Intravitreal Dexamethasone Implant at the Time of Silicon Oil Removal to Treat Persistent Macular Edema after Rhegmatogenous Retinal Detachment Repair

Background: An intravitreal dexamethasone implant (DEX-I) was found to be effective and safe for the treatment of cystoid macular edema (CME) after vitrectomy for rhegmatogenous retinal detachment (RRD) and in silicone oil (SO)-filled eyes. We aimed to investigate the efficacy and safety of DEX-I at the time of SO removal for the treatment of recalcitrant CME after successful RRD repair. Methods: A retrospective review of the medical records was performed on 24 consecutive patients (24 eyes) with recalcitrant CME after RRD repair who were treated with a single 0.7-mg DEX-I at the time of SO removal. The main outcome measures were changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A regression model was performed to assess the relationship between BCVA and CMT at 6 months and independent variables. Results: In all 24 patients, CME occurred after RRD repair and remained despite topical therapy. The mean time of CME onset was 27.4 +/- 7.7 days after vitrectomy. The mean time between vitrectomy and DEX-I was 106.8 +/- 10.1 days. The mean CMT was significantly decreased from 429.6 +/- 59.1 mu m at baseline to 294 +/- 46.4 mu m at month 6 (p < 0.0001). The mean BCVA significantly improved from 0.99 +/- 0.3 at baseline to 0.60 +/- 0.3 at month 6 (p < 0.0001). An elevation of intraocular pressure was observed in one (4.1%) eye, which was medically managed. A univariate regression model revealed a relationship between month-6 BCVA after DEX-I and gender (beta = -0.27; p = 0.03) and macular status (beta = -0.45; p = 0.001) when RRD occurred. No relationship between month-6 CMT and independent variables was found. Conclusions: DEX-I at the time of SO removal had an acceptable safety profile and achieved favorable outcomes in eyes affected by recalcitrant CME that occurred after RRD repair. RRD-related macular status is significantly associated with visual acuity after DEX-I.

Automated summary

In this study, we investigated the efficacy and safety of DEX-I combined with silicone oil (SO) removal for the treatment of recalcitrant cystoid macular edema (CME) after successful rhegmatogenous retinal detachment (RRD) repair. The results showed that DEX-I treatment significantly improved CME and visual acuity, and was safe to use.