Ivan Fiser, Martina Rubesova (Prague, Czech Republic)

Advantages:

CME after CRVO is a typical case where it is very difficult to define which treatment is best to start with. Triamcinolone can be helpful (which was shown in a recent study) but a recurrence can happen. Avastin also has a temporary effect. ILM peeling can be beneficial, too, but we also see recurrences of CME after it. Laser treatment of edematous retina is difficult. We have tried all imaginable consequences of procedures and our experience shows that it is good to start with Avastin or TMC for edema regression, then proceed to ILM peeling for Muller cells stimulation and finally treat the retina gently with laser to the ischemic areas to prevent from VEGF production and recurrence of CME.

Methods:

A group of 8 eyes with CME after was treated using above mentioned methods and their combinations. We found that ILM peeling itself helps in half of eyes but opens several questions: 1. Can the late RPE and/or neuroretina atrophy with vision worsening (2 eyes) be explained by the primary ischemia itself? 2. What are the reasons for the recurrence of CME (4 eyes)? 3. If Avastin or triamcinolone is used in combination therapy, should it be injected before vitrectomy or after? 4. Is laser beneficial in stabilizing the macula?

Effectiveness / Safety:

Case reports will be presented to support the above-mentioned proposal.

Take home message:

CME after CRVO is a complex disease sometimes requiring a combined treatment consisting of anti-VEGF, vitrectomy with ILM peeling and gentle laser coagulation.