Eyeworld

N EWS 34 | EYEWORLD | APRIL 2019 by Maxine Lipner EyeWorld Senior Contributing Writer Contact information Thorne: jthorne@jhmi.edu RESEARCH HIGHLIGHT did not matter whether the uveitis was active or inactive at the time of randomization, she said, adding that in order to qualify, patients needed be on a stable amount of medication, have OCT measurements outside the normal range, and not have severe glaucoma. The primary outcome that investigators sought was the proportion of improvement of the central subfield thickness from baseline to 8 weeks after injection as assessed with an OCT measurement graded by a masked reader. "Secondary outcomes included 20% or greater improvement in central subfield thickness and resolution of macular edema over the 24-week study follow-up," Dr. Thorne said. As part of the study, investigators also looked at improvement in BCVA and followed the IOP measurement to look for ocular hypertension, development of glaucoma, and need for glaucoma medications to control eye pressure, Dr. Thorne noted. I njections of corticosteroids directly into the eye are superior to those placed adjacent to the eye for treating uveitic macular edema, study 1 results published in Ophthalmology show, according to Jennifer Thorne, MD, PhD. The PeriOcular vs. INTravitreal cortico- steroids for uveitic macular edema (POINT) Trial examined the effectiveness of three corticosteroid treatment approaches for patients with uveitic macular edema: regional therapy with periocular triamcinolone injections, intravitreal triamcino- lone injections, and an intravitreal dexamethasone implant. While these treatments are three of the more commonly utilized modalities for uveitic macular edema, there is a relative paucity of head-to-head comparisons. "The idea behind the trial was to compare these three modalities for the treatment of uveitic macular edema in terms of effective- ness and safety," Dr. Thorne said. The trial included patients who had nonin- fectious uveitis complicated by macular edema. It Intravitreal vs. periocular approaches for uveitic macular edema continued on page 36 and further protecting the endothelium and the posterior capsule by using dispersive viscoelastic, replenishing it as necessary. CyPass explantation Peter T. Chang, MD, shared a case where he had to explant a CyPass Micro-Stent device (Alcon). A 69-year-old patient came to him unhappy with a CyPass surgery that she had had performed 3 months ago out of state. When Dr. Chang saw the patient, the pressure was 26 mm Hg and refraction was hyperopic. Dr. Chang said some of the potential op- tions he considered included leaving the CyPass alone and placing a new CyPass, leaving the CyPass alone and placing a tube shunt, pushing the CyPass further into the supraciliary space, or exchanging for a new CyPass. When Dr. Chang went in to exchange the CyPass, he found severe fibrosis in the supracil- iary space, and the CyPass didn't move when he tried to tap on it, yank on it, and cut it. When he did finally manage to remove it, Dr. Chang said he decided not to use another CyPass or tube shunt in light of the resulting cyclodialysis cleft. He concluded that the CyPass scars quickly in the supraciliary space, and though removal of the device is difficult, it's not impossible. The compa- ny recommends trimming the device, he said, but this may be difficult as well. Specialists need better ways to deal with improperly implanted CyPass devices, he added. On August 29, 2018, Alcon voluntarily with- drew the CyPass from the market due to safety concerns. An ASCRS task force provided moni- toring, intervention, and revision considerations that were published in the October 2018 issue of EyeWorld. continued from page 32 About the doctor Jennifer Thorne, MD, PhD Cross Family Professor of Ophthalmology and Epidemiology Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Reference 1. Thorne JE, et al. Periocular triamcinolone vs. intravitreal triamcinolone vs. intravitreal dexamethasone implant for the treatment of uveitic macular edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial. Ophthalmology. 2019;126:283–295. Financial interests Thorne: Allergan

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