The Eye Associates Department of Ophthalmology, Sarasota Memorial Hospital, Sarasota, Florida.
Retin Cases Brief Rep. 2024 Jul 1;18(4):421-427. doi: 10.1097/ICB.0000000000001404.
BACKGROUND/PURPOSE: To describe two cases of patients diagnosed with chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis who had limited treatment response to previous corticosteroid modalities and then received a single intravitreal fluocinolone 0.18-mg implant. Chronic postoperative cystoid macular edema (CME) may occur after intraocular surgery and is a common cause of postoperative visual loss. Sometimes called Irvine-Gass syndrome or persistent pseudophakic CME, chronic postoperative CME complicates roughly 0.1% to 2.0% of low-risk, small-incision phacoemulsification surgeries. There are a number of conventional approaches to chronic postoperative CME management, including topical corticosteroids with or without nonsteroidal anti-inflammatory drugs, intravitreal corticosteroid injections, and vascular endothelial growth factor (VEGF) inhibitor injections, but these options have several limitations. A major shortcoming of conventional formulations of anti-inflammatory therapies for chronic postoperative CME (i.e., topical drops, intraocular, and periocular injections) is the need for repeated dosing in chronic cases, which is expensive and burdensome to patients.
Series of two case reports. Patient 1, a 75-year-old Latina woman, presented with a history of longstanding, recurrent inflammation after cataract extraction and subsequent vitreoretinal surgeries. Patient 2, an 85-year-old white woman, presented with acute blurred vision, swelling, and pain 5 years after cataract surgery and laser peripheral iridotomy. Both were diagnosed with chronic postoperative CME and ultimately treated with the 3-year sustained-release fluocinolone acetonide intravitreal implant (FAi) 0.18 mg.
Compared with baseline, both patients experienced resolution of their disease symptoms, >3 lines of visual acuity improvement, and macular edema reduction of 56.2% and 38.4% at 15 and 6 months, respectively, after the fluocinolone implant. No steroid related adverse events including any intraocular pressure measurement >25 mmHg were observed.
A single intravitreal fluocinolone 0.18-mg implant can effectively and safely treat vision loss and increased central macular thickness because of chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis. The FAi 0.18 mg provides a safe, long-acting, low-dose anti-inflammatory treatment in patients with noninfectious posterior-segment inflammation associated with chronic postoperative CME.
背景/目的：描述两例患有慢性术后囊样黄斑水肿（CME）合并非感染性后部葡萄膜炎的患者，他们对先前的皮质类固醇治疗反应有限，然后接受了单次玻璃体内氟轻松 0.18mg 植入物治疗。慢性术后 CME 可能在眼内手术后发生，是术后视力丧失的常见原因。有时称为 Irvine-Gass 综合征或持续性假性晶状体后 CME，慢性术后 CME 使大约 0.1%至 2.0%的低风险、小切口超声乳化手术复杂化。慢性术后 CME 管理有许多常规方法，包括局部皮质类固醇联合或不联合非甾体类抗炎药、玻璃体内皮质类固醇注射和血管内皮生长因子（VEGF）抑制剂注射，但这些选择有几个局限性。慢性术后 CME 抗炎治疗的常规制剂（即局部滴眼剂、眼内和眼周注射）的一个主要缺点是慢性病例需要重复给药，这既昂贵又给患者带来负担。
一系列两例病例报告。患者 1 是一名 75 岁的拉丁裔女性，她在白内障摘除和随后的眼后段手术后有长期反复发作的炎症病史。患者 2 是一名 85 岁的白人女性，她在白内障手术后 5 年出现急性视力模糊、肿胀和疼痛，最终被诊断为慢性术后 CME，并接受了 3 年持续释放氟轻松醋酸酯玻璃体内植入物（FAi）0.18mg 治疗。
与基线相比，两名患者的疾病症状均得到缓解，视力分别提高了>3 行，黄斑水肿分别减少了 56.2%和 38.4%，分别在氟轻松植入后 15 天和 6 个月时。未观察到任何与类固醇相关的不良反应，包括眼压测量值>25mmHg。
单次玻璃体内氟轻松 0.18mg 植入物可有效、安全地治疗因非感染性后部葡萄膜炎合并慢性术后 CME 导致的视力丧失和中央黄斑厚度增加。FAi 0.18mg 为非感染性后段炎症合并慢性术后 CME 患者提供了一种安全、长效、低剂量的抗炎治疗。
