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Macular oedema secondary to rhegmatogenous retinal detachment repair: risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant

Eye volume 38, pages 1155–1161 (2024)Cite this article

Subjects

Abstract

Objectives

To assess the risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant (Ozurdex®) of patients with macular oedema (MO) secondary to rhegmatogenous retinal detachment repair (RRDR).

Methods

This was a retrospective, consecutive cohort study conducted in patients who underwent RRDR between January 2014 and December 2020 in the Rothschild Foundation Hospital and experienced postoperative MO (POMO) with a follow-up of at least 18 months.

Results

Of the 1152 patients screened, 36 eyes (3.1%) experienced POMO. The mean follow-up duration was 45.2 months (18.0–80.5 months). Twenty-five eyes (69.4%) were resistant to first-line therapy and received at least one Ozurdex® injection (mean number: 2.7 [1–12]). The multivariate analysis showed an increased risk of resistance in patients who underwent perfluorocarbon liquid (PFCL)-assisted drainage (adjusted odds ratio: 8.65; 95% confidence interval: 1.97–15.33; p = 0.01). Significant differences in best-corrected visual acuity and central macular thickness were found between before Ozurdex® injection and the last follow-up visit: from 0.57 ± 0.47 LogMAR to 0.34 ± 0.32 LogMAR (p = 0.02) and from 483.0 ± 124.0 µm to 354.6 ± 96.5 µm (p = 0.001), respectively. The absence of serous retinal detachment and the presence of hyperreflective foci at baseline were associated with a higher resistance and a poorer response to Ozurdex®. Two patients (8%) experienced hypertony, that was well controlled with hypotonic drops.

Conclusion

MO secondary to RRDR is challenging. Ozurdex® could be reasonably proposed as first-line treatment, at least when MO occurs following PFCL-assisted drainage, given the favourable long-term benefit/risk ratio.

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Fig. 1
Fig. 2
Fig. 3: SD-OCT macular scans of a 74-year-old phakic patient who experienced macular oedema after initial rhegmatogenous retinal detachment repair.
Fig. 4: SD-OCT macular scans of a 61-year-old pseudophakic patient with relapsing rhegmatogenous retinal detachment.

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Data availability

The data that support the findings of this study are available from the corresponding author, SS, upon reasonable request.

References

  1. Irvine AR. A newly defined vitreous syndrome following cataract surgery, interpreted according to recent concepts of the structure of the vitreous. Am J Ophthalmol. 1953;36:599–619.

    Article  CAS  PubMed  Google Scholar 

  2. Gass JD, Norton EW. Cystoid Macular edema and papilledema following cataract extraction: a fluorescein fundoscopic and angiographic study. Arch Ophthalmol. 1966;76:646–61.

    Article  CAS  PubMed  Google Scholar 

  3. Irvine AR. Cystoid maculopathy. Surv Ophthalmol. 1976;21:1–17.

    Article  CAS  PubMed  Google Scholar 

  4. Zur D, Loewenstein A. Postsurgical cystoid macular edema. Dev Ophthalmol. 2017;58:178–90.

    Article  PubMed  Google Scholar 

  5. Romano V, Angi M, Scotti F, et al. Inflammation and macular oedema after pars plana vitrectomy. Mediators Inflamm. 2013;2013:971758.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Starr MR, Cai L, Obeid A, Ryan EH, Eliott D, Ryan C, et al. Primary Retinal Detachment Outcomes (PRO) Study Group. Risk factors for presence of cystoid macular edema following rhegmatogenous retinal detachment surgery. Curr Eye Res. 2021;46:1867–75.

    Article  CAS  PubMed  Google Scholar 

  7. Merad M, Vérité F, Baudin F, Ghezala IB, Meillon C, Bron AM, et al. Cystoid macular edema after rhegmatogenous retinal detachment repair with pars plana vitrectomy: rate, risk factors, and outcomes. J Clin Med. 2022;11:4914.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chatziralli I, Theodossiadis G, Dimitriou E, Kazantzis D, Theodossiadis P. Macular edema after successful pars plana vitrectomy for rhegmatogenous retinal detachment: factors affecting edema development and considerations for treatment. Ocul Immunol Inflamm. 2021;29:187–92.

    Article  PubMed  Google Scholar 

  9. McKay BR, Bansal A, Kryshtalskyj M, Wong DT, Berger A, Muni RH. Evaluation of subretinal fluid drainage techniques during pars plana vitrectomy for primary rhegmatogenous retinal detachment-ELLIPSOID study. Am J Ophthalmol. 2022;241:227–37.

    Article  CAS  PubMed  Google Scholar 

  10. Du J, Landa G. Impact of prior pars plana vitrectomy on development of cystoid macular edema after uneventful cataract surgery. J Cataract Refract Surg. 2023;49:266–71.

    Article  PubMed  Google Scholar 

  11. Sengupta S, Vasavada D, Pan U, Sindal M. Factors predicting response of pseudophakic cystoid macular edema to topical steroids and nepafenac. Indian J Ophthalmol. 2018;66:827–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bellocq D, Korobelnik JF, Burillon C, Voirin N, Dot C, Souied E, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study. Br J Ophthalmol. 2015;99:979–83.

