WHEN WHAT VISION IS LEFT GOES BAD: CYSTOID MACULAR EDEMA IN A PATIENT WITH RETINITIS PIGMENTOSA

Title WHEN WHAT VISION IS LEFT GOES BAD: CYSTOID MACULAR EDEMA IN A PATIENT WITH RETINITIS PIGMENTOSA
Author, Co-Author Audrey Otto
Topic
Year
2013
Day
Program Number
R02013127
Room
Room 6C
Affiliation
Abstract BACKGROUND:
Retinitis Pigmentosa (RP) is the most common inherited retinal degeneration. In early stages patients present with complaints of nyctalopia and peripheral field loss. These symptoms worsen as the disease progresses due to continued degeneration of photoreceptors. Complications such as posterior subcapsular cataracts and cystoid macular edema (CME) can contribute to loss of central visual

CASE REPORT(S):
A 75 year-old African American female with RP and type II diabetes presented for her 3-month post-operative cataract evaluation OD. She reported taking Metformin, aspirin, Crestor, and Omega-3 FAs. The left eye underwent cataract surgery 8 years prior. The patient denied pain, changes in vision, or discomfort. Best-corrected Feinbloom acuity was 5/180 OD and 5/180 OS. Anterior segment examination revealed posterior chamber IOLs OU with an open posterior capsule OS. Posterior segment evaluation revealed a fundus appearance typical of RP with waxy optic nerve pallor, vessel attenuation, and mid-peripheral bone spicules. Macular scarring with associated cystic changes was noted OS. OCT and FA confirmed the diagnosis of CME OS with underlying subfoveal fibrosis. Treatment of CME associated with RP is more difficult than that seen in other disease processes. In cases of CME in RP patients with an absence of fibrosis, topical 1% dorzolamide TID has been shown to lead to complete resolution or >20% reduction in retinal thickness from baseline in 77.8% of patients. In this case due to its longstanding nature and poor prognosis, the most appropriate management is to help improve the patient’s daily activities with low vision devices and training such as CCTV and occupational therapy.

CONCLUSIONS:
While the pathogenesis of CME in RP is not completely understood, it has been shown that it responds well to topical dorzolamide. RP patients are not statistically at higher risk for developing post-operative CME, however it is critical to ensure CME is absent before referring for cataract surgery.

ADDITIONAL COMMENTS:
Posterior segment fundus photographs, OCT images, and fluorescein angiography images of the case will be presented.
Affiliation of Co-Authors
Outline