A patient developed macular oedema after cataract surgery which did not settle with the usual treatment of steroids and nsaid's - alphagan was prescribed with no change in the macular thickness on OCT. Colleagues comments on this scenario are to be welcomed
My approach is to add to Dexamethasone qtd and Diclofenac qtd AZOPT 1% ( Brinzolamide) and add orally Acetazolamide. Additional subtenon's injection of Triamcinolonei
Marianne, thankyou for your response but what I did not previously state, for which I apologise, is that the patient showed a positive steroid response to pred forte and was changed to Diamox and timolol. The macular oedema did not settle and a colleague commenced a trial of alphagan [brimonidine]- this is an unlicenced use and I can find no reference to the use of alphagan and macular oedema
Dear Peter,
I have not read any paper on alphagan use in ME, but in my opinion brimonidine could cause more inflammation. In contrast , I have mentioned well working and published in Ophthalmology Times protocol for ME - including simultaneous use of steroid 4+ NSAID 4+ Diamox or Azopt up to 3 mo. If after 1mo is no positive change subtenon's injection of Triamcinolonei .
Good luck and warmest regards,
Marainne
Definitely Brimonidine has anti-inflammatory effects.
Recently I prescribed Combigan ED to a patient suffering from recent non-ischemic CRVO with Cystoid Macular Edema in preparation for Intra-vitreal injection of Ozurdex implant (patient is contra-indicated for anti-VEGFs). Due to insurance related issues he had to repeat his OCT scan which revealed definite improvement in the macular height and extent of edema as well as UCVA.
I assume you are considering DME, but the principle applies to RVO related edema as well.
Dear Peter,
you can use anti veg F injection either bevacizumab or ranibizumab, if the patient has macular oedema and steroid responder wrt IOP
best regards
thirumalesh
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