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Wavy Lines, Distorted Vision and Blur
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Macular oedema: The treatment of macular oedema occurs after onward referral to your medical retina service in the form of laser or injections. The decision of whether to treat with focal or grid laser, intravitreal anti-VEGF or peri-ocular steroid depends on the aetiology, amount of retinal fluid, patient factors and local policy. CMO after cataract surgery (Irvine–Gass syndrome) is initially treated with topical NSAIDs and steroids until review, though it is increasingly believed that the drops buy time at best for the eye to heal itself in most cases. Treatment for Irvine–Gass involves topical steroid with a topical non-steroidal drop (e.g. g. dexamethasone 1% QDS and g. ketorolac TDS). These patients should then be followed up in the consultant clinic.
Macular Edema after Successful Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment: Factors Affecting Edema Development and Considerations for Treatment
Published in Ocular Immunology and Inflammation, 2021
Irini Chatziralli, George Theodossiadis, Eleni Dimitriou, Dimitrios Kazantzis, Panagiotis Theodossiadis
In conclusion, our study showed that macular edema can occur in 16.3% of patients with RRD treated with PPV and is more prominent in cases with macula off RRD, PVR, RRD with more than 1-week duration, and pseudophakic lens status. Our results also suggested that intravitreal dexamethasone implant is a viable treatment option in patients with macular edema post PPV. This sort of treatment has been shown to provide resolution or significant reduction in CRT with improvement in VA and low recurrence rate associated with good safety profile, even with a limited number of dexamethasone implant with average 1.4 implants. Since the mentioned specific factors have been found to affect macular edema development and its treatment, we should be more cautious in such patients regarding their follow-up and management. It has also to be mentioned that the spontaneous resolution and the Irvine-Gass syndrome has to be excluded before starting any treatment. Future studies are needed to scrutinize the pathophysiology of macular edema post-PPV for RRD repair, so as to confirm our results and unveil more targeted therapies.
Efficacy and Safety of Interferon Alpha 2A and Pegylated Interferon Alpha 2A in Inflammatory Macular Edema
Published in Ocular Immunology and Inflammation, 2020
Chloé Couret, Marion Servant, Pierre Lebranchu, Mohamed Hamidou, Michel Weber
This study confirmed the efficacy of IFN-α in the treatment of refractory IME with a poor initial prognosis. In our study, we chose to include patients with Irvine-Gass syndrome because it is known that the main etiology involves the release of inflammatory mediators such as prostaglandins and cytokines that impair the blood-retinal barrier leading to fluid accumulation within the retina.15 The anatomical, functional and subjective efficacy of IFN-α was observed in 88%, 87% and 86% of cases, respectively. The efficacy of two molecules was compared (IFN-α2a vs. PegIFN-α2b): both molecules were rapidly effective, from the first month of treatment, at low doses (3 MIU three times a week for IFN-α2a and 100 µg/week for PegIFN-α2b). The efficacy was maintained despite dose tapering but only suspensively with 69% of patients experiencing a relapse after a median time of 2.9 months after treatment discontinuation. AEs were common and led to treatment discontinuation in 36% of cases, but most of them were mild. No difference in efficacy and tolerance was observed between IFN-α2a and PegIFN-2b.
Interferon Alpha for Refractory Pseudophakic Cystoid Macular Edema (Irvine-Gass Syndrome)
Published in Ocular Immunology and Inflammation, 2020
Spyridon Dimopoulos, Christoph M. E. Deuter, Gunnar Blumenstock, Manfred Zierhut, Anastasia Dimopoulou, Bogomil Voykov, Karl-Ulrich Bartz-Schmidt, Deshka Doycheva
Our observational study demonstrated both anatomical and functional improvement of PCME during IFN therapy. Most of the patients responded quickly with a significant reduction of macular edema within 4 weeks, and the effect remained stable during the follow-up. The excellent anatomical results were in line with an improvement of BCVA. The PCME remained unchanged during the treatment in only one patient. It seems that IFN alpha-2a is a very effective drug in patients with chronic therapy-refractory PCME. The exact mechanism of action of IFN alpha on PCME is still unclear. Gillies and Su reported that interferon alpha-2b enhanced the barrier function of bovine retinal microvascular endothelium and reduced significantly the permeability of retinal vessels.24 Probabaly this is the mechanism by which IFN leads to reduction of macular edema in patients with Irvine-Gass syndrome.