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J.L. Ferreira, A. Rayes, T.R. Rayes, R.D. Cardoso; Intravitreal Injection of Triamcinolone Acetate for Early X–Ray Irradiation Retinopathy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5404.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To propose intra–vitreous triamcinolone for early X–Ray irradiation retinopathy.
Methods: case report of a 47 years old, male patient with linfoepithelioma at the cavum (T3N2BM0) treated with quimiotherapy ( cysplatin 100 mg/m2, fluorouracil 600 mg/m2 – 10 sections in 21 days) and radiotherapy (7000 cGy – 35 sections of 200 cGy, 1000 cGy per week) with ocular symptoms one year after initial treatment. Previous history of myopia:
OD: –8.50 = –0.50@180° (20/20); OS: –7.00 = –0.50@180° (20/20).
Refractive surgery in 1999. On 03/01/2004 the pacient was complaining of vision loss: 20/80 OD with 0.00 = –0.50 @ 160°; 20/20 OS with –0.75. The patient was submitted to retinography and fluorescein angiography: microaneurysms, perivascular sheathing, focal arteriolar narrowing, cotton–wool patches, intraretinal exsudation, cistoid macular edema. Optical coherence tomography of the macula showed evidence of serous retinal detachment.
Intra vitreous injection of 4 mg of triamcinolone acetonide (IVTA) on 03/08/2004. Vision OD improved to 20/25–2 within 10 days. Three months after initial treatment visual accuity OD deteriorated to 20/40. Topical treatment with dorzolamide hydrochloride and diclofenac 1% qid was instituted for 45 days, with visual improvement to previous
20/25–2 – stable with 8 months of follow up.
OCT (foveal thickness improved from 253 µm to 167 µm), retinography, fluorescein angiography and visual fields demonstrated a continuous improvement, although with reliquat and similar visual acuity.
intravitreous triamcinolone brought a dramatic improvement of visual acuity and resolution of serous retinal detachment. Topical dorzolamide hydrochloride and diclofenac 1%where used with good outcome, in order to avoid another injection of intravitreous triamcinolone. The instituted treatment was important to modulate and stabilize initial X–Ray irradiation retinopathy. Further studies are needed in order to establish the impact of early treatment to avoid chronic retinal detachment and other alterations.
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