Study shows intravitreal implant treats macular edema in cataract patients

VANCOUVER, British Columbia — The use of dexamethasone intravitreal implantation improved uveitic macular edema and the corresponding reduced visual acuity in patients who were pseudophakic or about to undergo cataract surgery.

Lead author Grace Levy-Clarke, MD, of Tampa Bay Uveitis Center, St. Petersburg, Florida, presented the study results here at the Association for Research in Vision and Ophthalmology meeting.

“For those of us who manage a lot of uveitis patients, the holy grail is patients who develop uveitic glaucoma and patients who develop uveitic macular edema,” Levy-Clarke told Healio.com/OSN. “It is one of the most visually disabling sequelae of uveitis.”

The most common side effects of intravitreal injections are increased IOP and cataract development, she said.

“For this study, I looked at a group of patients who were pseudophakic and patients going to surgery so we know we’ll see visual improvement regardless of the development or worsening of their cataract,” Levy-Clarke said.

She followed 16 eyes of nine patients for 3 to 15 months after dexamethasone intravitreal implantation.

“I found they all had improvement in macular edema and corresponding improvement in visual acuity,” Levy-Clarke said.

IOP rose in two patients, with one requiring more topical therapy as well as an oral medication to have pressure stabilized, she said.

“I knew this other patient was going to have problems with her IOP. She came in having been on topical steroids for 2 years, and as I predicted, her pressure did rise,” Levy-Clark said. “But we were able to do a Baerveldt, and her pressure stabilized.”

She said another patient had no improvement in visual acuity due to chronic untreated macular edema.

“My take is that for patients who are pseudophakic or going to imminent cataract surgery, this is a great adjunctive therapy,” Levy-Clarke said. “You can add it on to their systemic therapy, and it’s a nice way to get a good result for the patient. If they have to get another one, hopefully no more than two a year, monitor their pressures very carefully, but if no cataract development is in the horizon, that’s out of the picture.” – by Nancy Hemphill, ELS, FAAO

Reference:

Levy-Clarke G, et al. Dexamethasone intravitreal implantation to treat uveitic macular edema. Presented at: Association for Research in Vision and Ophthalmology; April 28-May 2, 2019; Vancouver, British Columbia.

Disclosures: Levy-Clarke reports she receives financial support from Allergan, Mallinckrodt and Sanofi/Genzyme and is a consultant for AbbVie. Please see the study abstract for all other authors’ relevant financial disclosures.