Abstract
Purpose
To investigate the functional and anatomical results of subtenon triamcinolone acetonide injection (TA) in eyes with retinitis pigmentosa (RP) that had cystoid macular edema (CME) unresponsive to carbonic anhydrase inhibitors (CAIs).
Materials and Methods
This is a prospective, interventional study. Forty-eight consecutive eyes that underwent subtenon TA for CME due to RP were recorded. Central macular thickness (CMT), best-corrected visual acuities (BCVAs) and intraocular pressures (IOPs) were evaluated before and after injection at 2nd week, 1st month, 2nd month and 3rd month, respectively. Spectral-domain optical coherence tomography (SD-OCT) was used to show anatomic findings. Complications such as cataract and glaucoma were recorded.
Results
A total of 48 eyes of 42 patients with a mean age of 36.25 ± 15.59 years (range 13 to 63 years) and a mean follow-up of 4.45 ± 0.74 months (range 4 to 6 months) were recorded in the study. The mean initial BCVA increased from 1.09 ± 0.52 to 0.54 ± 0.29 logarithmic minimum angle of resolution (log MAR) (p < 0.001) at 3 months after injection and the mean central macular thickness decreased from 591.45 ± 209.55 µm to 270.83 ± 95.48 µm (p < 0.001). The mean iOP increased from 13.58 ± 2.87 mmHg to 15.91 ± 2.47 mmHg (p < 0.001). Multiple injections (3 injections) in 1 eye, 2 injections in 4 eyes and 1 injection in rest of the eyes were performed at 3-month intervals. Complications such as glaucoma and cataract were not observed in any patient during and after the treatment.
Conclusion
In the present study, a significant improvement in visual acuity and CMT were observed in eyes with subtenon TA for CME due to RP unresponsive to CAIS. Further studies with a long follow-up period of the population are required to investigate the role of subtenon TA of CME due to RP.
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References
Rosenberg T, Haim M, Hauch AM, Parving A (1997) The prevalence of Usher syndrome and other retinal dystrophy-hearing impairment associations. Clin Genet 51(5):314–321
Fishman GA, Fishman M, Maggiano J (1977) Macular lesions associated with retinitis pigmentosa. Arch Ophthalmol 95(5):798–803
Fishman GA, Maggiano JM, Fishman M (1977) Foveal lesions seen in retinitis pigmentosa. Arch Ophthalmol 95(11):1993–1996
Adackapara CA, Sunness JS, Dibernardo CW, Melia BM, Dagnelie G (2008) Prevalence of cystoid macular edema and stability in oct retinal thickness in eyes with retinitis pigmentosa during a 48-week lutein trial. Retina 28(1):103–110
Hajali M, Fishman GA (2009) The prevalence of cystoid macular oedema on optical coherence tomography in retinitis pigmentosa patients without cystic changes on fundus examination. Eye (Lond) 23(4):915–919
Pruett RC (1983) Retinitis pigmentosa: clinical observations and correlations. Trans Am Ophthalmol Soc 81:693–735
Salvatore S, Fishman GA, Genead MA (2013) Treatment of cystic macular lesions in hereditary retinal dystrophies. Surv Ophthalmol 58(6):560–584
Apushkin MA, Fishman GA, Janowicz MJ (2004) Monitoring cystoid macular edema by optical coherence tomography in patients with retinitis pigmentosa. Ophthalmology 111(10):1899–1904
Chebil A, Touati S, Maamouri R, Kort F, El Matri L (2016) Spectral Domain optical coherence tomography findings in patients with retinitis pigmentosa. Tunis Med 94(4):265–271
Chung H, Hwang JU, Kim JG, Yoon YH (2006) Optical coherence tomography in the diagnosis and monitoring of cystoid macular edema in patients with retinitis pigmentosa. Retina 26(8):922–927
Hagiwara A, Yamamoto S, Ogata K, Sugawara T, Hiramatsu A, Shibata M, Mitamura Y (2011) Macular abnormalities in patients with retinitis pigmentosa: prevalence on OCT examination and outcomes of vitreoretinal surgery. Acta Ophthalmol 89(2):e122–e125
Hajali M, Fishman GA, Anderson RJ (2008) The prevalence of cystoid macularoedema in retinitis pigmentosa patients determined by optical coherence tomography. Br J Ophthalmol 92(8):1065–1068
Kim YJ, Joe SG, Lee DH, Lee JY, Kim JG, Yoon YH (2013) Correlations between spectral-domain OCT measurements and visual acuity in cystoid macular edema associated with retinitis pigmentosa. Invest Ophthalmol Vis Sci 54(2):1303–1309
