Irvine-Gass syndrome easily treated with topical medication, surgeon says

PUNTA DEL ESTE, Uruguay — The incidence of Irvine-Gass syndrome has decreased significantly with modern surgical procedures, and the condition is treatable with topical medication, a surgeon said here.

Of the cases of Irvine-Gass that still occur, 95% resolve with no treatment, Nauman Chaudhry, MD, said at Subspecialty Day of the Curso Regional Panamericano. He explained how to treat the other 5% of cases.

"The first line of treatment is still topical therapy, and since inflammation is the cornerstone of CME (cystoid macular edema), steroids usually work well," he said.

He said that treatment can be started with topical steroids administered twice a day.

"Xibrom (bromfenac ophthalmic solution 0.09%, Ista Pharmaceuticals) is a potent cyclo-oxygenase blocker, and it's detectable in the retina and choroid as soon as 24 hours later. It has good penetration for a topical drug," he said.

Most physicians believe the best choice is to use a dual topical therapy of steroids and nonsteroidal anti-inflammatory drugs, Dr. Chaudhry said.

"You should give it 6 to 12 weeks before you start your patient on something else," he said.

If there is no response to topical therapy, periocular steroids can be considered, but he advised continuing the topical therapy. For more severe cases, treatment can be started directly with intravitreal triamcinolone, which should show effects within a week. If that elicits no response, the patient should be re-evaluated to make sure there are no other conditions present, in which case the treatment cycle can be repeated.

"In cases of chronic or recurrent CME, vitrectomy might be necessary," Dr. Chaudhry said.