Intravitreal Ranibizumab in the treatment of refractory pseudophakic cystoid macular edema following cataract surgery.

摘要

Purpose: To report the short-term safety and efficacy of intravitreal ranibizumab (IVR) in patients with pseudophakic cystoid macular edema (PCME) following cataract surgery and refractory to both topical nepafenac (TN) and sub-tenon triamcinolone acetonide (STA). Methods: Six eyes of six patients with PCME who underwent non-complicated phacoemulsification and intraocular lens (IOL) implantation between January 2013 and August 2013 were included. Clinical charts and OCT scans of all patients were retrospectively reviewed. None of the patients included was diagnosed with diabetes mellitus, uveitis, or epiretinal membrane. Pre-surgery optical coherence tomography (OCT) scan revealed no macular alterations in all cases. One month after surgery, the included patients were diagnosed with PCME and firstly treated with TN three times a day during six weeks. After six weeks of treatment with TN, PCME persisted and all patients received STA injection. One month after STA injection, OCT scan revealed persistence of PCME in all cases. Consequently, the included patients were treated with IVR. Main outcome measures were occurrence of treatment-related ocular or systemic complications, mean best corrected visual acuity (BCVA) and macular thickness (MT) at baseline and after TN, ST and IVR treatment. Results: Mean number of injections was 1.33 (?±0.52). Mean baseline BCVA was 62.33 (?±19.86) ETDRS letters. Mean BCVA after 6 weeks of TN treatment and a STA injection was 72.33 (?±15.36) ETDRS letters. Mean BCVA one month after the first IVR injection was 78.17 (?±15.7) ETDRS letters. Mean BCVA of two patients who received a second IVR injection was 80.5 (?±9.19) ETDRS letters. Mean baseline MT was 543 (?±69.26) ?μm. Mean MT after 6 weeks of TN treatment and a STA injection was 510.2 (?±105.96) ?μm while one month after the first IVR injection was 352.5 (?±120.4) ?μm. Mean MT of two patients who received a second IVR injection was 261 (?±98.99) ?μm. Conclusions: Short term results suggest that IVR can be effective in the treatment of PCME refractory to treatment with TN and STA. Changes in MT after IVR treatment and differences in BCVA at baseline and after treatment with TN and STA were statistically significant (p0.05). On the other hand, differences in BCVA after TN and STA treatment and after IVR injections did not reach statistical significance.