Intravitreal and Subtenon Depot Triamcinolone As Treatment of Retinitis Pigmentosa Associated Cystoid Macular Edema

Overview

Journal Case Rep Ophthalmol Med

Publisher Wiley

Specialty Ophthalmology

Date 2014 Jan 24

PMID 24455364

Citations 4

Authors

Sidnei Barge

Renata Rothwell

Paula Sepulveda

Luis Agrelos

Affiliations

Soon will be listed here.

Abstract

We present a case of retinitis pigmentosa (RP) related cystoid macular edema (CME) refractory to oral acetazolamide and topical ketorolac that was treated with intravitreal and subtenon depot triamcinolone. A 32-year-old male with RP presented with complaints of bilateral decrease in visual acuity. His best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/100 in the left eye. After being informed of the available treatment options, the patient received bilateral intravitreal injection triamcinolone. The patient's BCVA improved to 20/40 in the right eye and 20/50 in the left eye and the CME was resorbed. However, 5 months after the injection in the left eye and two months in the right eye, visual acuity decreased due to recurrence of CME. We performed a second intravitreal injection in the left eye with improvement of visual and anatomic results, but we observed a recurrence of CME. Afterwards, we treated the patient with subtenon depot triamcinolone in both eyes, with the result that there was no recurrence after 4 months in OD or after 3 months in OS. We conclude that intravitreal and subtenon depot triamcinolone appear to provide at least temporary benefit in refractory CME as regards the improvement of visual acuity.

Citing Articles

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References

Fishman G, Maggiano J, Fishman M . Foveal lesions seen in retinitis pigmentosa. Arch Ophthalmol. 1977; 95(11):1993-6. DOI: 10.1001/archopht.1977.04450110087008. View

Apushkin M, Fishman G, Janowicz M . Monitoring cystoid macular edema by optical coherence tomography in patients with retinitis pigmentosa. Ophthalmology. 2004; 111(10):1899-904. DOI: 10.1016/j.ophtha.2004.04.019. View

Melo G, Farah M, Aggio F . Intravitreal injection of bevacizumab for cystoid macular edema in retinitis pigmentosa. Acta Ophthalmol Scand. 2007; 85(4):461-3. DOI: 10.1111/j.1600-0420.2006.00872.x. View

Sandberg M, Brockhurst R, Gaudio A, Berson E . The association between visual acuity and central retinal thickness in retinitis pigmentosa. Invest Ophthalmol Vis Sci. 2005; 46(9):3349-54. DOI: 10.1167/iovs.04-1383. View

Penfold P, Wen L, Madigan M, Gillies M, King N, Provis J . Triamcinolone acetonide modulates permeability and intercellular adhesion molecule-1 (ICAM-1) expression of the ECV304 cell line: implications for macular degeneration. Clin Exp Immunol. 2000; 121(3):458-65. PMC: 1905725. DOI: 10.1046/j.1365-2249.2000.01316.x. View

Moldow B, Sander B, Larsen M, Engler C, Li B, Rosenberg T . The effect of acetazolamide on passive and active transport of fluorescein across the blood-retina barrier in retinitis pigmentosa complicated by macular oedema. Graefes Arch Clin Exp Ophthalmol. 1998; 236(12):881-9. DOI: 10.1007/s004170050175. View

Grover S, Apushkin M, Fishman G . Topical dorzolamide for the treatment of cystoid macular edema in patients with retinitis pigmentosa. Am J Ophthalmol. 2006; 141(5):850-8. DOI: 10.1016/j.ajo.2005.12.030. View

Hamel C . Retinitis pigmentosa. Orphanet J Rare Dis. 2006; 1:40. PMC: 1621055. DOI: 10.1186/1750-1172-1-40. View

Batioglu F, Ozmert E, Parmak N, Celik S . Two-year results of intravitreal triamcinolone acetonide injection for the treatment of diabetic macular edema. Int Ophthalmol. 2007; 27(5):299-306. DOI: 10.1007/s10792-007-9072-7. View

10.

Wolfensberger T, Aptsiauri N, Godley B, Downes S, Bird A . [Antiretinal antibodies associated with cystoid macular edema]. Klin Monbl Augenheilkd. 2000; 216(5):283-5. DOI: 10.1055/s-2000-10561. View

11.

Querques G, Prascina F, Iaculli C, Delle Noci N . Intravitreal pegaptanib sodium (Macugen) for refractory cystoid macular edema in pericentral retinitis pigmentosa. Int Ophthalmol. 2007; 29(2):103-7. DOI: 10.1007/s10792-007-9175-1. View

12.

Adler R . Mechanisms of photoreceptor death in retinal degenerations. From the cell biology of the 1990s to the ophthalmology of the 21st century?. Arch Ophthalmol. 1996; 114(1):79-83. DOI: 10.1001/archopht.1996.01100130075012. View

13.

Hirakawa H, Iijima H, Gohdo T, Tsukahara S . Optical coherence tomography of cystoid macular edema associated with retinitis pigmentosa. Am J Ophthalmol. 1999; 128(2):185-91. DOI: 10.1016/s0002-9394(99)00100-2. View

14.

Saraiva V, Sallum J, Farah M . Treatment of cystoid macular edema related to retinitis pigmentosa with intravitreal triamcinolone acetonide. Ophthalmic Surg Lasers Imaging. 2003; 34(5):398-400. View

15.

Jonas J, Akkoyun I, Kamppeter B, Kreissig I, Degenring R . Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide. Eye (Lond). 2004; 19(1):65-71. DOI: 10.1038/sj.eye.6701395. View

16.

Vinores S, Derevjanik N, Ozaki H, Okamoto N, Campochiaro P . Cellular mechanisms of blood-retinal barrier dysfunction in macular edema. Doc Ophthalmol. 2000; 97(3-4):217-28. DOI: 10.1023/a:1002136712070. View

17.

Heckenlively J, Solish A, Chant S . Autoimmunity in hereditary retinal degenerations. II. Clinical studies: antiretinal antibodies and fluorescein angiogram findings. Br J Ophthalmol. 1985; 69(10):758-64. PMC: 1040734. DOI: 10.1136/bjo.69.10.758. View

18.

Garcia-Arumi J, Martinez V, Sararols L, Corcostegui B . Vitreoretinal surgery for cystoid macular edema associated with retinitis pigmentosa. Ophthalmology. 2003; 110(6):1164-9. DOI: 10.1016/S0161-6420(03)00259-8. View

19.

Ozdemir H, Karacorlu M, Karacorlu S . Intravitreal triamcinolone acetonide for treatment of cystoid macular oedema in patients with retinitis pigmentosa. Acta Ophthalmol Scand. 2005; 83(2):248-51. DOI: 10.1111/j.1600-0420.2005.00395.x. View

20.

Stanga P, Downes S, Ahuja R, Chong N, Antcliff R, Reck A . Comparison of optical coherence tomography and fluorescein angiography in assessing macular edema in retinal dystrophies: preliminary results. Int Ophthalmol. 2002; 23(4-6):321-5. DOI: 10.1023/a:1014438213665. View