Jorge Rodrigo, Villela Isabela Franco, Fernandes Christian, de Azevedo Bastos Thais Marino, Scott Ingrid U, da Silva Cunha Armando, Fialho Silvia Ligório, da Silva Pedro Henrique Reis, Messias André
Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, 3900, Bandeirantes Ave., Ribeirão Preto, SP, 14049-900, Brazil.
Faculty of Pharmacy, Minas Gerais Federal University, Belo Horizonte, Minas Gerais, Brazil.
Doc Ophthalmol. 2023 Aug;147(1):71-75. doi: 10.1007/s10633-023-09939-6. Epub 2023 Jun 28.
Pseudophakic cystoid macular edema (PCME) is the most common cause of visual acuity deterioration after uncomplicated cataract surgery. There is no consensus regarding how to manage recurrent or refractory cases.
A 54-year-old woman complained of decreased vision and central metamorphopsia in the right eye (OD) 3 months after uneventful cataract surgery. Visual acuity was 0.3 logMAR (20/40) OD and 0.1 logMAR (20/25) OS. Reduced macular brightness was seen OD on funduscopy associated with increased macular thickness on optical coherence tomography (OCT). Pseudophakic cystoid macular edema (PCME) was diagnosed, and treatment with oral acetazolamide was tried without success. The patient underwent a single intravitreal injection of an acetazolamide implant (260 μg) OD as off-label treatment. Four weeks following the injection, she reported complete resolution of her metamorphopsia and visual loss OD. Four months later, her visual acuity was 0.0 logMAR (20/20) in OD and 0.1 logMAR (20/25) in OS. The patient reported no discomfort after the injection procedure. Laboratory and ophthalmologic tests did not identify any adverse effects of the medication.
We show that PCME refractory to conventional treatment improved after intravitreal acetazolamide implant injection. Further investigation is warranted to confirm these preliminary findings.
人工晶状体眼黄斑囊样水肿（PCME）是单纯性白内障手术后视力下降最常见的原因。对于如何处理复发性或难治性病例尚无共识。
一名54岁女性在白内障手术顺利完成3个月后，右眼（OD）出现视力下降和中心视物变形。右眼视力为0.3 logMAR（20/40），左眼视力为0.1 logMAR（20/25）。眼底检查发现右眼黄斑亮度降低，光学相干断层扫描（OCT）显示黄斑厚度增加。诊断为人工晶状体眼黄斑囊样水肿（PCME），尝试口服乙酰唑胺治疗但未成功。该患者右眼接受了一次玻璃体内注射乙酰唑胺植入物（260μg）作为超说明书用药治疗。注射后四周，她报告右眼视物变形和视力丧失完全消失。四个月后，右眼视力为0.0 logMAR（20/20），左眼视力为0.1 logMAR（20/25）。患者报告注射后无不适。实验室和眼科检查未发现该药物的任何不良反应。
我们发现，玻璃体内注射乙酰唑胺植入物后，对传统治疗难治的PCME有所改善。有必要进行进一步研究以证实这些初步发现。
