First Author: K.Ornek TURKEY
Co Author(s): K. Örnek İ.E. Erbahçeci Timur T. Oğurel 0 0 0 0 0 0 0 0 0
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Macular edema (ME) in retinitis pigmentosa (RP) often impairs central vision dramatically. Treatment options are carbonic anhydrase inhibitors, corticosteroids, anti-vascular endothelial growth factor (VEGF) drugs, laser photocoagulation and vitrectomy. Off-label intravitreal injection of triamsinolone have also been effective. A sustained-release dexamethasone implant (DEX implant; OZURDEX, Allergan, Inc., Irvine, CA) has been shown to have favorable results in the treatment of ME secondary to RP in recent years. In this case report, we describe a case with severe visual loss due to bilateral refractory ME secondary to RP which dramatically improved within the first week following dexamethasone implant.
A 41-years-old woman with the diagnosis of RP was referred to our outpatient clinic due to severe visual deterioration in both eyes. She had refractory ME secondary to RP for about 12 years.
Best corrected visual acuity, full biomicroscopic and fundus examination performed in each visit. Macular edema was evaluated with optical coherance tomography.
The patient had been unresponsive to both topical carbonic anhydrase inhibitors (acetazolamide 500 mg daily) and topical corticosteroids. She had received intravitreal triamcinolone acetonide (TA) injections twice for OU. Following intravitreal TA injections visual acuity had increased to 3 meters from counting fingers (CF) in OD and 2 meters from CF in OS. In two years, due to cataract formation and recurrent macular edema, vision decreased to preinjection levels. She received bilateral phacoemulsification surgery with intraocular lens implantattion and intravitreal TA injection. Visual acuity improved to 3 meters from CF in OD and only to hand motions in OS. Four months later, visual acuity decreased to CF from 3 meters in OD. Optical coherence tomography revealed severe CME in both eyes, central foveal thickness was 613 µm in OD and 971 µm in OS. Intravitreal 0,7mg dexamethasone implant (Ozurdex, Allergan) was administered into both eyes without complications. At fourth day after both injections, visual acuitiers improved to 3 meters in OD and 1 meter in OS, and ME totally resolved. No recurrence was observed during the follow ups in four months.
Macular edema secondary to RP responds very fast to intravitreal dexamethasone implant with satisfactory results both for the patient and ophthalmologist.