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Session Title: Cornea Surgical II
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 10:18
Venue: Forum (Ground Floor)
First Author: : S.Cortina USA
Co Author(s): : R. Miller J. de la Cruz F. Chau
Cystoid macular edema (CME) is a common cause of decreased vision after Boston keratoprosthesis (Kpro) implantation, for which there is no standard treatment protocol. In this study we report our experience with several established therapies for CME.
University of Illinois Eye and Ear Infirmary. Chicago, United States
Medical records of all patients who underwent implantation of Kpro at Illinois Eye and Ear Infirmary from Feb 2007- Nov 2012 were retrospectively reviewed. Eyes with CME as confirmed on spectral domain optical coherence tomography (SD-OCT) in the postoperative period were included. Outcome measures included visual acuity (VA), intraocular pressure, SD-OCT macular thickness, type, frequency, and duration of treatment including topical steroids and non-steroidals, posterior sub-tenon (PST) and intravitreal triamcinolone (IVT), intravitreal bevacizumab, and dexamethasone implant (Ozurdex). Structural outcomes were categorized into resolution (R), improvement (I), stable (S), or worsened (W).
105 Kpro were implanted into 91 eyes of 85 patients over a 5 year period. 19 of 91 eyes (21%) were diagnosed with CME postoperatively. The median time from Kpro to diagnosis of CME was 3 months. The median follow up time was 21.9 months. The median VA at time of CME diagnosis was 20/200 and the median initial OCT macular thickness was 519 µm. 10 eyes had topical treatment only (3R, 3I, 2S, 2W). 9 eyes had additional treatments with injections: 1 had intravitreal Avastin (S); 1 had PST and IVT (S); 1 had PST, IVT and Avastin (W); 3 had at least one Ozurdex (1R, 2I) and 3 had PST, IVT, and Ozurdex (3I). The 8 steroid injected eyes received a median of 3 treatments over a median of 24.7 months. Overall, the median final VA was 20/250 (p= 0.25) and median final OCT macular thickness was 413 µm (p= 0.005). 4 eyes with pre-existing glaucoma had a transient pressure spike >30 mmHg following steroid injection; 3 were treated successfully with topical medication (3/4) and one required a glaucoma shunt procedure (1/4). There were no other ocular complications.
Treatment of CME following Kpro can be challenging. 12 of 19 eyes exhibited resolution or improvement of CME and 4 of these had improved VA. In chronic CME cases, corticosteroid injections more often resulted in anatomic improvement but often without VA improvement. As all 6 eyes treated with Ozurdex exhibited resolution or improvement, Ozurdex injection may be beneficial in treating chronic CME in Kpro patients.
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