Marques João Heitor, Abreu Ana Carolina, Silva Nisa, Meireles Angelina, Pessoa Bernardete, Melo Beirão João
Serviço de Oftalmologia, Centro Hospitalar e Universitário do Porto, Porto, Portugal.
Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
Int Med Case Rep J. 2021 Feb 26;14:127-132. doi: 10.2147/IMCRJ.S295045. eCollection 2021.
Cystoid macular edema (CME) due to Irvine-Gass syndrome (IGS) is one of the common causes of painless visual impairment post-cataract extraction. The treatment of recurrent cases remains unstandardized.
To evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (0.2 µg/day; ILUVIEN) in the off-label treatment of recurrent CME due to IGS.
Retrospective 36-month case series in the Ophthalmology Department of Centro Hospitalar Universitário do Porto, Portugal. Consecutive eyes of patients with recurrent cystoid macular edema due to Irvine-Gass syndrome who underwent a single intravitreal injection of fluocinolone acetonide intravitreal implant were included. Best-corrected visual acuity (logMAR), central macular thickness (µm) and safety (intraocular pressure, mmHg) at baseline and at 6, 12, 24 and 36 months post-administration of the fluocinolone acetonide intravitreal implant were recorded.
Five eyes from three patients were included. The duration of cystoid macular edema was 67.8±25.9 months and all five eyes received more than 2 intravitreal injections of a corticosteroid (triamcinolone and/or dexamethasone implant) prior to fluocinolone acetonide intravitreal implantation. At baseline (median - interquartile range), best-corrected visual acuity was 0.3-0.3; central macular thickness was 492.0-38.0; and intraocular pressure was 16.0-0. By Month 36, best-corrected visual acuity was 0.4 -0.3; central macular thickness was reduced to 369.0-324.0 and intraocular pressure was 17.0-3.0. Four of five eyes had increased intraocular pressure and were managed with intraocular pressure-lowering eye drops.
We report improved functional and anatomical outcomes after treatment with fluocinolone acetonide intravitreal implant, indicating its use as a therapeutic alternative in recurrent cases of cystoid macular edema due to Irvine-Gass syndrome. Additionally, in eyes with suboptimal response to intravitreal therapies, fluocinolone acetonide intravitreal implant may provide longer recurrence-free periods with reduced treatment burden.
因Irvine-Gass综合征（IGS）导致的黄斑囊样水肿（CME）是白内障摘除术后无痛性视力损害的常见原因之一。复发病例的治疗仍未标准化。
评估醋酸氟轻松玻璃体内植入物（0.2μg/天；ILUVIEN）在IGS所致复发性CME的非标签治疗中的有效性和安全性。
在葡萄牙波尔图大学中心医院眼科进行的一项为期36个月的回顾性病例系列研究。纳入因Irvine-Gass综合征导致复发性黄斑囊样水肿且接受单次醋酸氟轻松玻璃体内植入物注射的患者的连续眼。记录在注射醋酸氟轻松玻璃体内植入物前及注射后6、12、24和36个月时的最佳矫正视力（logMAR）、黄斑中心厚度（μm）和安全性（眼压，mmHg）。
纳入了3例患者的5只眼。黄斑囊样水肿持续时间为67.8±25.9个月，所有5只眼在接受醋酸氟轻松玻璃体内植入前均接受了2次以上的玻璃体内皮质类固醇注射（曲安奈德和/或地塞米松植入物）。基线时（中位数-四分位间距），最佳矫正视力为0.3-0.3；黄斑中心厚度为492.0-38.0；眼压为16.0-0。到36个月时，最佳矫正视力为0.4-0.3；黄斑中心厚度降至369.0-324.0，眼压为17.0-3.0。5只眼中有4只眼压升高，通过使用降眼压滴眼液进行处理。
我们报告了醋酸氟轻松玻璃体内植入物治疗后功能和解剖学结果得到改善，表明其可作为Irvine-Gass综合征所致复发性黄斑囊样水肿病例的一种治疗选择。此外，对于玻璃体内治疗反应欠佳的眼，醋酸氟轻松玻璃体内植入物可能提供更长的无复发期，并减轻治疗负担。
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