Intravitreal aflibercept (Eylea) injection for cystoid macular edema secondary to retinitis pigmentosa - a first case report and short review of the literature

Giannis-Aimant Moustafa, Marilita M Moschos, Giannis-Aimant Moustafa, Marilita M Moschos

Abstract

Background: Cystoid macular edema (CME) in retinitis pigmentosa (RP) has been managed in several ways as documented in the literature, with little success, though. The aim of our study was to report for the first time in literature the use of aflibercept in a patient with RP and CME.

Case presentation: A 52-year-old man presented for blurred vision in his right eye. Best-corrected visual acuity (BCVA) was 3/10 in his right eye and 7/10 in his left eye. Physical examination and appropriate laboratory tests lead to the diagnosis of bilateral RP with CME in the right eye. Retinal thickness in the foveal area of the right eye was 631 μm. The patient was treated with a single intravitreal injection of 0.05 ml/0.5 mg aflibercept. One month later, BCVA of the right eye increased to 4/10, while BCVA of the left eye was unchanged. RT in the right eye decreased to 129 μm. Multifocal electroretinogram response did not improve, yet peaks were better-shaped and no areas of eccentral vision were present. Three and six months after injection, these improvements were maintained.

Conclusion: This first-reported case indicates that intravitreal aflibercept injection for addressing CME in RP seems to be an effective treatment.

Figures

Figure 1
Figure 1
Timeline of events for the presented case.
Figure 2
Figure 2
Fundoscopy showing peripheral bone-spicule-like pigmentations and arterial narrowing characteristic of retinitis pigmentosa.
Figure 3
Figure 3
OCT scans of the right eye at presentation (A) and one month after intravitreal aflibercept (B) with macular thickness measuring 631 μm and 129 μm, respectively.
Figure 4
Figure 4
3D appearance of mfERG recording and mfERG traces on the right eye at presentation (A,B) and one month after the intravitreal aflibercept (C,D).

