Intravitreal Injection of Dexamethasone Implant in Serous Macular Detachment Associated with Waldenström's Disease
A female patient, aged 52 years, affected by WM since December 2010, came to our Department in November 2012 complaining of a decrease in visual acuity and floating vision in both eyes, which was more severe in the left eye, for the duration of about 1 month. The patient had been treated with systemic corticosteroid and was currently undergoing chemotherapy with Rituxan® (rituximab) and Velcade® (bortezomib). At the time of the visit, the best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/30 in the left eye. At the slit lamp examination, the anterior segment was normal in both eyes, with no opacity of the lens and/or any signs of ocular inflammation. The intraocular pressure at Goldmann tonometry was 14 mm Hg in both eyes. A bilateral CRVO was diagnosed and confirmed by fluorescein angiography (FAG) and spectral domain optical coherence tomography (SD-OCT). FAG showed a bilateral CRVO with macular edema, complicated by serous macular detachment (SMD) in the left eye. SD-OCT (Cross Line, MM5, 3D Macular, RTVue® SD-OCT) showed a foveal thickness of 349 µm in the right eye and 858 µm in the left eye (fig. ).\nThe left eye was treated with an intravitreal injection of dexamethasone (Ozurdex®; Allergan, Inc., Irvine, Calif., USA) 3 days after the diagnosis. Ozurdex is a biodegradable copolymer of lactic acid and glycolic acid containing micronized dexamethasone, which forms a matrix structure able to gradually release the total dose over time after the injection []. The most common local side effect can be an increase of intraocular pressure and cataract [].\nOne month after the injection, the SD-OCT of the left eye showed a slight reduction of foveal thickness (686 µm) that was not related to any improvement of visual function (fig. ).\nAt 2 and 6 months after the injection, the SD-OCT showed a further mild reduction of foveal thickness that was 680 and 547 µm, respectively (fig. ).\nThis proves that there was a partial response to the injection of Ozurdex, although a complete reduction of foveal thickness is never achieved, unlike the usual response in non-WM-related CRVO [].\nAt the time of the follow-ups, 1, 2, and 6 months after the injection, BCVA remained stable at 20/30, intraocular pressure was 14 mm Hg, and the patient did not show any sign of opacity of the lens or ocular inflammation.\nIt was not possible to repeat the FAG because the patient's general health condition deteriorated over time.\nWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the consent is available for review.