Abstract

Case Report

The management of Irvine-Gass Syndrome in a patient using Inhaler Steroid

Ayse Gul Kocak Altintas*, Cagri Ilhan and Mehmet Citirik

Published: 07 February, 2018 | Volume 2 - Issue 1 | Pages: 001-005

Irvine-Gass syndrome, is one of the most common causes of painless decrease in vision following even uneventful cataract surgery. It usually responds well to medical therapy, but, there are no widely acceptedconsensus on the efficacy of various therapeutic options for the treatment of Irvine-Gass syndrome. The patient presenting in this case report, has systemic hypertension and chronic obstructive pulmonary disease and he use oral anti-hypertension medication and inhaler steroid. He diagnosed as Irvine-Gass syndrome due to presence of decrease in visual acuity and macular edema with hyporeflective cystic intraretinal spaces in optical coherence tomography (OCT) since4th weekcontrol visitfollowing uneventful cataract surgery. After the responsiveness of several medications including topical steroid and non-steroidal anti-inflammatory drugs and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF), intravitreal sustained-release dexamethasone implant was applied. The visual acuity improved to 0.00 logMAR at 1st month after intravitreal dexamethasone therapy and consecutive OCT images showed complete resolution of macular edema with a normalization of the foveal profile.The visual acuity and foveal architecture remained stable in 2-year follow-up period and additional treatment was not needed. To the best of our knowledge, this is the first reportthatmentions the increment of visual acuity after a single dexamethasone implant, even though it did not response anti-VEGF combined with topical steroid and non-steroidal anti-inflammatory drugs. 

Read Full Article HTML DOI: 10.29328/journal.ijceo.1001011 Cite this Article Read Full Article PDF

Keywords:

Cystoid macular edema; Irvine-Gass syndrome; Dexamethasone implant

References

 

 