References

    1. Hamel C. Retinitis pigmentosa. Orphanet J Rare Dis. 2006;1:40. doi: 10.1186/1750-1172-1-40.
    1. Ozdemir H, Karacorlu M, Karacorlu S. Intravitreal triamcinolone acetonide for treatment of cystoid macular oedema in patients with retinitis pigmentosa. Acta Ophthalmol Scand. 2005;83(2):248–51. doi: 10.1111/j.1600-0420.2005.00395.x.
    1. Baumgartner WA. Etiology, pathogenesis, and experimental treatment of retinitis pigmentosa. Med Hypotheses. 2000;54(5):814–24. doi: 10.1054/mehy.1999.0957.
    1. Cox SN, Hay E, Bird AC. Treatment of chronic macular edema with acetazolamide. Arch Ophthalmol. 1988;106(9):1190–5. doi: 10.1001/archopht.1988.01060140350030.
    1. Vinores SA, Derevjanik NL, Ozaki H, Okamoto N, Campochiaro PA. Cellular mechanisms of blood-retinal barrier dysfunction in macular edema. Doc Ophthalmol. 1999;97(3–4):217–28. doi: 10.1023/A:1002136712070.
    1. Fishman GA, Gilbert LD, Fiscella RG, Kimura AE, Jampol LM. Acetazolamide for treatment of chronic macular edema in retinitis pigmentosa. Arch Ophthalmol. 1989;107(10):1445–52. doi: 10.1001/archopht.1989.01070020519031.
    1. Apushkin MA, Fishman GA, Janowicz MJ. Monitoring cystoid macular edema by optical coherence tomography in patients with retinitis pigmentosa. Ophthalmology. 2004;111(10):1899–904. doi: 10.1016/j.ophtha.2004.04.019.
    1. Thobani A, Fishman GA. The use of carbonic anhydrase inhibitors in the retreatment of cystic macular lesions in retinitis pigmentosa and X-linked retinoschisis. Retina. 2011;31(2):312–5. doi: 10.1097/IAE.0b013e3181e587f9.
    1. Apushkin MA, Fishman GA, Grover S, Janowicz MJ. Rebound of cystoid macular edema with continued use of acetazolamide in patients with retinitis pigmentosa. Retina. 2007;27(8):1112–8. doi: 10.1097/IAE.0b013e31805f6b79.
    1. Stanga PE, Downes SM, Ahuja RM, Chong NH, Antcliff R, Reck AC. Comparison of optical coherence tomography and fluorescein angiography in assessing macular edema in retinal dystrophies: preliminary results. Int Ophthalmol. 2001;23(4–6):321–5. doi: 10.1023/A:1014438213665.
    1. Grover S, Fishman GA, Fiscella RG, Adelman AE. Efficacy of dorzolamide hydrochloride in the management of chronic cystoid macular edema in patients with retinitis pigmentosa. Retina. 1997;17(3):222–31. doi: 10.1097/00006982-199705000-00009.
    1. Grover S, Apushkin MA, Fishman GA. Topical dorzolamide for the treatment of cystoid macular edema in patients with retinitis pigmentosa. Am J Ophthalmol. 2006;141(5):850–8. doi: 10.1016/j.ajo.2005.12.030.
    1. Ikeda Y, Yoshida N, Notomi S, Murakami Y, Hisatomi T, Enaida H, et al. Therapeutic effect of prolonged treatment with topical dorzolamide for cystoid macular oedema in patients with retinitis pigmentosa. Br J Ophthalmol. 2013;97(9):1187–91. doi: 10.1136/bjophthalmol-2012-303005.
    1. Giusti C, Forte R, Vingolo EM. Deflazacort treatment of cystoid macular edema in patients affected by Retinitis Pigmentosa: a pilot study. Eur Rev Med Pharmacol Sci. 2002;6(1):1–8.
    1. Scorolli L, Morara M, Meduri A, Reggiani LB, Ferreri G, Scalinci SZ, et al. Treatment of cystoid macular edema in retinitis pigmentosa with intravitreal triamcinolone. Arch Ophthalmol. 2007;125(6):759–64. doi: 10.1001/archopht.125.6.759.
    1. Saraiva VS, Sallum JM, Farah ME. Treatment of cystoid macular edema related to retinitis pigmentosa with intravitreal triamcinolone acetonide. Ophthalmic Surg Lasers Imaging. 2003;34(5):398–400.
    1. Saatci AO, Selver OB, Seymenoglu G, Yaman A. Bilateral intravitreal dexamethasone implant for retinitis pigmentosa-related macular edema. Case Rep Ophthalmol. 2013;4(1):53–8. doi: 10.1159/000350544.
    1. Ahn SJ, Kim KE, Woo SJ, Park KH. The effect of an intravitreal dexamethasone implant for cystoid macular edema in retinitis pigmentosa: a case report and literature review. Ophthalmic Surg Lasers Imaging Retina. 2014;45(2):160–4. doi: 10.3928/23258160-20140131-03.
    1. Newsome DA, Blacharski PA. Grid photocoagulation for macular edema in patients with retinitis pigmentosa. Am J Ophthalmol. 1987;103(2):161–6. doi: 10.1016/S0002-9394(14)74221-7.
    1. Garcia-Arumi J, Martinez V, Sararols L, Corcostegui B. Vitreoretinal surgery for cystoid macular edema associated with retinitis pigmentosa. Ophthalmology. 2003;110(6):1164–9. doi: 10.1016/S0161-6420(03)00259-8.
    1. Genead MA, Fishman GA, Walia S. Efficacy of sustained topical dorzolamide therapy for cystic macular lesions in patients with X-linked retinoschisis. Arch Ophthalmol. 2010;128(2):190–7. doi: 10.1001/archophthalmol.2009.398.
    1. Querques G, Prascina F, Iaculli C, Noci ND. Intravitreal pegaptanib sodium (Macugen) for refractory cystoid macular edema in pericentral retinitis pigmentosa. Int Ophthalmol. 2009;29(2):103–7. doi: 10.1007/s10792-007-9175-1.
    1. Artunay O, Yuzbasioglu E, Rasier R, Sengul A, Bahcecioglu H. Intravitreal ranibizumab in the treatment of cystoid macular edema associated with retinitis pigmentosa. J Ocul Pharmacol Ther. 2009;25(6):545–50. doi: 10.1089/jop.2009.0089.
    1. Stewart MW. The expanding role of vascular endothelial growth factor inhibitors in ophthalmology. Mayo Clin Proc. 2012;87(1):77–88. doi: 10.1016/j.mayocp.2011.10.001.
    1. Moschos MM, Chatziralli IP, Verriopoulos G, Triglianos A, Ladas DS, Brouzas D. Correlation between optical coherence tomography and multifocal electroretinogram findings with visual acuity in retinitis pigmentosa. Clin Ophthalmol. 2013;7:2073–8. doi: 10.2147/OPTH.S50752.
    1. Moradi A, Sepah YJ, Sadiq MA, Nasir H, Kherani S, Sophie R, et al. Vascular endothelial growth factor trap-eye (Aflibercept) for the management of diabetic macular edema. World J Diabetes. 2013;4(6):303–9. doi: 10.4239/wjd.v4.i6.303.
    1. Stewart MW. Aflibercept (VEGF Trap-eye): the newest anti-VEGF drug. Br J Ophthalmol. 2012;96(9):1157–8. doi: 10.1136/bjophthalmol-2011-300654.
    1. Yuzbasioglu E, Artunay O, Rasier R, Sengul A, Bahcecioglu H. Intravitreal bevacizumab (Avastin) injection in retinitis pigmentosa. Curr Eye Res. 2009;34(3):231–7. doi: 10.1080/02713680802710692.
    1. Melo GB, Farah ME, Aggio FB. Intravitreal injection of bevacizumab for cystoid macular edema in retinitis pigmentosa. Acta Ophthalmol Scand. 2007;85(4):461–3. doi: 10.1111/j.1600-0420.2006.00872.x.
    1. Holash J, Davis S, Papadopoulos N, Croll SD, Ho L, Russell M, et al. VEGF-Trap: a VEGF blocker with potent antitumor effects. Proc Natl Acad Sci U S A. 2002;99(17):11393–8. doi: 10.1073/pnas.172398299.
    1. Regeneron Pharmaceuticals Inc. EYLEA Full Prescribing Information. In: EYLEA Official Webpage. 2014. . Accessed 19 Jan 2015.

Source: PubMed

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