Late-Onset Irvine-Gass Syndrome Treated With A Unique Intravitreal Injection Of Anti-Vegf

To report a case of late-onset Irvine-Gass syndrome responding to a single intravitreal injection of anti-vegf without prior use of topical or systemic curative treatment

Department of Ophthalmology, Central Army Hospital, Algeria. 

Although of lower incidence than before, Irvine-Gass syndrome remains encountered in clinical practice.

We report the case of an 81-year-old lady, who has no significant medical history. She came forward initially for a gradual bilateral visual decrease. The ophthalmological examination finds nothing remarkable except a grade 3 nuclear cataract, bilaterally.

Cataract surgery was performed by phacoemulsification with intraocular lens implantation, without incident. To prevent postoperative cystoid macular edema (CME), the patient was put on diclofenac sodium 0.1% eye drops for 2 months. She regained 9/10 visual acuity in the weeks following the surgery.

Eight months later, she presented a decrease in visual acuity of the operated eye evolving for 3 weeks. The visual acuity had dropped to 1/10. The ophthalmological examination found no explanatory sign of the visual loss apart from a slight change in the macular appearance. Optical coherence tomograpgy (OCT) was performed upon presentation showing typical CME. The central foveal thickness was 650µ. Faced with the absence of signs in favor of another diagnosis, we made that of pseudophakic macular edema. Immediately after, we decided to treat the patient with an intravitreal injection of ranibizumab. At the 1-month follow-up, the visual acuity of the right eye was 8/10, and the OCT showed almost total resolution of the CME. The thickness of the central fovea was reduced to 277 µ. No recurrence occurred after 15 months of follow-up.

Late-onset Irvine Gass syndrome is defined by the occurrence of clinically significant pseudophakic CME either 3 or 6 months after cataract surgery. Although the intravitreal dexamethasone implant is preferred in the literature, probably because it is more plausible with regard to the inflammatory mechanism, anti-VEGF treatment should be considered, VEGF being classically implicated in the breakdown of the blood-retinal barrier leading to CME, and this, during a possible switch or in glaucoma patients.

Finally, as with our patient, recent reports suggest that patients treated early with intravitreal injections may express better functional and anatomical outcomes than those who are left on topical or systemic treatment for a long duration.