Cystoid Macular Edema In Patients Research Articles

The relationship of central foveal thickness to urinary iodine concentration in retinitis pigmentosa with or without cystoid macular edema.

Current treatments for cystoid macular edema (CME) in retinitis pigmentosa (RP) are not always effective, may lead to adverse effects, and may not restore visual acuity. The present research lays the rationale for evaluating whether an iodine supplement could reduce CME in RP. To determine whether central foveal thickness (CFT) in the presence of CME is related to dietary iodine intake inferred from urinary iodine concentration (UIC) in nonsmoking adults with RP. We performed a cross-sectional observational study of 212 nonsmoking patients aged 18 to 69 years referred to our institution for RP with visual acuity of no worse than 20/200 in at least 1 eye. Retinitis pigmentosa with or without CME. With the eye as the unit of analysis, the relationship of log CFT measured by optical coherence tomography to UIC measured from multiple spot samples and represented as a 3-level classification variable (<100, 100-199, and ≥200 µg/L), assigning greater weight to patients with more reliable UIC estimates. Analyses were limited to 199 patients after excluding 11 who failed to return urine samples for measuring UIC and 2 outliers for UIC. Of the 199 patients, 36.2% had CME in 1 or both eyes. Although log CFT was inversely related to UIC based on findings from all eyes (P = .02), regression of log CFT on UIC separately for eyes with and without CME showed a strong inverse significant relationship for the former group (P < .001) and no significant relationship for the latter group (P = .66) as tested. For the eyes with CME, CFT ranged from a geometric mean of 267 µm for a median UIC of less than 100 µg/L to a geometric mean of 172 µm for a median UIC of 200 µg/L or greater. In contrast, we found no significant association between CME prevalence and UIC based on the entire sample as tested (odds ratio, 1.01 [95% CI, 0.38-2.67]; P = .99). A higher UIC in nonsmoking adults with RP was significantly associated with less central foveal swelling in eyes with CME. Additional study is required to determine whether an iodine supplement can limit or reduce the extent of CME in patients with RP.

Treatment and functional outcome of patients with cystoid macular edema: a single-center experience.

The aim of this study was to describe a single-center experience in the treatment and follow-up of cystoid macular edema patients. Clinical records of all patients with cystoid macular edema followed up in the Rheumatologic and Ophthalmological Unit of our center between 1993 and 2013 were retrospectively evaluated. The outcome was assessed by visual acuity and optical coherence tomography status during follow-up. Comparisons were made by Fisher's exact test (p < 0.05 significant). In this study 16 eyes in 9 patients were analyzed. Our study includes mainly post-uveitic (78 %) cases with a high prevalence of human leukocyte antigen B51 (67 %). Systemic immunosuppressive therapy was prescribed in 87 % of cases. The most frequently used drugs were cyclosporine, interferon-α, and infliximab. The first two molecules appeared respectively the most used as the first option and the one with the longest survival on treatment. Interferon-α was the most effective drug in contrasting visual acuity loss compared to the majority of drugs, but significantly more effective than mycophenolate (p = 0.01) in reducing macular edema. At the end of follow-up, 50 % of patients showed a significant visual loss, while 88 % did not present macular edema. In our small cohort, interferon-α is the most promising drug in contrasting visual acuity loss in cystoid macular edema. Visual prognosis remains severe in these patients.

Werner syndrome with refractory cystoid macular edema and immunohistochemical analysis of WRN proteins in human retinas

