Persistent Cystoid Macular Edema

I have posted similar questions about persistent CME in the past; but I guess I keep hoping someone will have a magic cure or some new insight. Here goes: I had CME in one eye after Crystalens surgery two years ago. The surgeon implanted Crystalens dispite an anterior capsule tear. Perhaps the flexing movement of the implant caused the tear to extend, or maybe it has nothing to do with this, but I've had nothing but problems with this eye. CME occurred immediately post-op. It took several months to resolve even with drops and intravitreous steroid. It recurred a year later when I had a vitrectomy, got progressively worse for 6 months dispite monthy Avastin injections, got better, and now seems to be relapsing, now at the 9 month mark, to the worst degree yet. My retina thickness today was 462 and this is 9 months post-vitrectomy and after 8 Avastin since then. MY QUESTION: My retina specialist will not use Kenalog because I am a steroid responder (ocular hypertension)..He is a believer in Avastin. He says there is nothing better available. Is this class of drug (anti-vegf) my only choice. Frankly, I can't see how it is doing me any good. Maybe, my particular case would respond to a different approach. My retina doctor feels strongly that an IOL exchange would not benefit the situation, though that has been suggested by others due to retained cortex/elschnig pearls. Is there any research on new treatments for CME like mine???

[John C Hagan III, MD, FACS, FAAO]

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