Postoperative pseudophakic cystoid macular edema cme, also known as irvine gass syndrome, is one of the main causes of suboptimal visual acuity after cataract surgery. Efficacy of intravitreal bevacizumab in treating postoperative. Antivegf with intravitreal bevacizumab avastin, genetech has been shown. Cmo following cataract surgery was an entity reported first time by irvine in 1953. The advent of phacoemulsification and small incision cataract surgery has reduced the incidence of pcme, but the sheer volume of cataract surgery still makes pcme a prevalent morbidity. Because of the advances in cataract extraction, especially phacoemulsification, there is less surgical manipulation, shorter operative times, and decreased rates of. A 72yearold male with a history of uneventful bilateral cataract surgery was followedup with biomicroscopy and optical coherence tomography oct. Igs remains an important cause of painless decrease in vision following cataract extraction and intraocular lens iol. Kubilhan elmas, ozgur bilen, ali altynsoy ankara, turkey purpose. It may occur angiographically after uneventful intracapsular and extracapsular cataract surgery in up to 60% and 30% of cases respectively. So, it is important to point out to the unhappy patient that because of the cataract it was impossible to determine wheth er preexisting pathology was present prior to surgery. Cystoid macular edema one of the most common cause of vision loss following uncomplicated cataract removal either with or without implantation of intraocular lens other conditions that may be complicated with cme include. Intravitreal ranibizumab for the treatment of cystoid. Effectiveness and safety of dexamethasone implants for.
Cystoid macular edema is a condition in which swelling develops in the center of the retina macula. Cystoid macular edema after complicated cataract surgery. The prognosis for untreated cme after cataract surgery irvine gass syndrome is very good. Histologic sections were examined, revealing a significant correlation. Longstanding refractory pseudophakic cystoid macular edema.
The intravitreal dexamethasone implant has been found to be effective in the treatment of recalcitrant cme due to irvine gass syndrome in several retrospective case reports and case series in patients who have been treated with topical steroids, nsaids intravitreal steroid, and antivegf injections. Cystoid macular edema post cataract surgery irvine gass. While uveitic macular edema has many underlying causes, cme has been widely recognized as a common form of visual. Gass and norton subsequently published an angiographic study of its characteristics in 1966. Dexamethasone implant as an effective treatment option for macular edema due to irvine gass syndrome. Pdf treatment of pseudophakic cystoid macular edema. The standard of treatment for csme since 1985 has been laser photocoagulation. Antivascular endothelial growth factor drugs for retinal. Detecting pseudophakic cystoid macular edema collaborativeeye.
Irvine described macular changes occurring in patients after cataract surgery with loss of est corrected visual acuity in 1966 dr. To determine the preliminary efficacy and safety of offlabel dexamethasone implant for treatment of recurrent cystoid macular edema cme secondary to irvine gass syndrome igs. Eyeworld intravitreal bevacizumab for postop pseudophakic. The cause for cme can be remembered with the mnemonic depriven diabetes, epinepherine, pars planitis, retinitis pigmentosa, irvine gass syndrome, venous occlusion, e2prostaglandin analogues, nicotinic acidniacin. Usefulness of intravitreal dexamethasone implant in. Retinal physician current concepts in the etiology and. Small incision cataract surgery and phacoemulsification reduce the risk of pcme, however number of cataract surgery performed each year is significant and pcme is still a commonly encountered. Irvinegass syndrome, is one of the most common causes of painless. Usefulness of intravitreal dexamethasone implant in treatment. Despite treatment options for irvine gass syndrome which include nonsteroidal antiinflammatory drugs, corticosteroids and acetazolamide, and new fields of.