BackgroundTo present our findings in a case of Werner syndrome with refractory cystoid macular edema (CME) and to determine the expression and the distribution of WRN proteins in human retinas.Case presentationA 35-year-old man with Werner syndrome who developed CME after YAG laser treatment was studied. Optical coherence tomographic (OCT) scans were used to examine the CME in the right eye. The patient received topical eye drops (0.1% bromfenac sodium hydrate twice daily and 1% dorzolamide hydrochloride thrice daily), sub-Tenon triamcinolone injection thrice, intravitreal bevacizumab injection twice, and pars plana vitrectomy of the right eye. Genetic analyses were performed to diagnose the disease. To examine the expression and distribution of WRN proteins in the retinas, immunohistochemistry for WRN proteins was performed in human retinas. The CME in the right eye was not improved by any of the treatments. During the follow-up period, CME developed in the left eye. Genetic analyses detected compound heterozygosity, Mut4 and Mut11, in the WRN gene and the individual was diagnosed with Werner syndrome. Immunohistochemical analysis of WRN proteins expression in human retinas showed that WRN proteins were expressed in the parts of the Müller cells in the inner nuclear layer and outer nuclear layer.ConclusionPatients with Werner syndrome can develop severe CME after laser treatment. A pathological link may exist between mutations in the WRN gene and the development of CME in patients with Werner syndrome.

The Effect of an Intravitreal Dexamethasone Implant for Cystoid Macular Edema in Retinitis Pigmentosa: A Case Report and Literature Review

Intravitreal injection of a dexamethasone implant was used to treat a 24-year-old patient with retinitis pigmentosa (RP) who developed cystoid macular edema (CME) in both eyes that was refractory to oral acetazolamide and intravitreal bevacizumab treatment. After injection, best corrected visual acuity (BCVA) improved and central macular thickness decreased, but CME recurred in both eyes 6 months later. Although a second intravitreal dexamethasone implant injection resolved the CME and improved the BCVA, CME recurred in both eyes 6 months later. The intravitreal dexamethasone implant may be useful for CME in patients with RP, but its efficacy seems to be limited over time.

Therapeutic effect of prolonged treatment with topical dorzolamide for cystoid macular oedema in patients with retinitis pigmentosa

AimTo evaluate the therapeutic effect of continuous treatment with topical dorzolamide (a carbonic anhydrase inhibitor) for cystoid macular oedema (CME) associated with retinitis pigmentosa (RP).Methods18 eyes in 10 patients with...

Functional and anatomical results after a single intravitreal Ozurdex injection in retinal vein occlusion: a 6‐month follow‐up – The SOLO study

To evaluate the efficacy of intravitreal dexamethasone implants in eyes with cystoid macular oedema (CME) secondary to branch retinal vein occlusion (BRVO) or central retinal vein occlusion (CRVO) in the clinical everyday practice, examine the effects of early retreatment and compare the results with the GENEVA study. The charts of 102 patients (102 eyes) with CME secondary to BRVO (n = 54) or CRVO (n = 48) treated with Ozurdex at 8 centres were retrospectively reviewed. The patients were examined monthly over a 24-week period. Slit-lamp biomicroscopy, measurement of best-corrected visual acuity (BCVA) and measurement of the central retinal thickness (CRT) with spectral-domain optical coherence tomography (SD-OCT) were performed at baseline and at every follow-up examination. With progression of the disease (loss of one line or increased central retinal thickness (CRT) of 150 μm), a reinjection of Ozurdex or anti-VEGF was offered. Additional supplementing sectorial or panretinal laser photocoagulation was considered based on the individual status of the retina. In the BRVO group, the median BCVA was 0.6 logMAR (Snellen equivalent of 0.25) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.3 logMAR (Snellen equivalent of 0.50) after 8 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 12 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 16 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 20 weeks and 0.45 logMAR (Snellen equivalent of 0.35) after 24 weeks. The mean CRT was 559 ± (SD) 209 μm at baseline and it decreased to 335 ± 148 μm after 4 weeks, 316 ± 137 μm after 8 weeks, 369 ± 126 μm after 12 weeks, 407 ± 161 μm after 16 weeks, 399 ± 191 μm after 20 weeks and 419 ± 196 μm after 24 weeks. In the CRVO group, the median BCVA was 0.7 logMAR (Snellen equivalent of 0.20) at baseline and improved to 0.4 logMAR (Snellen equivalent of 0.40) after 4 weeks, 0.4 logMAR (Snellen equivalent of 0.40) after 8 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 12 weeks, 0.6 logMAR (Snellen equivalent of 0.25) after 16 weeks, 0.5 logMAR (Snellen equivalent of 0.32) after 20 weeks and 0.52 logMAR (Snellen equivalent of 0.30) after 24 weeks. The mean CRT at baseline was 740 ± 351 μm and it decreased to 419 ± 315 μm after 4 weeks, 352 ± 261 μm after 8 weeks, 455 ± 251 μm after 12 weeks, 497 ± 280 μm after 16 weeks, 468 ± 301 μm after 20 weeks and 395 ± 234 μm after 24 weeks. The BCVA improvement was statistically significantly better (p < 0.05) compared with baseline in both groups at every follow-up visit. The mean CRT maintained significantly better when compared with baseline in both groups at all follow-up visits. Early reinjection was indicated in BRVO in 40.7% after 17.5 ± 4.2 weeks and in CRVO in 50% after 17.68 ± 4.2. Six eyes (11%) with BRVO received a sectorial laser photocoagulation at a mean interval of 22 ± 5.0 weeks. Seven eyes (15%) with CRVO received a panretinal laser photocoagulation after a mean interval of 18 ± 7.0 weeks. The BCVA improvement and the mean CRT reduction were statistically significant (p < 0.05) compared with baseline in both groups at every follow-up visit. Dexamethasone intravitreal implant resulted in a significant improvement of the BCVA and reduction of CME in patients with BRVO or CRVO. Early retreatment after 16 weeks instead of 24 weeks, like in the GENEVA study, was indicated in 50% to stabilize the improved functional and anatomical results.

