Título

INTRAVITREAL DEXAMETHASONE IMPLANT IN REFRACTORY IRVINE-GASS SYNDROME: A CASE REPORT

Introdução / Purpose

Present a case of Intravitreal dexamethasone use as an important option therapy for Irvine-Gass Syndrome in a pseudophakic patient after long-lasting and refractory macular edema.

Material e Método / Methods

A case of a patient with refractory cystoid macular edema(CME) after a cataract surgery in the right eye followed up for one year. Submitted firstly to oral and topical treatment with non-steroidal anti-Inflammatory(NSAI) and oral carbonic anhydrase followed by a course of intra-vitreous Anti-angiogenic factors. After lack of response to the first two treatment option after 5 months of therapy, the patient was efficiently treated with intravitreal Ozurdex® without the observation of any complications.

Resultados / Results

Postoperative CME is a main cause of decreased visual acuity following uncomplicated surgery. It pathogenesis is thought to be multifactorial; however, the major etiology appears to be the upregulation of inflammatory mediators in the aqueous and vitreous humors after surgical manipulation. Inflammation breaks down the blood-retinal-barriers, which leads to increased vascular permeability. The transudate accumulates in the outer and inner layers of the retina to create cystic spaces.
The Dexamethasone implant (Ozurdex®) is a biodegradable intravitreal drug delivery implant providing sustained release of 0.7mg of corticosteroid, modulating the mediators acting on ocular inflammation process.

Discussão e Conclusões / Discussion

There is currently no standardized treatment for postoperative CME. Therapeutic modalities include corticosteroids, NSAI drugs and oral carbonic anhydrase inhibitors. Anti-VEGF agents and dexamethasone implants. In our case of treatment, Ozurdex® reduced macular edema and improved visual acuity without observation of side effects, suggesting that treatment of post-operative CME with sustained-release dexamethasone implant may be considered as an excelent option for patients diagnosed with Irvine-Gass syndrome, even in cases with longer edema duration and in refractory cases.

Palavras Chave

Irvine-Gass Syndrome ; Refractory ; Ozurdex