The effectiveness of subtenon triamcinolone injection for the treatment of macular edema in children with retinitis pigmentosa

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Abstract

Aim: This study aimed to assess the functional and anatomical results of subtenon triamcinolone injections in children with retinitis pigmentosa (PR) and cystic macular edema (CME), refractory to local carbonic anhydrase inhibitors.

Material and methods: We examined 11 children (9 girls, 2 boys) aged 9 to 17 years who underwent subtenon injections of triamcinolone (22 eyes). The follow-up period ranged from 1.6 to 33.1 months (average 9.7±11.6 months), the number of triamcinalone injections ranged from 1 to 11, averaging 3. Before and after injection, best corrected visual acuity (BCVA), the thickness and structure of the retina in the macular zone (optical coherence tomography [OCT] was performed by using the NIDEK RS-3000, Japan or the Spectralis, Heidelberg Engineering, Germany), and intraocular pressure (IOP) were assessed.

Results: The CME height at the end of the observation period decreased in 10 cases (45.5%), and the average central retinal thickness decreased from 70 to 594 μm (on average, 219.1±183.4 μm). In 12 eyes (54.5%), the CME height at the end of the observation period did not change significantly. BCVA improved in two eyes (9.1%) and did not change in the other cases. Two children (18%) developed ophthalmic hypertension in both eyes after two injections of triamcinalone. In one child, IOP returned to normal on the background of hypothetical therapy. In another child, due to non-compensation of IOP at the maximum hypotensive mode, sinus trabeculectomy was performed in both eyes, and IOP normalization was achieved.

Conclusion: Subtenon injection of triamcinolone in children with CME against a background of PR is in most cases is an effective and safe method of treatment and can be recommended if carbonic anhydrase inhibitors are ineffective at reducing/ resorbing edema and maintaining or improving visual function. Considering that the action of triamcinolone is short lived, and its repeated injection is required, and the resorption of CME and an increase in visual acuity are not always achievable, it is necessary to continue the search for more effective treatment methods.

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About the authors

Lyudmila A. Katargina

Helmholtz National Medical Research Center of Eye Diseases

Email: katargina@igb.ru

MD, PhD, professor

Russian Federation, Moscow

Ekaterina V. Denisova

Helmholtz National Medical Research Center of Eye Diseases

Author for correspondence.
Email: deale_2006@inbox.ru
ORCID iD: 0000-0003-3735-6249
SPIN-code: 4111-4330

MD, PhD

Russian Federation, Moscow

Maria A. Khrabrova

Helmholtz National Medical Research Center of Eye Diseases

Email: deale_2006@inbox.ru
ORCID iD: 0000-0001-9422-4264

MD, PhD student

Russian Federation, Moscow

Natalia A. Osipova

Helmholtz National Medical Research Center of Eye Diseases

Email: natashamma@mail.ru
ORCID iD: 0000-0002-3151-6910

MD, PhD

Russian Federation, Moscow

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Supplementary files

Supplementary Files
Action
1. Fig.1. The state of the photoreceptor layer in children with retinitis pigmentosa and cystic macular edema according to optical coherence tomography data: a — the photoreceptor layer is preserved; b — partial destruction; c — complete destruction.

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2. Fig.2. Patient P., 16 years old. Optical coherence tomography results. Right а and left b eyes before the start of injections of trimcinolone, Cystoid cavities in the outer and inner nuclear layers of the retina. The central retinal thickness is 618 μm on the right, 626 μm on the left after ten injections of trimcinolone. Right c resorption of macular edema, CRT 272 μm. Left d — small cyst-like cavities in the layers of the retina, parafoveal, CRT 201 μm.

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