Intravitreal Bevacizumab for Radiation-Induced Cystoid Macular Oedema in Patients with Nasopharyngeal Carcinoma: A Clinical Series

Aims: To evaluate the outcome of intravitreal bevacizumab in the treatment of radiation-induced cystoid macular oedema among patients who underwent external beam radiotherapy for nasopharyngeal carcinoma. Methods: Five patients were recruited. The length of time from the last external beam radiation therapy to presentation ranged from 12 months to 15 years. Intravitreal bevacizumab (1.25 mg/0.05 ml) was given and repeated monthly injections were administered until best corrected visual acuity (BCVA) improved to 6/9 or until 3 further injections did not show further improvement in BCVA. BCVA was measured and fundus photography, optical coherence tomography (OCT) and fluorescein angiography were performed at baseline. BCVA and OCT were recorded at each monthly visit. The duration of follow-up ranged from 6 months to 2 years. Results: Five patients (7 eyes) were recruited. At the final visit, 3 eyes (71.4%) showed reduction in the central subfield thickness (CST; mean reduction of 17.6%, range 9-149 µm) with improvement in BCVA, whilst 2 eyes worsened in terms of CST and final BCVA. Another 2 eyes remained altered in BCVA despite slight improvement in CST. Conclusion: The use of intravitreal bevacizumab in this group of patients showed variable response in terms of CST and BCVA outcome but remains a viable option to treat this challenging condition.

Werner syndrome accompanied with refractory CME and WRN proteins expression in human retinas

AbstractPurpose To present a case of Werner syndrome accompanied with refractory cystoid macular edema (CME), and analyze the expression and the distribution of WRN proteins in human retinas.Methods A 35‐year‐old individual with Werner syndrome exhibited CME after YAG laser treatment. Optical coherence tomography (OCT) scans were indicative of CME in the right eye. The patient received topical eye drops (0.1% bromfenac sodium hydrate twice daily and 1% dorzolamide hydrochloride thrice daily), sub‐Tenon triamcinolone injection thrice, intravitreal bevacizumab injection twice, and pars plana vitrectomy in the right eye. Genetic analyses were performed to conduct diagnosis of the individual. To examine the expression and distribution of WRN proteins in the retinas, immunohistochemistry for WRN proteins in human retinas was performed.Results CME in the right eye could not be improved by any of the treatment. During the follow‐up period, CME developed in the left eye. Genetic analyses detected compound heterozygosity of Mut4 and Mut11 in WRN gene and the individual was diagnosed with Werner syndrome. Immunohistochemical analysis of WRN proteins expression in human retinas indicated that WRN proteins were expressed in Müller cells of the inner nuclear layer and the outer nuclear layer.Conclusion Patients with Werner syndrome may develop severe CME. A pathological link may exist between the potential mutation in WRN gene and the development of CME in patients with Werner syndrome.

