Carbonic Anhydrase Inhibitor with Topical NSAID Therapy to Manage Cystoid Macular Edema in a Case of Gyrate Atrophy

2017 ◽  
Vol 27 (6) ◽  
pp. e179-e183 ◽  
Author(s):  
Elena Piozzi ◽  
Salvatore Alessi ◽  
Silvia Santambrogio ◽  
Giovanni Cillino ◽  
Marco Mazza ◽  
...  
Keyword(s):  
Carbonic Anhydrase ◽  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Carbonic Anhydrase Inhibitor ◽  
Gyrate Atrophy ◽  
First Case ◽  
Membrane Bound ◽  
Inflammatory Drugs

Purpose Gyrate atrophy of the choroid and retina (GACR) is a rare chorioretinal dystrophy characterized by a deficiency of the enzyme ornithine aminotransferase, inherited in an autosomal recessive pattern. Case Report We report a case of a 17-year-old girl with GACR, for whom the level of serum ornithine had been reduced by an arginine-restricted diet. The patient was responsive to an association of topical nonsteroidal anti-inflammatory drugs (NSAIDs) and a carbonic anhydrase inhibitor (CAI) to reduce cystoid macular edema (CME). Conclusions The efficacy of topical NSAIDs and systemic CAI association indicates that the imbalance in the distribution of retinal pigment epithelium membrane-bound carbonic anhydrase could play a major role in CME pathogenesis in GACR. To our knowledge, this is the first case of therapy with CAI treatment for GACR-related CME.

scholarly journals Dorzolamide in a management of cystoid macular edema in a patient with retinitis pigmentosa sine pigmento

2017 ◽  
Vol 145 (5-6) ◽  
pp. 296-300
Author(s):  
Jelena Karadzic ◽  
Igor Kovacevic ◽  
Aleksandra Radosavljevic ◽  
Ivan Stefanovic
Keyword(s):  
Retinitis Pigmentosa ◽  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Visual Field Loss ◽  
Ophthalmological Examination ◽  
Inherited Retinal Dystrophies ◽  
Retinal Dystrophies ◽  
Advanced Stages

Introduction. Retinitis pigmentosa (RP) is a group of inherited retinal dystrophies caused by mutations in various genes. The disease leads to progressive photoreceptors loss (rods predominantly) and retinal pigment epithelium alteration. RP can lead to blindness in the advanced stages of the disease, when the central retina is involved, mostly due to the presence of cystoid macular edema (CME). Several therapeutic approaches for CME in RP patients have been attempted but responses have been variable. Case outline. A 51-year-old man was referred due to progressive six-month-long blurring of vision in both eyes. The patient underwent complete ophthalmological examination at baseline. Based on the clinical presentation of mottled mid periphery of the retina and characteristic tubular visual field loss, hence typical fluorescein angiography and optical coherence tomography (OCT) findings, the patient was diagnosed as bilateral retinitis pigmentosa sine pigmento with CME. In an attempt to control the edema, treatment was started with dorzolamide, instilled three times daily in each eye, which resulted in reduction of macular edema in a one-month-period, as documented by OCT. This effect was further monitored for five months and was stable. Conclusion. In the presented case, we investigate the six-month therapeutic efficacy of dorzolamide for dealing with the CME secondary to RP. Topical carbonic anhydrase inhibitors are considered as the first option for treatment of CME in RP patients, due to their high efficacy and safety.

Taxane Induced Cystoid Macular Edema: Case Report and Integrated Pathogenic Theory

2019 ◽  
Vol 14 (1) ◽  
pp. 43-47 ◽  
Author(s):  
M. Kanakis ◽  
I. Georgalas ◽  
T. Makatsoris ◽  
N. Pharmakakis
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Fluorescein Angiography ◽  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Additional Treatment ◽  
Published Data ◽  
Optical Coherence

Purpose: To report a case of a 73-year-old man who presented with decreased visual acuity due to bilateral macular edema after paclitaxel administration for prostate cancer. Methods: The ophthalmic evaluation consisted of medical and ocular history, Best Corrected Visual Acuity, slit-lamp biomicroscopy and Spectral-domain optical coherence tomography / Fluorescein Angiography. Results: Optical Coherence Tomography and Fluorescein Angiography revealed silent cystoid macular edema. After consulting with the oncologist, the cessation of paclitaxel therapy was decided. The patient presented a gradual but steady resumption of the retinal edema, with complete restoration of normal retinal morphology and function within two months. The pathogenesis of the silent Cystoid Macular Edema (CME) is still unclear. Based on our case and a critical review of the previous observations and published data, we propose that the underlying cause of Taxane induced CME is the functional failure of Aquaporin mediated water transport at the level of retinal Intermediate and Deep capillary plexuses, and at lesser extent at the level of the Retinal Pigment Epithelium. Conclusion: Taxane induced silent CME should be attributed to the action of Taxanes on the microtubule guided aquaporin vesicles transport to the cell membrane. In our case of Taxane induced silent CME, withdrawal of the taxane was enough for complete recovery, and no additional treatment was needed.

