João Alves Ambrósio*, Vítor Miranda, Catarina Aguiar, Raquel Soares, João Chibante Pedro and Miguel Ruão

Ophthalmology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal

*Corresponding Author: João Alves Ambrósio, Ophthalmology Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.

Received: November 03, 2023; Published: November 21, 2023

Abstract

Introduction: Irvine-Gass Syndrome (IGS), also known as pseudophakic cystoid macular edema (CME), is a postoperative complication that can lead to reduced visual acuity following cataract surgery. While many cases resolve spontaneously, those that persist pose therapeutic challenges. Currently, there is no standardized treatment for recurrent cases. However, clinical evidence and theoretical reasoning support the use of intravitreal corticosteroids. The 0.19-mg sustained-release fluocinolone acetonide (FAc) implant (ILUVIEN®, Alimera Science) is approved for the treatment of chronic diabetic macular edema and the prevention of relapse in non-infectious posterior uveitis. This study aims to evaluate the efficacy and safety of the off-label use of ILUVIEN® in patients with IGS.

Methods: Five eyes from five patients with IGS who underwent FAc implants at Centro Hospitalar de Entre o Douro e Vouga were retrospectively reviewed. Patients were examined at baseline, at months 1, 3, and quarterly thereafter.

Results: Two patients were female, and the mean age was 78.8 ± 11.1 years. Before receiving ILUVIEN®, all eyes received short-term corticosteroid therapies with triamcinolone and/or dexamethasone (3.5 ± 0.5 intravitreal injections). The mean duration of CME before the FAc implant was 1.9 ± 0.9 years. The mean follow-up time after the FAc was 14.4 ± 5.2 months. The study demonstrated significant improvements in anatomical and functional outcomes, with either maintained or reduced central foveal thickness (CFT) and either maintained or improved best-corrected visual acuity (BCVA). The median BCVA at baseline and at the last observation was 0.30 [0.10; 0.65] logMAR, and 0.10 [0.10; 0.10] logMAR, respectively. The median CFT before FAc was 423 [371; 487] µm. At the last observation, it significantly decreased to 262 [282; 305] µm. No significant intraocular pressure (IOP) increase was observed. Two eyes required IOP-lowering medication before the FAc implant and continued it throughout.

Conclusions: In this study, both BCVA and CFT improved from baseline after treatment with FAc in patients with IGS in a routine clinical setting. ILUVIEN® may play a role in eyes with recurrent CME, providing longer recurrence-free periods and reducing the burden of short-acting corticosteroids. In this series, there were no safety concerns regarding the increase in IOP.

Keywords: Cataract Surgery; Irvine–Gass Syndrome; Cystoid Macular Edema; Fluocinolone Acetonide; Intravitreal Implant; Iluvien