Association of p.P347L in the rhodopsin gene with early-onset cystoid macular edema in patients with retinitis pigmentosa

Purpose: To describe early-onset cystoid macular edema (CME) in a family with retinitis pigmentosa (RP) due to the p.P347L in the rhodopsin gene (RHO).Methods: All affected family members, including a 44-year-old mother and four children in their teens (two daughters, 17 and 15 years old, and two sons, 13 and 11 years old), have a mutation of p.P347L in RHO. Funduscopy, Goldmann perimetry, spectral domain optical coherence tomography (SD-OCT) and electroretinogram (ERG) were performed in all affected members to assess the retinal anatomy and function.Results: The mother had very poor visual acuity of light perception in both eyes, and marked foveal atrophy was observed via SD-OCT. Although the macular appearance in the funduscopy looked unremarkable in the four children, SD-OCT revealed bilateral CME in all the children. The rod response in ERG was extinguished and the cone response was decreased in all children.Conclusion: The results present the possibility that CME in RP patients may be associated with a specific genotype such as the p.P347L in RHO. We speculate that the severe visual prognosis of this mutation may be related to early-onset CME, as shown in this family. However, further investigation in more RP patients with this mutation and CME will be needed.

The clinical efficacy of a topical dorzolamide in the management of cystoid macular edema in patients with retinitis pigmentosa

Cystoid macular edema (CME) is one of the common complications of retinitis pigmentosa (RP), and is responsible for patient complications such as blurred and reduced visual acuity and for subsequent atrophic changes in the fovea. The objective of this work was to evaluate the clinical efficacy of a topical dorzolamide (a carbonic anhydrase inhibitor) in CME associated with RP. Sixteen eyes of nine patients with CME secondary to typical forms of RP were included in the study. Baseline visual acuity, visual field, and optical coherence tomography (OCT) measurements were obtained for all patients. All patients used 1% dorzolamide three times daily in each eye. Patients underwent follow-up exams at 1, 3, and 6 months after treatment. The response to treatment was monitored by visual acuity and visual field measurement testing using the Humphrey Field Analyzer (HFA: the central 10-2 Program); in addition, foveal thickness was measured by OCT. Evaluation of macular sensitivity calculated by HFA as the average of 12 central points. Thirteen (81.3%) of 16 eyes showed a clear decrease in retinal thickness after treatment. Evaluation of macular sensitivity, calculated by HFA as the average of 12 central points (with the exception of foveal point data, showed an improvement of more than 1.0 dB in nine (56.3%) of 16 eyes. Moreover, both the mean deviation value and macular sensitivity were significantly improved. No severe side-effects were seen in any of the patients examined. The results demonstrated that a topical dorzolamide is effective for the treatment of CME in patients with RP, and that the positive treatment effects last for up to 6 months.

VITREOUS INFLAMMATORY FACTORS AND SEROUS MACULAR DETACHMENT IN BRANCH RETINAL VEIN OCCLUSION

To investigate whether vascular endothelial growth factor, soluble intercellular adhesion molecule-1 (sICAM-1), and pigment epithelium-derived factor are associated with serous retinal detachment (SRD) secondary to branch retinal vein occlusion. The subjects were 44 branch retinal vein occlusion patients with macular edema and 16 controls. Patients were divided into 2 groups by optical coherence tomography findings, that is, 18 patients with SRD and 26 with cystoid macular edema. The area of capillary nonperfusion was measured with fluorescein angiography and Scion Image software. Vitreous fluid samples obtained during pars plana vitrectomy were examined by enzyme-linked immunosorbent assay. The incidence of major branch retinal vein occlusion was significantly higher in SRD patients (17/18, 94%) than in cystoid macular edema patients (15/26, 58%, P = 0.007), while the nonperfused retinal area was significantly larger in SRD patients (P = 0.006). Vitreous fluid levels of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) showed a significant increase across the 3 groups (control group, cystoid macular edema group, and SRD group) (P trend < 0.001 and P trend < 0.001, respectively), while the pigment epithelium-derived factor level showed a significant decrease across the 3 groups (P trend < 0.001). An excessive increase of vascular permeability secondary to upregulation of vascular endothelial growth factor and soluble intercellular adhesion molecule-1 (sICAM-1) along with downregulation of pigment epithelium-derived factor may contribute to the development of SRD in BRVO patients.