P seudophakic cystoid macular edema is a common form of uveitic macular edema occurring following cataract extraction. The management of irvinegass syndrome in a patient using. Mayer wj, kurz s, wolf a, kook d, kreutzer t, kampik a, et al. Intravitreal avastin may be successful treatment in most irvine gass syndrome cases. Cystoid macular edema following cataract surgery aphakic or pseudophakic cystoid macular edema, also known as irvine gass syndrome, is a known risk of cataract surgery. Dexamethasone posteriorsegment drug delivery system in the treatment of macular edema resulting from uveitis or irvine gass syndrome. To describe the efficacy of intravitreal bevacizumab avastin in patients with cystoid macular edema cme after cataract surgery irvinegass syndrome. Methods this retrospective case series comprised 16 eyes of 16 patients with cme after cataract surgery refractory to current standard treatment who received an injection of 1. Followup study of cystoid macular edema following cataract extraction. There are numerous causes of macular edema, but only the postsurgical form will be discussed here. Pseudophakic cystoid macular edema pcme is the most common complication of cataract surgery. Postcataract cme is usually selflimited, but for chronic cme or in cases of multiple recurrences, photoreceptor damage with permanent impairment of central vision may result. Irvine gass ig syndrome was initially clinically described by irvine,1 and then angiographically characterised by gass and norton. Sep 25, 2018 mayer wj, kurz s, wolf a, kook d, kreutzer t, kampik a, et al.
Alternative treatment methods in eyes with pseudophakic. Despite advances in cataract surgery, such as microincision and new phacoemulsification techniques, cme may occur even in. Patients included had to have clinically significant pcme and have been treated with the dex between 2012 and 2015. Bevacizumab is the preferred, initial antivegf treatment. Treatmentprognosis of cystoid macular edema the prognosis for untreated cme after cataract surgery irvine gass syndrome is very good. The management of irvinegass syndrome in a patient. This small study demonstrates that an intravitreal dexamethasone implant is effective and safe for recurrent cystoid macular edema secondary to irvine gass syndrome. Pseudophakic cystoid macular edema pcme also known as irvine gass syndrome igs, was initially reported by irvine in 1953. The incidence following cataract surgery irvine gass syndrome of clinically significant cme with decreased vision is only 0. Cystoid macular edema cme is a common cause of decreased vision following complicated or uncomplicated cataract surgery. A newly defined vitreous syndrome following cataract surgery. Postoperative inflammation and posterior uveitis can also lead to cystoid macular edema cme or irvine gass syndrome. It is a common final pathway for many ocular diseases, including diabetic retinopathy, vascular occlusions, postsurgical conditions and uveitic diseases. Despite advances in cataract surgery, such as microincision and new phacoemulsification techniques, cme may occur even in uncomplicated surgeries 1.
Intravitreal dexamethasone implant in treatment of recurrent cystoid macular oedema cme due to irvinegass syndrome was mentioned in a case series by sudhalkar et al 27. It is a broad name for several conditions seen together. Successful treatment of pseudophakic cystoid macular edema with intravitreal bevacizumab. Nov 01, 2015 managing pseudophakic cystoid macular edema advancements have been made with current imaging.
Pseudophakic cystoid macular edema irvinegass syndrome. Irvine gass syndrome, pseudophakic cystoid macular edema pcme is one of the most common causes of vision impairment after the cataract surgery 1,2. Intravitreal dexamethasone implant for recurrent cystoid. Ozurdex for combined pseudophakic cystoid macular edema and diabetic macular edema after cataract surgery. Proposed etiologic factors for cme include inflammation, vitreomacular traction, and vascular instability. Cystoid macular edema following cataract surgery was initially reported by irvine in 1953 and is known as the irvinegass syndrome irvine 1953. The pseudophakic macular cystoid edema, also known as irvine gass syndrome, is one of the possible causes for low visual acuity after cataract surgery. Intravitreal bevacizumab for refractory pseudophakic cystoid macular edema. Pseudophakic cystoid macular edema pcme, also known as irvinegass syndrome, is the most common cause of unexpected visual loss after cataract surgery.
