Treating Cystoid Macular Edema with Ocular hpyertension

[BUTTERCUP109]

This is more a comment than a question...because it may be useful to others who come to this forum for help. I have posed this question previously without getting much good advice: What can I do to treat chronic cystoid macular edema that has not responded to topical treatments or intravitreous Avastin if intravitreal steroids are contraindicated due to elevated intraocular pressure? I saw a specialist today and the answer may be to have a drain surgically placed prior to receiving the steroid injection. An internal limiting membrane peel was also suggested to help the CME resolve. I feel very relieved that there may be a solution to my problem, even if it means another surgery. I hope this concept may  help others. Comments?

[BUTTERCUP109]

Regarding the attempts to control my IOP, I've been on Cosopt for about 3 months and a week ago added Alphagan when it was found that my IOP was in the upper 30s. We are watching the pressure while I stay on Cosopt/Alphagan and drop the Pred Forte. I'm only on Nevanac for the CME. I've had CME now for over a year.

[BUTTERCUP109]

Thank you both for your comments. I need all the input I can get since this is a very difficult quandry I'm facing. All advice is welcome.

[JodieJ]

Some (but not all) surgeons use ICG staining of the ILM during surgery.  This practice is controversial, because there is some evidence that ICG dye is toxic and damages the retina.  If you do decide to have an ILM peel, find a surgeon who doesn't use dye.  (You'd probably want to get a second opinion before proceeding with this option.)

I applaud your continued efforts to resolve your vision problems.  Best wishes.

[Ray T Oyakawa, MD]

Consider having the steroid injection and if the secondary elevation in IOP can not be controlled by meds, have surgery for glaucoma.


Dr. O.