First Author: I.Martins de Almeida PORTUGAL
Co Author(s): C. Costa Ferreira A. Gomes Rocha J. Chibante Pedro 0 0 0 0 0 0 0 0 0
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Pseudophakic cystoid macular edema (PCME) is the most common cause of visual loss after cataract surgery. The incidence of clinical PCME in uncomplicated cases lies between 0,2-2% but increases in the presence of a risk factor like iris trauma, rupture of posterior capsule, vitreous loss or incarceration, dislocated intraocular lens, use of iris fixed lenses, active uveitis or diabetes. Signs and symptoms reach a peak 4-6 weeks postoperatively with spontaneous resolution of the edema and recovery of visual acuity in 90% of the patients. The authors present a clinical case of PCME.
Although PCME pathogenesis may be multifactorial, inflammation caused by surgical manipulation appers to be the major cause and because of that, blocking the prostaglandin synthesis has been the clinical approach. However chronic visually significant PCME remains difficult to treat and may not respond to conventional medical therapies.
Clinical case report of chronic PCME
A 81-year-old female was submitted to phacoemulsification with intraocular lens (IOL) implantation in her right eye (RE). Due to a zonular dehiscence, an anterior vitrectomy was performed and an angle-supported anterior chamber IOL was implanted. Postoperatively she was treated with deflazacort 60mg 3 days, topical quinolona four times daily for 8 days, topical dexamethasone four times daily for 1 month and topical Ketorolac three times daily for 1 month. 3 months after that she complained of red eye with decreased VA in the RE; the BCVA was 2/10 with +0,25 (-4,0x115°) and the fundus examination reveled absence of the foveal light reflex with macular edema. Optical coherence tomography (OCT) was performed showing a remarkable increase in retinal thickness with disappearance of the foveal depression (645µm) and optically empty intraretinal spaces, typical of cystoid macular edema. She was treated with combined therapy of topical ketorolac and dexamethasone. 5 months after the OCT showed a persistent macular edema (723 µm); because of that an intravitreal injection of triamcinolone acetonide (TAAC) was employed. 1 year after her right BCVA was 5/10 with -0,25 (-2,0x130°), right intraocular pressure was of 12 mm Hg, fundoscopy was normal and the OCT showed no intraretinal edema.
Although intravitreal injection of TAAC has been used by some authors to treat PCME, its use is still limited hampered by some complications including intraocular pressure and endophtalmitis. This case is an example of a good anatomical and functional result in chronic PCME resistant to topical medical treatment, showing that intravitreal injection of TAAC should still be considered as a good option nowadays.