Topical steroidal and nonsteroidal antiinflammatory drugs for the treatment of cystoid macular edema in retinitis pigmentosa.

Abstract

Oral carbonic anhydrase inhibitors have been the treatment of choice for managing cystoid macular edema (CMO) in retinitis pigmentosa. We report a case illustrating the effectiveness of topical steroidal and nonsteroidal antiinflammatory drugs (NSAIDs) in managing CMO in a patient with retinitis pigmentosa, who is unable to take oral carbonic anhydrase inhibitor because of chronic renal impairment. An 85-year-old woman with retinitis pigmentosa-related CMO in the left eye was prospectively followed up after treatment with a 4 times daily regimen consisting of a topical steroid (prednisolone acetate 1%) and an NSAID (ketorolac trometamol 0.5%). The right eye showed no evidence of CMO. Oral acetazolamide was avoided as the patient had chronic renal impairment. Three months after treatment, best-corrected visual acuity in the left eye improved from 20/200 to 20/60, and spectral domain optical coherence tomography showed complete resolution of CMO. Topical steroid and NSAID were therefore stopped. However, 6 months later, left best-corrected visual acuity was reduced to 20/120 and spectral domain optical coherence tomography showed recurrence of CMO. This was managed with the same treatment regimen of topical steroid and NSAID, which resulted in complete resolution of CMO with best-corrected visual acuity in the left eye improving to 20/80 after 3 months. To our knowledge, this is the first report that demonstrates the effectiveness of topical steroids or NSAIDs in managing CMO in a retinitis pigmentosa patient with chronic renal impairment who is unable to take a carbonic anhydrase inhibitor because of chronic renal impairment.