly rise with the use of prophylactic antiglaucoma drops even with repeated injections.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosures:

No financial disclosures. None of the authors have any proprietary interest.

Figures

Figure 1.
Figure 1.
Fluorescein angiogram (FA) and optical coherence tomography (OCT) of an eye treated with combined intravitreal triamcinolone acetonide (TCA) and bevacizumab. A1. Baseline FA shows petalloid macular leakage corresponding to CME and a hot disc. A2. Baseline OCT passing through the fovea shows subretinal fluid (SRF) and minimal intraretinal cysts inferior to the fovea. B1 and B2. FA and OCT at 3 months showing increased dye leakage, and increased SRF and intraretinal cysts, respectively. C1 and C2. FA and OCT at 6 months shows more diffuse leakage of dye during the late phase on FA and greatly increased SRF and intraretinal fluid (IRF) on OCT. D1 and D2. FA and OCT at 12 months shows decreased leakage on FA, and resorbed SRF and minimal IRF on OCT.
Figure 2.
Figure 2.
Fluorescein angiogram (FA) and optical coherence tomography (OCT) of an eye treated with intravitreal triamcinolone acetonide (TCA) alone. A1. Baseline FA shows diffuse macular leakage and petalloid leakage in the fovea corresponding to diffuse CME. A2. Baseline OCT passing through the fovea shows large intraretinal cysts and an evaginated foveal contour. B1 and B2. FA and OCT at 3 months shows no dye leakage, and minimal intraretinal cysts with restoration of the foveal contour, respectively. C1 and C2. FA and OCT at 6 months shows recurrence of diffuse leakage of dye during the late phase on FA and recurrence of intraretinal fluid (IRF) on OCT. D1 and D2. FA and OCT at 12 months showing essentially unchanged FA and OCT findings from 6 months.
Figure 3.
Figure 3.
Graph showing the mean change in visual acuity score during the first year of follow-up.
Figure 4.
Figure 4.
Graph showing the mean change in central foveal thickness during the first year of follow-up.
See this image and copyright information in PMC

References

    1. Kim SJ, Martin DF, Hubbard GB 3rd, et al. Incidence of postvitrectomy macular edema using optical coherence tomography. Ophthalmology 2009;116(8):1531–7. - PubMed
    1. Frisina R, Pinackatt SJ, Sartore M, et al. Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2015;253(1):47–56. - PubMed
    1. Furino C, Boscia F, Recchimurzo N, Sborgia C, Alessio G. Intravitreal dexamethasone implant for refractory macular edema secondary to vitrectomy for macular pucker. Retina 2014;34(8):1612–6. - PubMed
    1. Chen CH, Wu PC, Liu YC. Intravitreal bevacizumab injection therapy for persistent macular edema after idiopathic macular epiretinal membrane surgery. J Ocul Pharmacol Ther 2011;27(3):287–92. - PubMed
    1. Taney LS, Baumal CR, Duker JS. Sustained-release dexamethasone intravitreal implant for persistent macular edema after vitrectomy for epiretinal membrane. Ophthalmic Surg Lasers Imaging Retina 2015;46(2):224–8. - PubMed

MeSH terms