Jan 05, 2020 pseudophakic cystoid macular edema cme, also known as irvine gass syndrome, is one of the most common causes of visual loss after cataract surgery. Cystoid macular edema post cataract surgery irvine gass sydrome. This retrospective case series comprised 16 eyes of 16 patients with cme after cataract surgery refractory to current standard treatment who received an injection of 1. Drugs vascular endothelial growth factor vegf is a protein that stimulates production of new blood vessels. Pseudophakic cystoid macular edema cme is a condition in which postsurgical inflammation leads to macular swelling. Dexamethasoneimplant for the treatment of macula edema due.
Cystoid macular edema post cataract surgery irvine gass sydrome cystoid macular edema remains one of the most frustrating situations of all for both patient and ophthalmologist. Gass the incidence is more common in older types of cataract surgery, where postcataract cme could occur in 2060% of patients, but with modern cataract surgery, incidence. Decreased or blurred vision depends on the extent of the edema. Pseudophakic cystoid macular edema cme, also known as irvine gass syndrome, results in painless vision loss and typically presents 4 to 6 weeks after cataract surgery, although risk factors for this complication can often be identified much earlier. Irvine gass syndrome, which describes vision loss after cataract surgery due to cystoid macular edema cme, is still recognized as one of the most common causes of poor visual outcome following cataract surgery 1, 2. To evaluate the functional and anatomical outcome after intravitreal ranibizumab injection in 2 patients with cystoid macular edema cme related to irvine gass syndrome. Irvine gass ig syndrome describes a macular oedema that develops following ophthalmic surgery. When blood passes through these vessels, fluid leaks into the surrounding tissue through the abnormal blood vessel walls.
Listing a study does not mean it has been evaluated by the u. Irvinegass syndrome, pseudophakic cystoid macular edema or postcataract cme is one of the most common causes of visual loss after cataract surgery. Pseudophakic cystoid macular edema, also known as irvine gass syndrome, was first reported by a. Cystoid macular edema cme is any type of macular edema that involves cyst formation,including irvine gass syndrome and. The condition that exclude patients from bevacizumab treatment is horizontal epiretinal membrane, and vertical traction revealed in spectral optical coherence tomography. Thirteen years later, gass and norton demonstrated its typical presentation using fluorescein angiography fa. Controversies in the management of irvinegass syndrome. This retrospective case series comprised 8 eyes of 8 patients with cme after cataract surgery refractory to current standard treatment that received an injection of 1.
The frequency was more common in older types of cataract surgery, where cme could occur in 2060% of patients. Two patients with pseudophakic cme refractory to current standard topical treatment were enrolled in this study. Pseudophakic cystoid macular edema pcme, also known as irvine gass syndrome, is the most common cause of unexpected visual loss after cataract surgery. Dexamethasone intravitreal implant for pseudophakic. Treatment of cystoid macular edema with bevacizumab in course of. Intravitreal bevacizumab for pseudophakic cystoid macular. Pseudophakic cystoid macular edema cme, also known as irvine gass syndrome, results in painless vision loss and typically presents 4 to 6 weeks after cataract surgery. To describe the efficacy of intravitreal bevacizumab avastin in patients with cystoid macular edema cme after cataract surgery irvine gass syndrome. Cataract iol intravitreal bevacizumab for postop pseudophakic cystoid macular edema a recent study, published in the january issue of the journal of cataract and refractive surgery concluded that intravitreal injection of avastin bevacizumab, genentech, san francisco, although safe, did not result in improved visual function in patients with postoperative cme. To determine the efficacy, safety, and predictive outcome factors for intravitreal dexamethasone implant dex in pseudophakic cystoid macular edema pcme. However, there is no prospective study on the use of this implant in either recalcitrant or recurrent cystoid macular edema secondary to irvine gass syndrome in patients with uncomplicated pseudophakia.
