First Author: V.Prabhu INDIA
Co Author(s): 0 0 0 0 0 0 0 0 0
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To report successful use of intravitreal triamcinolone acetonide injection for CRVO with Cystoid Macular edema in a healthy, infertile woman recruited for in vitro fertilization cycle for infertility.
38 year old healthy young female presented with painless defective vision in Left Eye (LE) with metamorphopsia 4 months after her second consecutive IVF treatment cycle with monophasic OCP No other relevant ocular and or systemic history.
On ocular examination Best Corrected Visual Acuity (BCVA) in Right Eye (RE) 6/6, LE was 3/60 .Slit lamp biomicroscopic examination of anterior segment of Both eyes was normal .On Fundus examination, RE was found to be within normal limits, LE showed dilated tortuous central retinal vein with multiple dot and blot haemorrhages all over the fundus with cystoid macular edema (CME) which was confirmed on optical coherence tomography.In both eyes intraocular pressure was within normal limits. All the systemic and local causes investigated were within normal limits. Hence, a clinical diagnoses of Left Eye CRVO with CME secondary to OCP was made.Single injection of low dose (0.05ml/2mg)triamcinolone acetonide injection (IVTA) given intravitreally under aseptic precautions (after fully informed consent). No complication during or after the procedure was noted.
The retinal haemorrhages and macular edema regressed as seen on optical coherence tomography within 3 months following the injection. Visual acuity also improved to 6/9 in (left eye) after three months remaining stable up to 6 months on last follow-up.
Use of OCP in infertile woman is on the rise with increase in advanced treatment modalities like IVF. However, the exact pathogenetic mechanism for thrombotic occlusion of central retinal vein secondary to OCP use is unknown. Multipotent triamcinolone acetonide in low dose ( lower adverse effects) not only resolved the edema but also resulted in visual gain Treating infertility specialists should be aware of retinal vascular catastrophy and if visual disturbances occur IVF therapy terminated and patient referred for specialist ophthalmic care. Patients should be instructed to report to the physician any unusual symptoms such as blurring, spots or metamorphopsia.