Exploring the Efficacy and Safety of Intravitreal Fluocinolone Acetonide Implant (ILUVIEN®) in the Management of Irvine-Gass Syndrome: Insights from a Retrospective Case Series Analysis

Introduction: Irvine-Gass Syndrome (IGS), also known as pseudophakic cystoid macular edema (CME), is a postoperative complication that can lead to reduced visual acuity following cataract surgery.While many cases resolve spontaneously, those that persist pose therapeutic challenges.Currently, there is no standardized treatment for recurrent cases.However, clinical evidence and theoretical reasoning support the use of intravitreal corticosteroids.The 0.19-mg sustained-release fluocinolone acetonide (FAc) implant (ILUVIEN®, Alimera Science) is approved for the treatment of chronic diabetic macular edema and the prevention of relapse in noninfectious posterior uveitis.This study aims to evaluate the efficacy and safety of the off-label use of ILUVIEN® in patients with IGS.Methods: Five eyes from five patients with IGS who underwent FAc implants at Centro Hospitalar de Entre o Douro e Vouga were retrospectively reviewed.Patients were examined at baseline, at months 1, 3, and quarterly thereafter.Results: Two patients were female, and the mean age was 78.8 ± 11.1 years.Before receiving ILUVIEN®, all eyes received short-term corticosteroid therapies with triamcinolone and/or dexamethasone (3.5 ± 0.5 intravitreal injections).The mean duration of CME before the FAc implant was 1.9 ± 0.9 years.The mean follow-up time after the FAc was 14.4 ± 5.2 months.The study demonstrated significant improvements in anatomical and functional outcomes, with either maintained or reduced central foveal thickness (CFT) and either maintained or improved best-corrected visual acuity (BCVA).The median BCVA at baseline and at the last observation was 0.30 [0.10; 0.65] logMAR, and 0.10 [0.10; 0.10] logMAR, respectively.The median CFT before FAc was 423 [371; 487] µm.At the last observation, it significantly decreased to 262 [282; 305] µm.No significant intraocular pressure (IOP) increase was observed.Two eyes required IOP-lowering medication before the FAc implant and continued it throughout. Conclusions:In this study, both BCVA and CFT improved from baseline after treatment with FAc in patients with IGS in a routine clinical setting.ILUVIEN® may play a role in eyes with recurrent CME, providing longer recurrence-free periods and reducing the burden of short-acting corticosteroids.In this series, there were no safety concerns regarding the increase in IOP.