Bonfiglio Vincenza, Fallico Matteo R, Russo Andrea, De Grande Vittorio, Longo Antonio, Uva Maurizio G, Reibaldi Michele, Avitabile Teresio
Department of Ophthalmology, University of Catania, Catania - Italy.
Eur J Ophthalmol. 2015 Jul 30;25(5):e98-e100. doi: 10.5301/ejo.5000599.
Cystoid macular edema may occur following scleral buckling and therefore deteriorate the visual outcome. Inflammation may be the major causative factor in the development of postoperative cystoid macular edema. This case demonstrates the effectiveness of a dexamethasone implant as a treatment after the onset of choroidal inflammation and cystoid macular edema 6 months following scleral buckling and having visual acuity restored.
A 59-year-old phakic woman treated with scleral buckling for macula-off retinal detachment presented 2 months after surgery with cystoid macular edema with choroidal inflammation. Optical coherence tomography and fluorescein angiography were performed. From the time of the diagnosis, the patient's condition had been nonresponsive to medical therapy and only partially responsive to sub-Tenon triamcinolone acetonide. An intravitreal implant with a sustained release of 0.7 mg dexamethasone was implanted.
Following an intravitreal injection with a dexamethasone implant, the macular edema subsided completely and optical coherence tomography showed decreased foveal thickness from 510 μm to 220 μm. Choroidal fluorescein leakage disappeared. Best-corrected visual acuity improved from 0.70 to 0.20 logMAR, a condition maintained throughout the 6 months of follow-up.
Cystoid macular edema and choroidal inflammation are difficult to treat, but the improvement observed in this case of post scleral buckling macular edema and choroidal inflammation showed how a dexamethasone implant proved to be useful during the 6-month follow-up.
巩膜扣带术后可能发生黄斑囊样水肿，从而使视力预后恶化。炎症可能是术后黄斑囊样水肿发生的主要致病因素。本病例展示了地塞米松植入物在巩膜扣带术后6个月脉络膜炎症和黄斑囊样水肿发作后作为治疗手段的有效性，且视力得以恢复。
一名59岁有晶状体女性因黄斑脱离性视网膜脱离接受巩膜扣带术治疗，术后2个月出现伴有脉络膜炎症的黄斑囊样水肿。进行了光学相干断层扫描和荧光素血管造影。从诊断之时起，患者的病情对药物治疗无反应，仅对球后注射曲安奈德有部分反应。植入了一种持续释放0.7毫克地塞米松的玻璃体内植入物。
玻璃体内注射地塞米松植入物后，黄斑水肿完全消退，光学相干断层扫描显示中心凹厚度从510微米降至220微米。脉络膜荧光素渗漏消失。最佳矫正视力从0.70提高到0.20 logMAR，在整个6个月的随访期间保持这一状态。
黄斑囊样水肿和脉络膜炎症难以治疗，但本病例中巩膜扣带术后黄斑水肿和脉络膜炎症的改善表明，地塞米松植入物在6个月的随访期间证明是有用的。
