Abstract
Purpose :
Cystoid macular edema (CME), a vision-threatening condition, is one of the most frequent complications in retinitis pigmentosa (RP). Although various treatment approaches using carbonic anhydrase inhibitors (CAI) or steroids have been reported, and intravitreal or sub-Tenon’s corticosteroids have shown efficacy in managing CME, topical steroid therapy, which is less invasive, has not been reported yet. The present study hence retrospectively investigated the efficacy of additional topical 0.1% betamethasone (BM) in persistent CME after CAI therapy in RP.
Methods :
This study included patients who started topical application of BM for persistent CME after previous CAI treatments from 2009 to 2016. Patients were excluded if they had complications that may contribute to CME. All patients received additional topical BM with the CAI treatment. BM therapy was stopped if the patients showed increasing intraocular pressure (IOP): >20 mmHg twice consecutively or >25 mm once. CME was diagnosed using spectral-domain optical coherence tomography (Spectralis; Heidelberg Engineering, Heidelberg, Germany). Central foveal thickness (CFT) was regarded as the average of vertical and horizontal foveal thickness. We defined response to treatment as reduction of ≥11% in CFT compared to the baseline. Best-corrected visual acuity (BCVA) and IOP were obtained from the medical records. We compared the CFT and BCVA between baseline and 1–3, 5–7, 10–14, and 16–20 months. Repeated measures ANOVA with Bonferroni’s correction was used for data analysis.
Results :
Sixteen eyes of 10 patients with RP (39.4±13.8y; 5 men) were included. Previous treatments were brinzolamide in 14 eyes, dorzolamide in 5, bromfenac in 2, and systemic acetazolamide in 1 patient. CFT effectively decreased in 13 of 16 eyes (81.3%). CFT decreased significantly in 1–3 months (326±102 μm; N＝16; p＝0.03) and 5–7 months (297±102 μm; N＝12; p＝0.03) compared to baseline but not in 10–14 months (271±96 μm; N＝9; p＝0.485) and 16–20 months (281±134 μm; N＝9; p＝0.289). There were no significant intergroup differences in BCVA throughout the study. BM treatment was stopped in 4 patients because of IOP elevation.
Conclusions :
We demonstrated the efficacy of BM administration with CAI treatment for persistent CME. Topical steroid could be an alternative option for managing CME in RP.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.