ABSTRACT
Cystoid macular oedema (CMO) is one of the most frequent postoperative macular complications to cause partial visual recovery after successful retinal detachment (RD) repair. Refractory CMO is difficult to treat and many strategies have been employed with varying degrees of success. We report for the first time the use of ILUVIEN implant to treat refractory CMO after successful RD repair. A 65-year-old female presented with right eye full-thickness macular hole and underwent pars plana vitrectomy, internal limiting membrane peeling and cryotherapy with gas tamponade with 12% C3F8. She subsequently developed right eye macula-on RD and proliferative vitreoretinopathy and required multiple procedures for successful retinal reattachment. Later, she developed CMO that responded to intravitreal triamcinolone injections and intravitreal dexamethasone 0.7-mg implants but recurrence of CMO continued to be a problem. After receiving ILUVIEN intravitreal implant, her visual acuity improved and CMO resolved without recurrence for 13 months. Refractory CMO after RD repair is difficult to treat and in a quarter of cases will not improve without treatment. Our case shows that a single ILUVIEN implant maintained anatomical dry fovea and improved vision. This also demonstrates that ILUVIEN is an effective management strategy to reduce the need for repeated treatments.
Introduction
There are several pre- and postoperative factors that may influence visual outcome after successful retinal detachment (RD) repair. The most important preoperative factors are visual acuity (VA) and the duration of the RD. Cystoid macular oedema (CMO) and epiretinal membranes are the main postoperative factors and CMO appears to be the most frequent postoperative macular complication to cause partial visual recovery after successful RD repair.1
The exact aetiology of CMO after RD repair is unclear but inflammation is thought to be an important mechanism.2,3 Spontaneous resolution of CMO within 2 years postoperatively has been reported in up to 76% of cases.4 Many strategies have been employed to manage CMO after RD surgery, with varying degrees of success. Different anti-inflammatory medications have been used, including non-steroidal anti-inflammatory medications and topical, periocular and intravitreal corticosteroids.3,5,6
ILUVIEN implant (non-biodegradable 0.2 µg/d fluocinolone acetonide; Alimera Sciences, Inc.) is a sustained-release intravitreal steroid lasting up to 36 months that has been approved in the UK to treat chronic refractory CMO in pseudophakic eyes unresponsive to available therapies.7
We report for the first time the use of ILUVIEN implant to treat highly refractory CMO after successful RD repair and the outcomes of 20-month follow-up period after ILUVIEN implant.
Discussion
Refractory CMO after RD repair is difficult to treat and in a quarter of cases it will not improve without treatment. Intravitreal corticosteroid injections have shown to be an effective treatment option. We are not aware of any published literature in which ILUVIEN was used to treat this condition. This approach not only maintained an anatomical dry fovea but also provided visual improvement with a single ILUVIEN implant. This also demonstrates that ILUVIEN is an effective management strategy to reduce the need for repeated treatments. There is a risk of IOP elevation after receiving ILUVIEN intravitreal implant but in our case IOP was well controlled with short-term treatment. Further investigation of more cases with longer follow-up is needed. Better understanding of the exact aetiology of CMO after RD repair will lead to the development of more targeted treatment options.