References

1. L Kodjikian., et al. “Management of Irvine-Gass syndrome”. Journal Français d'Ophtalmologie 9 (2017): 788-792.
2. S R Irvine. “A Newly Defined Vitreous Syndrome Following Cataract Surgery*”. American Journal of Ophthalmology5 (1953): 599-619.
3. A Grzybowski., et al. “Pseudophakic cystoid macular edema: update 2016”. Clinical Interventions in Aging 11 (2016): 1221-1229.
4. SM Cohen., et al. “Cystoid macular edema after pars plana vitrectomy for retained lens fragments”. Journal of Cataract and Refractive Surgery9 (2006): 1521-1526.
5. D Zur and A Loewenstein. “Postsurgical Cystoid Macular Edema”. (2017): 178-190.
6. K Miyake and N Ibaraki. “Prostaglandins and Cystoid Macular Edema”. Survey on Ophthalmology 47 (2002): S203-S218.
7. L Ersoy., et al. “Aqueous flare is increased in patients with clinically significant cystoid macular oedema after cataract surgery”. British Journal of Ophthalmology7 (2013): 862-865.
8. A J Flach. “The incidence, pathogenesis and treatment of cystoid macular edema following cataract surgery”. Transactions of the American Ophthalmological Society 96 (1998): 557-634.
9. J K SCHMIER., et al. “EVALUATION OF COSTS FOR CYSTOID MACULAR EDEMA AMONG PATIENTS AFTER CATARACT SURGERY”. Retina5 (2007): 621-628.
10. A Daruich,. et al. “Mechanisms of macular edema: Beyond the surface”. Progress in Retinal and Eye Research 63 (2018): 20-68.
11. S S Ong., et al. “BILATERAL INTRAVITREAL 0.19-MG FLUOCINOLONE ACETONIDE IMPLANT FOR PERSISTENT NONDIABETIC CYSTOID MACULAR EDEMA AFTER VITRECTOMY”. Retinal Cases and Brief Reports 3 (2021): 261-265.
12. D H Geroski and H F Edelhauser. “Drug delivery for posterior segment eye disease”. Investigative Ophthalmology and Visual Science 5 (2000): 961-964.
13. V Sarao., et al. “Intravitreal Steroids for the Treatment of Retinal Diseases”. The Scientific World Journal 1-14 (2014).
14. P A Campochiaro., et al. “Sustained Delivery Fluocinolone Acetonide Vitreous Inserts Provide Benefit for at Least 3 Years in Patients with Diabetic Macular Edema”. Ophthalmology10 (2012): 2125-2132.
15. D F Kiernan. “Sustained-release Low-dose Fluocinolone Acetonide Intravitreal Implant for Chronic Postoperative Cystoid Macular Edema: Two Case Reports”. Retinal Cases and Brief Reports (2023).
16. J R de Oliveira Dias., et al. “New Drugs and New Posterior Delivery Methods in CME”. Current Ophthalmology Report 2 (2017): 160-168.
17. A Chronopoulos., et al. “Intravitreal fluocinolone acetonide implant for chronic postoperative cystoid macular edema - two years results”. European Journal of Ophthalmology2 (2023): 1054-1060.
18. JH Marques., et al. “Fluocinolone Acetonide 0.19 mg Implant in Patients with Cystoid Macular Edema Due To Irvine-Gass Syndrome”. International Medical Case Reports Journal 14 (2021): 127-132.
19. C KOUTSANDREA., et al. “INTRAOCULAR TRIAMCINOLONE ACETONIDE FOR PSEUDOPHAKIC CYSTOID MACULAR EDEMA”. Retina2 (2007): 159-164.
20. F Boscia., et al. “Intravitreal Triamcinolone Acetonide in Refractory Pseudophakic Cystoid Macular Edema: Functional and Anatomic Results”. European Journal of Ophthalmology1 (2005): 89-95.
21. N Benhamou., et al. “Intravitreal triamcinolone for refractory pseudophakic macular edema”. American Journal of Ophthalmology 2 (2003): 246-249.
22. MD Conway., et al. “Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema”. Journal of Cataract and Refractive Surgery 1 (2003): 27-33.
23. LM Meyer and CL Schönfeld. “Cystoid Macular Edema after Complicated Cataract Surgery Resolved by an Intravitreal Dexamethasone 0.7-mg Implant”. Case Reports in Ophthalmology3 (2011): 319-322.
24. T Brynskov., et al. “Longstanding refractory pseudophakic cystoid macular edema resolved using intravitreal 0.7 mg dexamethasone implants”. Clinical Ophthalmology (2013): 1171.
25. RN Khurana., et al. “Dexamethasone Intravitreal Implant for Pseudophakic Cystoid Macular Edema in Patients With Diabetes”. Ophthalmic Surgery, Lasers and Imaging Retina1 (2015): 56-61.
26. D Bellocq., et al. “Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study”. British Journal of Ophthalmology7 (2015): 979-983.
27. D Bellocq., et al. “Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study”. British Journal of Ophthalmology (2016).
28. Y Dang., et al. “Comparison of dexamethasone intravitreal implant and intravitreal triamcinolone acetonide for the treatment of pseudophakic cystoid macular edema in diabetic patients”. Drug Design, Development and Therapy (2014): 1441.
29. R Frisina., et al. “Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane”. Graefe’s Archive for Clinical and Experimental Ophthalmology1 (2015): 47-56.

Citation

Citation: João Alves Ambrósio. “Exploring the Efficacy and Safety of Intravitreal Fluocinolone Acetonide Implant (ILUVIEN®) in the Management of Irvine-Gass Syndrome: Insights from a Retrospective Case Series Analysis".Acta Scientific Ophthalmology 6.12 (2023): 22-27.

Copyright

Copyright: © 2023 João Alves Ambrósio. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.