Postsurgical Macular Edema after Rhegmatogenous Retinal Detachment: Risk Factors for Recalcitrance to First-Line Therapy and Long-Term Response to Dexamethasone Intravitreal Implant

Abstract

Abstract Objectives: To assess the risk factors for recalcitrance to first-line therapy and the long-term response to dexamethasone intravitreal implant (Ozurdex®) of postsurgical macular edema (PSME) after rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective consecutive cohort study of patients who underwent RRD repair between January 2014 and December 2020 at the Rothschild Foundation Hospital and who experienced PSME with at least 18 months of follow-up. Results: Of the 1 152 patients screened, 36 eyes had a PSME (incidence: 3.1%). The mean follow-up was 45.2 months (18.0-80.5 months). Twenty-five eyes (69.4%) were recalcitrant to first-line therapy and received at least one Ozurdex® (mean number: 2.7 [1-12]). On multivariate analysis, perfluorocarbon liquid (PFCL)-assisted drainage was found to significantly increase the risk of recalcitrance (adjusted odds ratio 8.65; 95% confidence interval 1.97-15.33; p = 0.01). A significant difference in best-corrected visual acuity (BCVA) and central macular thickness (CMT) was found before Ozurdex® and at the last follow-up visit: 0.57 ± 0.47 LogMAR vs. 0.34 ± 0.32 LogMAR (p = 0.02) and 483.0 ± 124.0 µm to 354.6 ± 96.5 µm (p=0.001). The absence of serous retinal detachment and the presence of hyperreflective foci at baseline were negative prognostic factors both for recalcitrance and for response to Ozurdex®. Two patients (8%) experienced hypertony, which was well controlled with hypotonic drops. Conclusion: PSME after RRD is highly recalcitrant. Ozurdex® could be reasonably proposed as a first-line treatment, at least if it occurs after PFLC-assisted drainage, given the favorable benefit/risk ratio in the long term.