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

Barge, Sidnei; Rothwell, Renata; Sepúlveda, Paula; Agrelos, Luís

doi:10.1155/2013/591681

Cited by 7 publications

(4 citation statements)

References 39 publications

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“…A case report of bilateral RP-CMO refractory to IVTA reported CMO reduction and VA improvement following bilateral sub-Tenon injections of triamcinolone 62. CMO recurred in one eye at 3 months.…”

Section: Avenues Of Interventionmentioning

confidence: 96%

Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention

2016

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Hereditary retinal diseases are now the leading cause of blindness certification in the working age population (age 16–64 years) in England and Wales, of which retinitis pigmentosa (RP) is the most common disorder. RP may be complicated by cystoid macular oedema (CMO), causing a reduction of central vision. The underlying pathogenesis of RP-associated CMO (RP-CMO) remains uncertain, however, several mechanisms have been proposed, including: (1) breakdown of the blood-retinal barrier, (2) failure (or dysfunction) of the pumping mechanism in the retinal pigment epithelial, (3) Müller cell oedema and dysfunction, (4) antiretinal antibodies and (5) vitreous traction. There are limited data on efficacy of treatments for RP-CMO. Treatments attempted to date include oral and topical carbonic anhydrase inhibitors, oral, topical, intravitreal and periocular steroids, topical non-steroidal anti-inflammatory medications, photocoagulation, vitrectomy with internal limiting membrane peel, oral lutein and intravitreal antivascular endothelial growth factor injections. This review summarises the evidence supporting these treatment modalities. Successful management of RP-CMO should aim to improve both quality and quantity of vision in the short term and may also slow central vision loss over time.

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Section: Avenues Of Interventionmentioning

confidence: 96%

Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention

2016

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“…Intraocular inflammation including cytokines and chemokines reaction disturbed the BRB function and led to CMO. 12 Barge and colleagues 7 described a case report that triamcinolone via subtenon and intravitreal injection showed temporary benefits in refractory CMO with improvement of visual acuity. Moreover, Lucia and colleagues reported that in non-randomised comparative trail.…”

Section: Discussionmentioning

confidence: 99%

“… 6 Several previous studies have reported that CAI and corticosteroids showed effective improvement of CMO in RP. 7 However, CAI and corticosteroids may not adequately demonstrate desired effects or may permit recurrence by single agent treatment. 8–10 Few studies have focused on additional treatments to persistent CMO in RP.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of additional topical betamethasone in persistent cystoid macular oedema after carbonic anhydrase inhibitor treatments in retinitis pigmentosa

et al. 2018

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ObjectiveWe investigated the efficacy of additional topical betamethasone in persistent cystoid macular oedema (CMO) after carbonic anhydrase inhibitors (CAIs) therapy.Methods and analysisThis retrospective cohort study included 16 eyes of 10 patients with retinitis pigmentosa (RP). All patients were previously administered CAI for at least 3 months to treat CMO secondary to RP and lacking an effective reduction (≥11%) of central foveal thickness (CFT). We administered topical 0.1% betamethasone daily in each affected eye following a preceding course of the CAI medication as a first treatment. CMO was diagnosed using spectral-domain optical coherence tomography. CFT was regarded as the average of vertical and horizontal foveal thickness. Best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained from patient medical records. We compared the CFT and BCVA between baseline and the average of 1–3, 5–7, 10–14 and 16–20 months period.ResultsIn treatments with brinzolamide in 14 eyes, dorzolamide in 2 eyes and bromfenac in 2 eyes, CFT effectively decreased in 12 of 16 eyes (81%). CFT decreased significantly in 1–3 months (326±102 µm; n=16; P=0.029) and 5–7 months (297±102 µm; n=12; P=0.022) compared with baseline but not within 10–14 months (271±96 µm; n=9; P=0.485) or 16–20 months (281±134 µm; n=9; P=0.289). There were no significant intergroup differences in BCVA throughout the study. Betamethasone treatment was stopped in three patients because of IOP elevation.ConclusionOur data suggested that additional betamethasone might improve treatments for persistent CMO. Topical steroids could be an alternative option for managing persistent CMO in RP.

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“…Many treatments have been attempted for RP-associated CMO, including grid laser, vitrectomy, oral lutein, intravitreal dexamethasone, intravitreal triamcinolone, topical carbonic anhydrase inhibitors, oral carbonic anhydrase inhibitors, oral corticosteroids, topical non-steroidal anti-inflammatory medication, and topical steroid [ 6 , 7 , 8 , 9 , 10 ]. However, all of the aforementioned treatments have limited and highly variable efficacy.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Retinitis Pigmentosa-Associated Cystoid Macular Oedema Using Intravitreal Aflibercept (Eylea) despite Minimal Response to Ranibizumab (Lucentis): A Case Report

Strong

Gurbaxani²,

Michaelides

2016

Case Rep Ophthalmol

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Background: We present an interesting case of bilateral retinitis pigmentosa (RP)-associated cystoid macular oedema that responded on two separate occasions to intravitreal injections of aflibercept, despite previously demonstrating only minimal response to intravitreal ranibizumab. This unique case would support a trial of intravitreal aflibercept for the treatment of RP-associated cystoid macular oedema. Case Presentation: A 38-year-old man from Dubai, United Arab Emirates, presented to the UK with a 3-year history of bilateral RP-associated cystoid macular oedema. Previous treatment with topical dorzolamide, oral acetazolamide, and intravitreal ranibizumab had demonstrated only minimal reduction of cystoid macular oedema. Following re-confirmation of the diagnosis by clinical examination and optical coherence tomography imaging, bilateral loading doses of intravitreal aflibercept were given. Central macular thickness reduced and the patient returned to Dubai. After 6 months, the patient was treated with intravitreal ranibizumab due to re-accumulation of fluid and the unavailability of aflibercept in Dubai. Only minimal reduction of central macular thickness was observed. Once available in Dubai, intravitreal aflibercept was administered bilaterally with further reduction of central macular thickness observed. Visual acuity remained stable throughout. Conclusions: This is the first case report to demonstrate a reduction of RP-associated CMO following intravitreal aflibercept, despite inadequate response to ranibizumab on two separate occasions. Aflibercept may provide superior action to other anti-VEGF medications due to its intermediate size (115 kDa) and higher binding affinity. This is worthy of further investigation in a large prospective cohort over an extended time to determine the safety and efficacy of intravitreal aflibercept for use in this condition.

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

Cited by 7 publications

References 39 publications

Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention

Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention

Efficacy of additional topical betamethasone in persistent cystoid macular oedema after carbonic anhydrase inhibitor treatments in retinitis pigmentosa

Treatment of Retinitis Pigmentosa-Associated Cystoid Macular Oedema Using Intravitreal Aflibercept (Eylea) despite Minimal Response to Ranibizumab (Lucentis): A Case Report

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