  1. Yonekawa Y, Kim IK. Pseudophakic cystoid macular edema. Curr Opin Ophthalmol. 2012; 23: 26-32. Ref.: https://goo.gl/Ph25rB
  2. Henderson BA, Kim JY, Ament CS, Ferrufino-Ponce ZK, Grabowska A, et al. Clinical pseudophakic cystoid macular edema: risk factors for development and duration after treatment. J Cataract Refract Surg. 2007; 33: 1550-1558. Ref.: https://goo.gl/jEMiYd
  3. Eriksson U, Alm A, Bjärnhall G, Granstam E, Matsson AW. Macular edema and visual outcome following cataract surgery in patients with diabetic retinopathy and controls. Graefes Arch Clin Exp Ophthalmol. 2011; 249: 349-359. Ref.: https://goo.gl/onPmzT
  4. Chu CJ, Johnston RL, Buscombe C, Sallam AB, Mohamed Q, et al. Risk factors and incidence of macular edema after cataract surgery. Ophthalmology. 2016; 123: 316-323. Ref.: https://goo.gl/HgDgU6
  5. Benitah NR, Arroyo JG. Pseudophakic cystoid macular edema. Int Ophthalmol Clin. 2010; 50: 139-153. Ref.: https://goo.gl/c9vnTf
  6. Vukicevic M, Gin T, Al-Qureshi S. Prevalence of optical coherence tomography-diagnosed postoperative cystoid macular oedema in patients following uncomplicated phacoemulsification cataract surgery. Clin Experiment Ophthalmol. 2012; 40: 282-287. Ref.: https://goo.gl/9NtJ4C
  7. Altıntaş AGK, Coban P, Arifoğlu, HB, Koklu G, Ozcan PY, et al. Comparison of phaco parameters effect on macular thickness changes after uneventful phacosurgery in diabetic and non-diabetic patients. Int Eye Sci. 2016; 16: 201-206. Ref.: https://goo.gl/Geqk7q
  8. Kiernan DF, Hariprasad SM. Controversies in the Management of Irvine-Gass Syndrome. Ophthalmic Surg Lasers Imaging Retina. 2013; 44: 522-527. Ref.: https://goo.gl/sooJbP
  9. Randazzo A, Vinciguerra P. Chronic macular edema medical treatment in Irvine-Gass syndrome: case report. Eur J Ophthalmol. 2010; 20: 462-465. https://goo.gl/DkU34D
  10. Chylack LT Jr, Leske MC, McCarthy D, Khu P, Kashiwagi T, et al. Lens opacities classification system II (LOCS II). Arch Ophthalmol. 1989; 107: 991-997. Ref.: https://goo.gl/fxN3Yn
  11. Quintana NE, Allocco AR, Ponce JA, Magurno MG. Non-steroidal anti-inflammatory drugs in the prevention of cystoid macular edema after uneventful cataract surgery. Clin Ophthalmol. 2014; 8: 1209-1212. Ref.: https://goo.gl/Xp6PC8
  12. Dal D, Sarac O, Toklu Y, Kocak Altintas AG, Cakmak HB, et al. The Effect of Perioperative Topical Ketorolac 0.5% on Macular Thickness after Uneventful Phacoemulsification. J Ophthalmol. 2017. Ref.: https://goo.gl/tLxfU7
  13. Yilmaz T, Cordero-Coma M, Gallagher MJ. Ketorolac therapy for the prevention of acute pseudophakic cystoid macular edema: a systematic review. Eye. 2012; 26: 252-258. Ref. https://goo.gl/b51r3v
  14. Barone A, Russo V, Prascina F, DelleNoci N. Short-term safety and efficacy of intravitreal bevacizumab for pseudophakic cystoid macular edema. Retina. 2009; 29: 33-37. Ref.: https://goo.gl/vRa5Qy
  15. Kessel L, Tendal B, Jørgensen KJ, Erngaard D, Flesner P, et al. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops. A systematic review. Ophthalmology. 2014; 121: 1915-1924. Ref.: https://goo.gl/hgtH8v
  16. Mason JO, Albert MA, Vail R. Intravitreal bevacizumab (Avastin) for refractory pseudophakic cystoid macular edema. Retina. 2006; 26: 356-357. Ref.: https://goo.gl/vpPxgs
  17. Spitzer MS, Ziemssen F, Yoeruek E, Petermeier K, Aisenbrey S, et al. Efficacy of intravitreal bevacizumab in treating postoperative pseudophakic cystoid macular edema. J Cataract Refract Surg. 2008; 34: 70-75. Ref.: https://goo.gl/TxVbjh
  18. Mitropoulos PG, Chatziralli IP, Peponis VG, Drakos E, Parikakis EA. Intravitreal Ranibizumab for the Treatment of Irvine-Gass Syndrome. Ocul Immunol Inflamm. 2015; 23: 225-231. Ref.: https://goo.gl/uAoCqE
  19. Demirel S, Batioglu F, Ozmert E. Intravitreal Ranibizumab for the Treatment of Cystoid Macular Edema in Irvine-Gass Syndrome. J Ocul Pharmacol Ther. 2012; 28: 636-639. Ref.: https://goo.gl/u78ERb
  20. Benhamou N, Massin P, Haouchine B, Audren F, Tadayoni R, et al. Intravitreal triamcinolone for refractory pseudophakic macular edema. Am J Ophthalmol. 2003; 135: 246-249. Ref.: https://goo.gl/SFrcu7
  21. Williams GA, Haller JA, Kuppermann BD, Blumenkranz MS, Weinberg DV, et al. Dexamethasone posterior-segment drug delivery system in the treatment of macular edema resulting from uveitis or Irvine-Gass syndrome. Am J Ophthalmol. 2009; 147: 1048-1054. Ref.: https://goo.gl/mZocX6
  22. Medeiros MD, Navarro R, Garcia-Arumí J, Mateo C, Corcóstegui B. Dexamethasone Intravitreal Implant for Treatment of Patients With Recalcitrant Macular Edema Resulting From Irvine-Gass Syndrome. Investigative Ophthalmology & Visual Science. 2013; 54: 3320-3324.
  23. Bellocq D, Korobelnik JF, Burillon C, Voirin N, Dot C, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study. Br J Ophthalmol.2015; 99: 979-983. Ref.: https://goo.gl/NYX6TD
  24. Mayer WJ, Kurz S, Wolf A, Kook D, Kreutzer T, et al. Dexamethasone implant as an effective treatment option for macular edema due to Irvine-Gass syndrome. J Cataract Refract Surg. 2015; 41: 1954-1961. Ref.: https://goo.gl/N7jF5N

Figures:

Figure 1

Figure 1

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More