Clinical guidelines for diagnosing and managing ocular manifestations in children with mucopolysaccharidosis

The mucopolysaccharidoses (MPS) are a group of rare lysosomal storage disorders characterized by the accumulation of glycosaminoglycans in several tissues and organs. This accumulation results in an array of clinical manifestations and premature death in severe cases. Ocular problems are very common in children with MPS and may involve the cornea, sclera, trabecular meshwork, retina, optic nerve and also the posterior visual pathways. The aims of this study are to give an overview of ocular problems in MPS and to provide clinical guidelines for paediatric ophthalmologists for early diagnosis and management of ocular manifestations in children with MPS. Diagnostic problems may arise in children with severe corneal clouding, hampering visualization of the fundus. Intraocular pressures may be falsely high, even leading to suspicion and unnecessary pressure-lowering treatment. Simple interventions such as the use of prescription glasses or photochromatic glasses can considerably improve quality of life in children with MPS.

The rate and prognosis of cystoid macular edema in patients with phaco time longer than one minute

The rate and prognosis of cystoid macular edema in patients with phaco time longer than one minute

Risk factors analysis of cystoid macular edema in patients with anterior uveitis

目的 分析前葡萄膜炎患者并发黄斑囊样水肿(CME)的发生率及相关危险因素.方法 采用回顾性病例分析方法,连续收集在天津市眼科医院就诊的各种原因所致的前葡萄膜炎患者108例129眼,详细询问病史并进行眼科检查,应用光学相干断层扫描(OCT)检查或荧光素眼底血管造影(FFA)检查确定CME的存在.结果 前葡萄膜炎患者108例129眼中单眼发病者87例,双眼发病者21例.出现CME改变者41例43眼,发生率为33.3%.其中并发CME患者的最低平均矫正视力为0.41±0.16,未发生CME患者的最低平均视力为0.56±0.13,二者比较差异有统计学意义(q=5.040,P=0.000);2组患者恢复期平均矫正视力(0.82±0.18/0.85±0.14)比较差异无统计学意义(q=1.130,P=0.260).对2组患者的眼部及全身相关因素的多变量Logistic回归分析发现,CME的发生与病史反复发作(P=0.017,OR=7.62,95%CI:1.44～40.23)、HLA-B27阳性(P=0.049,OR=3.93,95%CI:1.01～15.30)、玻璃体细胞(P=0.023,OR=3.46,95%CI:1.19～10.04)、年龄较大(P=0.001,OR=1.09,95%CI:1.04～1.15)和初诊时矫正视力低(P=0.007,OR=0.01,95%CI:0.00～0.25)均呈明显相关,性别(P=0.09,OR=0.39,95%CI:0.13～1.16)、伴随的高血压病(P=0.960,OR=1.04,95%CI:0.32～3.35)或糖尿病史(P=0.510,OR=1.57,95%CI:0.41～6.06)、幼年性关节炎(P=0.470,OR=2.61,95%CI:0.19～35.27)和最终矫正视力(P=0.870,OR=0.73,95%CI:0.02～30.20)与CME的发生均无明显相关.结论 病情反复发作、HLA-B27阳性、玻璃体细胞和年龄是前葡萄膜炎患者并发CME的主要危险因素.经积极治疗后,多数患者视力恢复较好,仅少数患者造成永久性视力损害。

Continuous oral versus single pulse intravenous corticosteroid in the prevention of inflammation following cataract surgery in uveitis patients

