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C. Kafkala, J.Y. Choi, P. Choopong, C.S. Foster; Octreotide as a Treatment for Uveitic Cystoid Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2850.
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Purpose: The presence of Octreotide, an analogue of the neuropeptide somatostatin with anti–angiogenic and anti–inflammatory properties, and its receptors sst1, sst2B and sst5, has been demonstrated in human RPE. Published reports indicate that it may be a useful treatment for diabetic and idiopathic macular edema. The purpose of this presentation is to relate the Massachusetts Eye and Ear Infirmary Immunology Service experience with Octreotide in the setting of Uveitic macular edema. Methods: Five patients (8 eyes) from the Ocular Immunology and Uveitis Service with uveitic macular edema recalcitrant to conventional therapy were given octreotide subcutaneously (100µg TID) or intramuscularly (LAR 20mg q4wks). The etiologies were idiopathic uveitis in two cases, sarcoid uveitis in two cases and HLA–B27 related uveitis in one case. The uveitis was quiet on immunomodulatory therapy, but CME was highly active and did not respond to additional treatment with steroids (systemic, peribulbar, intraocular), NSAIDs (po) and acetazolamide. The course of macular edema was monitored with clinical examination, fluorescein angiography and optical coherence tomography. Additional data on age, sex, previous treatment regimen, Snellen visual acuity, duration of treatment with octreotide and side –effects were recorded. Results: The duration of treatment with octreotide varied from six to twenty–four months. Improvement was noticed in four patients, documented with better visual acuity, decreased or no leakage on the FA and decreased retinal thickness on the OCT, which in three patients showed complete resolution of the macular edema. The fifth patient exhibited no significant changes in vision, FA and OCT. No side–effects were noted. Conclusions: Cystoid macular edema is the main cause of irreversible loss of visual acuity in uveitis patients. The MEEI experience with treating patients with refractory uveitic macular edema shows that octreotide might be a viable treatment option. However, further studies in larger populations of uveitic patients are needed to investigate its efficacy.
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