title: Efficacy of intravitreal dexamethasone implant for prostaglandin-induced refractory pseudophakic cystoid macular edema: case report and review of the literature.
abstract: BACKGROUND
  Macular edema is a known complication even after uneventful cataract surgery. The chronic use of prostaglandin analogs is a risk factor for the development of pseudophakic cystoid macular edema (CME). Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered first-line therapy but refractory postsurgical CME represents a therapeutic challenge, as there is not an evidence-based treatment.
  
  
  OBJECTIVE
  To report the use of a single implant of intravitreal dexamethasone for tafluprost-associated pseudophakic CME refractory to NSAIDs and to sub-Tenon's corticosteroid injections.
  
  
  METHODS
  A 64-year-old female with ocular hypertension treated with tafluprost experienced decreased vision (visual acuity 20/60) and metamorphopsia 2 months after uneventful cataract extraction. Spectral domain optical coherence tomography (SD-OCT) revealed CME. After 1 month of topical and oral NSAIDs, CME was still evident on SD-OCT (visual acuity 20/50). Two sub-Tenon's betamethasone injections were performed at a 2-week interval. As CME was still present, 2 months after the diagnosis of CME (visual acuity 20/40), the patient underwent a single dexamethasone intravitreal implant. One month later, macular appearance was normal, and visual acuity increased to 20/30. This result was maintained throughout the 6 months of follow-up.
  
  
  CONCLUSIONS
  In this report, a single implant of intravitreal dexamethasone successfully treated pseudophakic CME associated with the use of prostaglandin analogs unresponsive to NSAIDs and sub-Tenon's betamethasone. The results of this report need to be corroborated by powered, prospective, randomized trials. The need for repeated treatments as well as the retreatment interval in patients requiring more than a single injection are issues still needing further investigations.
authors: University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors: Matteo
authors: M
authors: Sacchi
authors: University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors: Edoardo
authors: E
authors: Villani
authors: University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors: Francesca
authors: F
authors: Gilardoni
authors: University Eye Clinic, San Giuseppe Hospital, University of Milan, Milan, Italy.
authors: Paolo
authors: P
authors: Nucci
keywords: cataract surgery; intravitreal dexamethasone implant; prostaglandin-induced refractory cystoid macular edema; pseudophakic cystoid macular edema; tafluprost