Abstract Purpose To compare post‐operative inflammation and development of cystoid macular oedema (CMO) in uveitis patients undergoing cataract surgery and intraocular lens (IOL) implantation who had either pre‐operative oral or intra‐venous (IV) corticosteroid. Methods Retrospective case note study comparing uveitis patients undergoing phakoemulsification cataract surgery and implantation of an acrylic IOL (performed by one surgeon), having either oral corticosteroid (usually 40mg prednisolone two weeks prior to surgery and tapered by 5‐10mg weekly post‐operatively) or a single 500mg IV methylprednisolone pulse one hour prior to surgery. Results 30 procedures (35 patients) were identified where pre‐operative oral corticosteroid had been given, and 93 procedures (76 patients) where IV corticosteroid was given. In the oral corticosteroid cohort there were 2 (7%) episodes of fibrinous uveitis and 4 (13%) episodes of CMO within 90 days of the surgery. In the IV cohort there were 3 (3%) episodes of fibrinous uveitis and 16 (17%) episodes of CMO within 90 days of surgery. There was no statistically significant difference in the number of episodes of fibrinous uveitis or CMO between the two groups. Conclusion There was no difference in the incidence of post‐operative fibrinous uveitis or CMO in patients who were given either pre‐operative oral or IV corticosteroid. A single pulse of 500mg IV methylprednisolone appears a reasonable alternative to a course of oral prednisolone in uveitis patients undergoing cataract surgery.

TOPICAL NEPAFENAC AS AN ALTERNATE TREATMENT FOR CYSTOID MACULAR EDEMA IN STEROID RESPONSIVE PATIENTS

To evaluate the use of nepafenac 0.1% in patients with cystoid macular edema who are known steroid responders. Patients (N = 15) with clinical and angiographic cystoid macular edema (> or = 2 months) and a history of increased intraocular pressure following administration of topical corticosteroids participated in this prospective, open-label, pilot study. All patients were treated with nepafenac 0.1% four times daily for 6 weeks and the dose was tapered off over the ensuing 6 weeks. The total treatment duration was 12 weeks. Visual acuity and retinal thickness were measured. For the entire population, there was a mean significant improvement in visual acuity and retinal thickness at 4 weeks and 12 weeks posttreatment compared with baseline (P < 0.0001). A subgroup analysis revealed that patients with pseudophakic cystoid macular edema (n = 11) had a mean significant improvement in visual acuity and retinal thickness compared with baseline at 4 weeks and 12 weeks posttreatment (P < 0.0001). Although the improvement in the vitreoretinal interface disorders group was not statistically different from baseline (probably due to the outlier), three of the four patients with vitreoretinal interface disorders had improvement in visual acuity and retinal thickness. Nepafenac was well tolerated. Nepafenac may be an effective and safe therapy for treating chronic cystoid macular edema in patients who are steroid responders.

Treatment of Cystoid Macular Edema in Retinitis Pigmentosa With Intravitreal Triamcinolone

To evaluate the results of treatment with intravitreal triamcinolone acetonide injection in patients with cystoid macular edema secondary to retinitis pigmentosa. This prospective, nonrandomized comparative trial included 20 eyes of 20 patients with cystoid macular edema secondary to retinitis pigmentosa (group A) and 20 eyes of 20 control individuals (group B) with the same characteristics who declined treatment. All treated eyes received an intravitreal injection of 0.1 mL of triamcinolone acetonide (4 mg). The total follow-up was 12 months. The main outcome measures were best-corrected visual acuity, central macular thickness measured by optical coherence tomography, and intraocular pressure. No statistically significant changes were observed in best-corrected visual acuity. Central macular thickness showed statistical differences between the 2 groups. Intraocular pressure showed a statistically significant increase after the first day, at 1 month, and at 3 months in both groups but no significant increase afterward. Intravitreal triamcinolone administration may be useful for select cases of cystoid macular edema in patients with retinitis pigmentosa but its efficacy seems to be limited over time. Therefore, to obtain a good anatomical result and an improvement of best-corrected visual acuity, further treatment would be necessary after 6 months.