Surgical removal of the cataract causes the release of inflammatory mediators such as vasoendothelial growth factor vegf and prostaglandins. Irvine gass irvine gass is an inflammatory process occurring in up to 20% of cataract extraction with intraocular lens. Prevention of macular edema after cataract surgery. Gass and norton subsequently reported its characteristics with fluorescein angiography 14. In contrast to findings in a previous case report, the beneficial effect of vascular endothelial growth factor inhibition in irvinegass syndrome was not observed. The pseudophakic macular cystoid edema, also known as irvine gass syndrome. Irvine gass syndrome postcataract and postsurgical.
Prophylaxis and treatment of cystoid macular edema after cataract. Diabetic macular edema dme is similarly caused by leaking macular capillaries. It can occur in many situations, but most commonly will occur with inflammatory diseases, with certain medications, and after eye surgery. To present a patient with irvine gass syndrome in the right eye complicated with a macular hole mh in the same eye and possible associations between these two entities.
Irvine gass syndrome fluid accumulation within the sensory retina in the macular area. Treatment of cystoid macular edema with bevacizumab in. Sep 19, 20 dexamethasoneimplant for the treatment of macula edema due to irvine gass syndrome the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Macular hole formation in a patient with irvinegass syndrome. Vegf is also inlammatory mediators and inlammation is the major etiologic factor in the development of irvine gass syndrome 14,16. Approximately 20% of the patients who undergo uncomplicated phacoemulsification or extracapsular extraction develop angiographically proven cme peterson et al 1992. Postsurgical macular oedema psmo is the main cause of visual loss after ophthalmic surgery. Because of the heterogeneity of definitions and diagnostic criteria, its incidence has been reported to be between 1% and 30% table 1, with, however, an incidence of 1%2% of clinically significant pcme in patients with no risk factors. Pseudophakic cystoid macular edema was first described by a. Gass and norton described these changes are ystic spaces in macula and termed irvine gass syndrome.
Reported almost immediate improvement of bcva and complete resolution of cme after a single. Mar 05, 2014 pseudophakic cystoid macular edema, also known as irvine gass syndrome, was first reported by a. Cystoid macular edema cme, not a true diagnosis but a finding arising from numerous causes, is named for its intraretinal polycystic histopathologic appearance. Crstoday cystoid macular edema after cataract surgery. Treatment of cystoid macular edema with bevacizumab in course of irvinegass syndrome. When cme develops following cataract surgery and its cause is thought to be directly related to the surgery, it is referred to as irvine gass syndrome or pseudophakic cme. To evaluate the functional and anatomic outcome after intravitreal ranibizumab injection in two patients with cystoid macular. Case series of sudhalkar et al included patients with pseudophakic cme previously resolved by topical therapy and periocular steroids. A smaller percentage up to 20% will persist for up to 5 years.
Prophylaxis and treatment of cystoid macular edema after. It was first clinically described in 1953 by irvine1 in his proctor lecture. Gass described that the peak incidence occurred at six weeks postoperatively, and suggested there was a difference between angiographic versus clinically significant pcme, in that only a few patients complained of. Request pdf treatment of cystoid macular edema with bevacizumab in course of irvine gass syndrome to determine clinical effect of intravitreal bevacizumab avastin in patients with cystoid. In conclusion, the intravitreal dexamethasone implant is a valid treatment option for patients with recurrent pseudophakic cme secondary to irvine gass syndrome who have been treated with topical therapy and a posterior subtenon triamcinolone acetonide injection. Pseudophakic cystoid macular edema cme, also known as irvine gass syndrome, is one of the most common causes of visual loss after cataract surgery. About half of the cases will regain normal vision in about 6 months. Irvinegass ig syndrome was initially clinically described by irvine,1 and then angiographically characterised by gass and norton. Later through studies it was described as the most. Incidence of ig syndrome is extremely variable and mainly depends on the series and also.
Anti vegf therapy bevacizumab has been used for the treatment. Pseudophakic cystoid macular edema pcme, also known as irvine gass syndrome, is a common cause of vision loss following cataract surgery. Pathogenesis of pseudophakic cystoid macular oedema. Managing pseudophakic cystoid macular edema retinal physician.
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