Oishi A, Otani A, Sasahara M, Kojima H, Nakamura H, Kurimoto M, Yoshimura N (2009) Photoreceptor integrity and visual acuity in cystoid macular oedema associated with retinitis pigmentosa. Eye (Lond) 23(6):1411–1416
Grover S, Fishman GA, Anderson RJ, Alexander KR, Derlacki DJ (1997) Rate of visual field loss in retinitis pigmentosa. Ophthalmology 104:460–465
Heckenlively JR (1987) RP cone–rod degeneration. Trans Am Ophthalmol Soc 85:438–470
Strong S, Liew G, Michaelides M (2017) Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention. Br J Ophthalmol 101:31–37
Fishman GA, Gilbert LD, Fiscella RG, Kimura AE, Jampol LM (1989) Acetalazomide for treatment of chronic macular edema in retinitis pigmentosa. Arch Ophthalmol 107:1445–1452
Giusti C, Forte R, Vingolo EM (2002) Deflazacort treatment of cystoid macular edema in patients affected by retinitis pigmentosa: a pilot study. Eur Rev Med Pharmacol Sci 6:1–8
Grover S, Apushkin MA, Fishman GA (2006) Topical dorsolamide for the treatment of cystoid macular edema in patients with retinitis pigmentosa. Am J Ophthalmol 141:850–858
Kim JE (2006) Intravitreal triamcinolone acetonide for treatment of cystoid macular edema associated with retinitis pigmentosa. Retina 26:1094–1096
Newsome DA, Blacharski PA (1987) Grid photocoagulation for macular edema in patients with retinitis pigmentosa. Am J Ophthalmol 103:161–166
Ozdemir H, Karacorlu M, Karacorlu S (2005) Intravitreal triamcinolone acetonide for treatment of cystoid macular oedema in patients with retinitis pigmentosa. Acta Ophthalmol Scand 83:248–251
Scorolli L, Morara M, Meduri A et al (2007) Treatment of cystoid macular edema in retinitis pigmentosa with intravitreal triamcinolone. Arch Ophthalmol 125:759–764
Wolfensberger TJ (1999) The role of carbonic anhydrase inhibitors in the management of macular edema. Doc Ophthalmol 97:387–397
Adler R (1996) Mechanisms of photoreceptor death in retinal degeneration: from the cell biology of the 1990 s to the ophthalmology of the 21st century. Arch Ophthalmol 141:79–83
Baumgartner WA (2000) Etiology, pathogenesis, and experimental treatment of retinitis pigmentosa. Med Hypotheses 54:814–824
Bird AC (1992) Investigation of disease mechanisms in retinitis pigmentosa. Ophthal Paediatr Genet 13:57–66
Hamel C (2006) Retinitis pigmentosa. Orphanet J Rare Dis 101:687–693
van Soest S, Westerveld A, de Jong PT, Bleeker-Wagemakers EM, Bergen AA (1999) Retinitis pigmentosa: defined from a molecular point of view. Surv Ophthalmol 43:321–334
Melo GB, Farah ME, Aggio FB (2007) Intravitreal injection of bevacizumab for cystoid macular edema in retinitis pigmentosa. Acta Ophthalmol Scand 85:461–463
Saraiva VS, Sallum JM, Farah ME (2003) Treatment of cystoid macular edema related to retinitis pigmentosa with intravitreal triamcinolone acetonide. Ophthalmic Surg Lasers Imaging 34:398–400
Artunay O, Yuzbasioglu E, Rasier R, Sengul A, Bahcecioglu H (2009) Intravitreal Ranibizumab in the treatment of cystoid macular edema associated with retinitis pigmentosa. J Ocul Pharmacol Ther 25(6):545–550
Yuzbasioglu E, Artunay O, Rasier R, Sengul A, Bahcecioglu H (2009) Intravitreal Bevacizumab (Avastin) Injection in Retinitis Pigmentosa. Curr Eye Res 34:231–237
Fileta JB, Scott IU, Flynn HW Jr (2014) Meta-analysis of infectious endophthalmitis after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmic Surg Lasers Imaging Retina 45(2):143–149
Sachdeva MM, Moshiri A, Leder HA, Scott AW (2016) Endophthalmitis following intravitreal injection of anti-VEGF agents: long-term outcomes and the identification of unusual micro-organisms. J Ophthalmic Inflamm Infect 6(1):2
Karabag RY, Parlak M, Cetin G, Yaman A, Osman Saatci A (2015) Retinal tears and rhegmatogenous retinal detachment after intravitreal injections: its prevalence and case reports. Digit J Ophthalmol 21(1):8–10
Mansour AM, Sheheitli H, Kucukerdonmez C et al (2018) Intravitreal dexamethasone implant in retinitis pigmentosa– related cystoid macular edema. Retina 38(2):416-423.