Intravitreal triamcinolone acetonide in the management of cystoid macular edema in Behçet’s disease

To determine the efficacy of intravitreal triamcinolone acetonide (ivTA) injection in the management of cystoid macular edema (CME) due to uveitis in patients with Behçet's disease. Ten eyes of seven patients with CME associated with Behçet's disease were included in the study. A quantity of 4 mg of triamcinolone acetonide was injected intravitreally in all of the eyes. The maculas of the patients were evaluated with optical coherence tomography (OCT) and fluorescein angiography (FA). The change in visual acuity, fluorescein leakage, macular thickness, and potential complications were assessed. The mean follow-up was 15.6 months (range 7-19 months). There was an increase of more than two Snellen lines in the visual acuity in seven of the ten eyes (70%) at the last examination. Macular edema regressed completely in eight of the ten eyes (80%) at the last visit on OCT and FA. The mean central macular thickness assessed by OCT was 406 mum before treatment and 186.9 mum at the last visit. The intraocular pressure (IOP) exceeded 21 mmHg in six eyes of five patients (60%) during the follow-up. At the last visit, the IOP was less than 21 mmHg in five eyes with medication. One eye underwent glaucoma filtration surgery. Four eyes of three patients had cataract progression. In four eyes of four patients (40%), a second ivTA injection was given due to relapsing CME. Intravitreal triamcinolone acetonide (ivTA) may be beneficial in the management of CME in patients with Behçet's disease. Repeated ivTA injections might be required if CME reoccurs.

Risk factors for cystoid macular oedema in patients with uveitis

To determine ophthalmologic and systemic factors associated with the presence of cystoid macular oedema (CMO) in patients with uveitis. Retrospective cross-sectional study in which 97 consecutive patients with uveitis filled in an extensive questionnaire for the presence of cardiovascular diseases and its risk factors. An analysis of the ophthalmologic and questionnaire data was conducted. CMO was present in 44% (43/97) of patients. Its presence was strongly associated with increasing age (P=0.001) and age at onset of uveitis (P<0.001). For patients older than 50 years, the risk of having CMO was 3.8-fold (95% confidence intervals 1.6-9.0) larger than for younger patients. The most frequent anatomic location of uveitis associated with CMO was panuveitis (49%). Papillary leakage on fluorescein angiography was associated with CMO (P<0.001), independently of other risk factors. After adjustment for age, multivariate logistic regression showed no association between cardiovascular disease and its risk factors and the presence of CMO. Age, independent of duration of uveitis, was a major risk factor for the presence of CMO in uveitis. A positive correlation between CMO and papillary leakage on angiography was noted.

Topical Dorzolamide for the Treatment of Cystoid Macular Edema in Patients With Retinitis Pigmentosa

To determine if topical dorzolamide, as observed with the use of systemic acetazolamide and methazolamide, would be effective in treating cystoid macular edema (CME) in patients with retinitis pigmentosa (RP). Prospective, nonrandomized clinical trial. setting: Institutional. patients: Fifteen patients with CME and RP. intervention: A baseline visual acuity and optical coherence tomography (OCT) measurements were obtained in all patients. Each one of them was then treated with topical dorzolamide, three times a day, for at least four weeks in both eyes. main outcome measures: Significant decrease in "foveal thickness" (more than 16%) and "foveal zone thickness" (more than 11%), as measured by OCT. Thirteen (87%) of 15 patients showed a significant decrease in retinal thickness in at least one eye after use of topical dorzolamide for at least four weeks. Five patients (33%) demonstrated improvement in both eyes. All patients, except one, who responded showed the effect within four weeks, but were monitored for a period of two to nine months (average 4.5 months). Four patients (31%) who showed an initial improvement in macular edema showed worsening with continued treatment. The present study documents the potential efficacy of topical dorzolamide for treating CME in patients with RP. We observed that some patients may show a "rebound phenomenon" with continued use of the medication; hence, there is a need for careful follow-up in patients being treated.