    Article  PubMed  Google Scholar 

  13. Bellocq D, Pierre-Kahn V, Matonti F, Burillon C, Voirin N, Dot C, et al. Effectiveness and safety of dexamethasone implants for postsurgical macular oedema including Irvine-Gass syndrome: the EPISODIC-2 study. Br J Ophthalmol. 2017;101:333–41.

    PubMed  Google Scholar 

  14. Thanos A, Todorich B, Yonekawa Y, Papakostas TD, Khundkar T, Eliott D, et al. Dexamethasone intravitreal implant for the treatment of recalcitrant macular edema after rhegmatogenous retinal detachment repair. Retina. 2018;38:1084–90.

    Article  CAS  PubMed  Google Scholar 

  15. Freissinger S, Vounotrypidis E, Wolf A, Kortuem KU, Shajari M, Sakkias F, et al. Evaluation of functional outcomes and OCT-biomarkers after intravitreal dexamethasone implant for postoperative cystoid macular edema in vitrectomized eyes. J Ophthalmol. 2020;2020:3946531.

    PubMed  PubMed Central  Google Scholar 

  16. Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M. Visual acuities “hand motion” and “counting fingers” can be quantified with the freiburg visual acuity test. Investig Ophthalmol Vis Sci. 2006;47:1236–40.

    Article  Google Scholar 

  17. Miyake K, Miyake Y, Maekubo K, Asakura M, Manabe R. Incidence of cystoid macular edema after retinal detachment surgery and the use of topical indomethacin. Am J Ophthalmol. 1983;95:451–6.

    Article  CAS  PubMed  Google Scholar 

  18. Gebler M, Pfeiffer S, Callizo J, Hoerauf H, Feltgen N, Bemme S. Incidence and risk factors for macular oedema after primary rhegmatogenous retinal detachment surgery: a prospective single-centre study. Acta Ophthalmol. 2022;100:295–301.

    Article  PubMed  Google Scholar 

  19. Gharbiya M, Visioli G, Iannetti L, Iannaccone A, Tamburrelli AC, Marenco M, et al. Comparison between scleral buckling and vitrectomy in the onset of cystoid macular edema and epiretinal membrane after rhegmatogenous retinal detachment repair. Retina. 2022;42:1268–76.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Daien V, Papinaud L, Domerg C, Lacombe S, Daures JP, Villain M. Incidence and characteristics of cystoid macular edema after cataract surgery. Ophthalmology. 2016;123:663–4.

    Article  PubMed  Google Scholar 

  21. Lai TT, Huang JS, Yeh PT. Incidence and risk factors for cystoid macular edema following scleral buckling. Eye. 2017;31:566–71.

    Article  PubMed  Google Scholar 

  22. Pole C, Chehaibou I, Govetto A, Garrity S, Schwartz SD, Hubschman JP. Macular edema after rhegmatogenous retinal detachment repair: risk factors, OCT analysis, and treatment responses. Int J Retina Vitr. 2021;7:9.

    Article  Google Scholar 

  23. Peyman GA, Schulman JA, Sullivan B. Perfluorocarbon liquids in ophthalmology. Surv Ophthalmol. 1995;39:375–95.

    Article  CAS  PubMed  Google Scholar 

  24. Ankamah E, Sebag J, Ng E, Nolan JM. Vitreous antioxidants, degeneration, and vitreo-retinopathy: exploring the links. Antioxidants. 2019;9:7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rajesh B, Zarranz-Ventura J, Fung AT, Busch C, Sahoo NK, Rodriguez-Valdes PJ, et al. Safety of 6000 intravitreal dexamethasone implants. Br J Ophthalmol. 2020;104:39–46.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Vitreoretinal Surgery, Rothschild Foundation Hospital, 25-29 rue Manin, 75019, Paris, France

    Soufiane Souissi, Violaine Allou, Laura Trucchi, Yannick Le Mer & Ramin Tadayoni

  2. Department of Ophthalmology, Lariboisière Hospital, 2 rue Ambroise Paré, 75010, Paris, France

    Ramin Tadayoni & Aude Couturier

Authors
  1. Soufiane Souissi
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  2. Violaine Allou
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  3. Laura Trucchi
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  4. Yannick Le Mer
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  5. Ramin Tadayoni
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  6. Aude Couturier
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Contributions

SS, RT, AC: design. SS, VA, LT, YLM, RT, AC: Conduct of the study. SS, VA, LT: Collection. SS, RT, YLM, AC: Management. SS, VA: Analysis. SS, VA, LT: Interpretation of the data. SS, VA: Preparation. SS, YLM, RT, AC: Review. SS, AC: approval of the manuscript.

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Correspondence to Soufiane Souissi.

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Souissi, S., Allou, V., Trucchi, L. et al. Macular oedema secondary to rhegmatogenous retinal detachment repair: risk factors for resistance to first-line therapy and long-term response to dexamethasone intravitreal implant. Eye 38, 1155–1161 (2024). https://doi.org/10.1038/s41433-023-02852-x

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