The effect of internal limiting membrane peeling on chronic recalcitrant pseudophakic cystoid macular edema. Am J Ophthalmol

Department of Ophthalmology, Tulane University, New Orleans, Louisiana, United States
American Journal of Ophthalmology (Impact Factor: 3.87). 05/2002; 133(4):571-2. DOI: 10.1016/S0002-9394(01)01402-7
Source: PubMed


To describe the effect of internal limiting membrane peeling in chronic recalcitrant pseudophakic cystoid macular edema.
Two interventional case reports.
Two consecutive patients with chronic pseudophakic cystoid macular edema of 11-22 months duration, after uncomplicated cataract surgery, unresponsive to previous treatment, were enrolled. The surgical technique consisted of pars plana vitrectomy and internal limiting membrane peeling. Main outcome measures included best-corrected visual acuity, biomicroscopic appearance, and perifoveal leakage on fluorescein angiography. Optical coherence tomography scans were performed postoperatively.
Pars plana vitrectomy with internal limiting membrane peeling resulted in anatomical, angiographic, and functional improvement in both patients, for total follow-up periods of 8 and 11 months, respectively.
To our knowledge, this is the first report of chronic pseudophakic cystoid macular edema that favorably responded to pars plana vitrectomy with internal limiting membrane peeling, as concluded after a MEDLINE search.

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    • "Several studies on PPV for treating recalcitrant pseudophakic CME have been published [13, 14, 26]. Harbour et al. reported on 24 consecutive patients who underwent PPV for chronic pseudophakic CME that failed to respond medically [13]. "
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    ABSTRACT: To describe an association between extrafoveal vitreoretinal traction and intractable chronic pseudophakic cystoid macular edema (CME) by the use of optical coherence tomography (OCT). In a retrospective case series study, charts and OCT findings of patients who had postoperative recalcitrant pseudophakic CME for at least 6 months and vitreoretinal traction membranes were analyzed. Excluded were eyes that either had another vitreoretinopathy that could affect the analysis or had undergone an intravitreal intervention. Three eyes (three patients) with macular edema following uneventful cataract surgery were detected to be associated with multifocal extrafoveal vitreoretinal traction sites in each. Retinal edema that was underlying each of the traction sites in all eyes was in continuum in at least one site per eye with the central macular edema, thus manifesting as diffuse macular edema. Chronic pseudophakic macular edema may be related to extrafoveal vitreoretinal traction.
    The Open Ophthalmology Journal 05/2011; 5(1):35-41. DOI:10.2174/1874364101105010035
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    ABSTRACT: Cystoid macular edema (CME) is a common problem after cataract extraction. It can occur after uncomplicated surgery in patients with otherwise healthy eyes, after complicated surgery, or after surgery in patients with ocular diseases such as uveitis or diabetic retinopathy. Usually vision loss from cystoid macular edema is temporary and responds to treatment with topical anti-inflammatory medications. However, some cases respond poorly to conservative treatment and may develop permanent visual loss. A review of the medical literature was performed for all articles published in English between August 1, 2001 and July 31, 2002 on the topic of cystoid macular edema after cataract surgery. The authors selected nine articles that were most relevant to the practicing ophthalmologist for inclusion in this review. Topics of interest included vitreous loss, retained lens fragments, diabetes, uveitis, retinitis pigmentosa, ocular hypotensive lipids, internal limiting membrane peeling, and intravitreal triamcinolone injection.
    Current Opinion in Ophthalmology 03/2003; 14(1):39-43. DOI:10.1097/00055735-200302000-00007 · 2.50 Impact Factor
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    ABSTRACT: Purpose: To evaluate the effect of intravitreal triamcinolone acetonide for chronic pseudophakic cystoid macular oedema (CME) resistant to medical treatment. Methods: Six eyes of six patients with chronic pseudophakic CME, aged 58–74 years (average 66 years), made up the study population. All eyes had persistent CME despite having received medical treatment for at least 3 months. Intravitreal injection of 4 mg (0.1 ml) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed as well as potential complications related to the injection procedure and corticosteroid medication. Results: The follow-up period was between 6 and 10 months (mean 8.5 months). Baseline central macular thickness averaged 504 µm. At 1 month, a reduction in the mean central macular thickness of 52% from 504 µm to 264 µm was obtained. At 3 and 6 months, the mean central macular thicknesses were 240 µm and 232 µm, respectively. Five of the six eyes maintained a visual gain of 15 or more letters from baseline at 6 months. During follow-up no patient had intraocular pressure (IOP) exceeding 21 mmHg. No injection-related complications were encountered. Conclusions: Intravitreal triamcinolone acetonide is a promising therapeutic method for chronic pseudophakic CME resistant to medical treatment. Further study with a longer follow-up period and larger series is warranted to assess the treatment's longterm efficacy and safety and the need for retreatment.
    Acta Ophthalmologica Scandinavica 12/2003; 81(6):648-652. DOI:10.1046/j.1395-3907.2003.0146.x · 1.85 Impact Factor
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