Efficacy Of Electrophoresis With Dexamethasone In The Complex Treatment Of Cystoid Macular Edema After Cataract Surgery In Patients With Uveitis

Cataract in uveitis can develop as a result of a direct inflammatory process of the uvea. Cystoid macular edema (CME) after cataract surgery in patients with uveitis is one of the most common and sight threatening postoperative inflammatory complications. Intravitreal injection of corticosteroids and Anti-VEGF are routine options for treatment. However, reinjection often be required of the limited potency and duration of the positive effects of intravitreal injection. Endonasal electrophoresis of dexamethasone (EED) is one of the effective methods treatment inflammatory pathology of the eye.

Purpose: evaluation of the effectiveness of  EED in the complex treatment of patients with CME after cataract surgery in patients with uveitis.

In a randomized clinical trial 51 eyes of 47 patients with uveitis and CME after uncomplicated cataract surgery were enrolled in the study. Patients were divided into three groups with randomized digits table. In the first group 16 patients (16 eyes) received intravitreal injection of corticosteroid (IVC); in the second group, 16 patients (17 eyes) received intravitreal injection of Anti-VEGF (IVA); in the third group, 15 patients (18 eyes) received IVA with a 10-day course of EED (IVA+EED). 

Two main outcome measures were changes in best corrected visual acuity (BCVA), measured with logarithm of minimal angle of resolution and cental macular thickness (CMT), measured with optical coherence tomography (OCT). Other metods of ophthalmological survey were also used: refractometry, tonometry, biomicroscopy of the anterior segment, ophthalmoscopy of the fundus, ultrasound examination of the eye, specular microscopy. Laboratory methods were used:general blood analysis, determination of blood glucose, C-reactive protein, rheumatoid factor, antistreptolysin, coagulogram, serological reactions to various infections and viruses. The mean follow-up was 24,5 weeks. The results obtained were processed by the method of variation statistics.

The mean value of CMT in all three groups before treatment was 526.7±11,2 μm and the difference between groups did not reach statistical signifance (p=0.125). The best improvement in BCVA and reduction in CMT was achieved at 6 weeks in all groups but worsened with time until 22 weeks. BCVA improved from baseline by 0.23, 0.20 and 0.26 and CMT decreased from baseline by 246.7 μm, 213.5 μm and 287.2 μm respectively in the groups IVC, IVA, IVA+EED (p<0.001). The results in the group IVA+EED were better than those in the other groups, although the difference did not reach statistical signifance (p=0.153). The median period of effect of therapy was 20,2±2,1 weeks, 18,4±1.9 weeks and 22,4±1,7 weeks respectively in the groups IVC, IVA, IVA+EED.

This study shows that IVC and IVA are both effective in improving in BCVA and reduction in CMT in CME. But the best results were obtained  in the third group. IVA in combination with EED is an effective treatment with the longest lasting effect in CME after cataract surgery in patients with uveitis. The use of electrophoresis allows you to painlessly simultaneously combine the effects of Anti-VEGF with corticosteroid. The advantages of the electrophoretic method of application of corticosteroids (possibility of use of an outpatient basis, prolonged effect of the treatment, painlessness, atraumatic) allow us to recommend it for more extensive use in ophthalmological practice in the therapy CME after cataract surgery in patients with uveitis.