Sudhalkar A, Kodjikian L, Borse N (2017) Intravitreal dexamethasone implant for recalcitrant cystoid macular edema secondary to retinitis pigmentosa: a pilot study. Graefes Arch Clin Exp Ophthalmol 255(7):1369–1374
Ahn SJ, Kim KE, Woo SJ, Park KH (2014) The effect of an intravitreal dexamethasone implant for cystoid macular edema in retinitis pigmentosa: a case report and literature review. Ophthalmic Surg Lasers Imaging Retina 45:160–164
Alhassan M, Quintyn JC (2013) Unilateral intravitreal dexamethasone implant for bilateral retinitis pigmentosa-related macular edema. Graefes Arch Clin Exp Ophthalmol 251:2827–2828
Buchaim G, Rezende MP, Maia M (2013) Implante intravítreo de liberação crônica de dexametasona (Ozurdex) para o trata mento de edema macular por retinose pigmentar: relato de caso. Arq Bras Oftalmol 76:377–379 (in Portuguese)
Patil L, Lotery AJ (2014) Coat’s-like exudation in rhodopsin retinitis pigmentosa: successful treatment with an intravitreal dexamethasone implant. Eye (Lond) 28:449–451
Saatci AO, Selver OB, Seymenoglu G, Yaman A (2013) Bilateral intravitreal dexamethasone implant for retinitis pigmentosa-related macular edema. Case Rep Ophthalmol 4:53–58
Srour M, Querques G, Leveziel N et al (2013) Intravitreal dexamethasone implant (Ozurdex) for macular edema secondary to retinitis pigmentosa. Graefes Arch Clin Exp Ophthalmol 251:1501–1506
Siqueira RC, Messias A, Voltarelli JC, Messias K, Arcieri RS, Jorge R (2013) Resolution of macular oedema associated with retinitis pigmentosa after intravitreal use of autologous BM-derived hematopoietic stem cell transplantation (letter). Bone Marrow Transpl 48:612–613
Adamus G, Wang S, Kyger M, Worley A, Lu B, Burrows GG (2012) Systemic immunotherapy delays photoreceptor cell loss and prevents vascular pathology in Royal College of Surgeons rats. Mol Vis 18:2323–2337
Guadagni V, Novelli E, Piano I, Gargini C, Strettoi E (2015) Pharmacological approaches to retinitis pigmentosa: a laboratory perspective. Prog Ret Eye Res 48:62–81
Sacchetti M, Mantelli F, Merlo D, Lambiase A (2015) Systematic review of randomized clinical trials on safety and efficacy of pharmacological and nonpharmacological treatments for retinitis pigmentosa. J Ophthalmol 2015:737053
Wang C, Hu J, Bernstein PS, Teske MP, Payne M, Yang Z, Li C et al (2006) Intravitreal injection of triamcinolone acetonide for macular edema due to retinitis pigmentosa and other retinal diseases. Adv Exp Med Biol 572:309–314
Cellini M, Pazzaglia A, Zamparini E, Leonetti P, Campos EC (2008) Intravitreal vs. subtenon triamcinolone acetonide for the treatment of diabetic cystoid macular edema. BMC Ophthalmol 8:5
Choudhry S, Ghosh S (2007) Intravitreal and posterior subtenon triamcinolone acetonide in idiopathic bilateral uveitic macular oedema. Clin Exp Ophthalmol 35:713–718
Schaal Y, Hondur AM, Tezel TH (2016) Subtenon triamcinolone for cystoid macular edema due to retinitis pigmentosa unresponsive to oral acetazolamide. Can J Ophthalmol 51(4):e113–e115
Byun YS, Park YH (2009) Complications and safety profile of posterior subtenon injection of triamcinolone acetonide. J Ocul Pharmacol Ther 25(2):159–162
Kawamura R, Inoue M, Shinoda H, Shinoda K, Itoh Y, Ishida S, Tsubota K (2011) Incidence of Increased Intraocular pressure after subtenon injection of triamcinolone acetonide. J Ocul Pharmacol Ther 27(3):299–304
Gharaee H, Khalife M, Poor SS, Abrishami M (2011) Infectious scleritis after subtenon triamcinolone acetonide Injection. Ocul Immunol Inflamm 19(4):284–285
Wang JK, Shih TY (2014) Traumatic optic neuropathy secondary to posterior subtenon triamcinolone acetonide injection in a case with scleritis. JAMA Ophthalmol 132(6):741
Rhatigan M, McAnena L, McElnea E, Connell P, Fulcher T (2017) Orbital abscess following posterior subtenon injection of triamcinolone acetonide. Orbit 36(3):135–136
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Karasu, B. Short-term outcomes of subtenon triamcinolone acetonide injections in patients with retinitis pigmentosa-associated cystoid macular edema unresponsive to carbonic anhydrase inhibitors. Int Ophthalmol 40, 677–687 (2020). https://doi.org/10.1007/s10792-019-01228-z
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DOI: https://doi.org/10.1007/s10792-019-01228-z