Retinol dehydrogenases: Membrane-bound enzymes for the visual function

2014 ◽  
Vol 92 (6) ◽  
pp. 510-523 ◽  
Author(s):  
Mustapha Lhor ◽  
Christian Salesse
Keyword(s):  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Membrane Binding ◽  
Large Family ◽  
Structural Features ◽  
Visual Cycle ◽  
Retinoid Metabolism ◽  
Current State ◽  
Membrane Bound ◽  
Membrane Bound Enzymes

Retinoid metabolism is important for many physiological functions, such as differenciation, growth, and vision. In the visual context, after the absorption of light in rod photoreceptors by the visual pigment rhodopsin, 11-cis retinal is isomerized to all-trans retinal. This retinoid subsequently undergoes a series of modifications during the visual cycle through a cascade of reactions occurring in photoreceptors and in the retinal pigment epithelium. Retinol dehydrogenases (RDHs) are enzymes responsible for crucial steps of this visual cycle. They belong to a large family of proteins designated as short-chain dehydrogenases/reductases. The structure of these RDHs has been predicted using modern bioinformatics tools, which allowed to propose models with similar structures including a common Rossman fold. These enzymes undergo oxidoreduction reactions, whose direction is dictated by the preference and concentration of their individual cofactor (NAD(H)/NADP(H)). This review presents the current state of knowledge on functional and structural features of RDHs involved in the visual cycle as well as knockout models. RDHs are described as integral or peripheral enzymes. A topology model of the membrane binding of these RDHs via their N- and (or) C-terminal domain has been proposed on the basis of their individual properties. Membrane binding is a crucial issue for these enzymes because of the high hydrophobicity of their retinoid substrates.

scholarly journals Cystoid macular edema in gyrate atrophy of choroid and retina associated with hyperornithinemia

2019 ◽  
Vol 55 (2) ◽  
pp. 179-184
Author(s):  
Martina Galiot Delić ◽  
Petra Kristina Ivkić ◽  
Zlatko Juratovac ◽  
Sanja Perić ◽  
Tomislav Jukić ◽  
...  
Keyword(s):  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Vitamin B6 ◽  
Gyrate Atrophy

Cilj: Cilj rada je prikazati klinički tijek, dijagnostiku i liječenje šestgodišnje djevojčice s giratnom atrofijom i obostranim cistoidnim edemom makule. Prikaz slučaja: U četverogodišnje djevojčice tijekom sistematskog pregleda nađeni su slabija vidna oštrina i konvergentni strabizam. Nakon dvogodišnjeg liječenja slabovidnosti primjećuje se obostrani makularni edem te se dijete upućuje na daljnju obradu na Kliniku za oftalmologiju. Djevojčica je tada imala vidnu oštrinu 0.15 na oba oka, obostrani edem makule i ovalne zone korioretinalne atrofije na periferiji mrežnice. Uvedena je antiedematozna terapija. Učinjena je cjelovita klinička i laboratorijska obrada i u plazmi nađena visoka koncentracija ornitina, te je postavljena dijagnoza giratne atrofije (GA) korioretine. U terapiju je uveden piridoksin (vitamin B6). Po terapiji je došlo do neznatnog smanjenja koncentracije ornitina u plazmi te je uvedena i prehrana s ograničenim unosom proteina kojom se također nije postigao željeni učinak. Naposljetku je uz navedeno započeto liječenje aminokiselinom L-lizinom. Kombinacija navedenih terapijskih mjera dovela je do značajnog smanjenja koncentracije ornitina u plazmi, koja je smanjena na oko trećinu u odnosu na koncentracije prije početka liječenja. Uz laboratorijske pokazatelje bolje kontrole bolesti zamijećeno je prolazno kliničko poboljšanje, smanjenje makularnog edema, ali se progresija perifernih atrofičnih lezija nije zaustavila. Zaključak: Cistoidni edem makule u pacijenata s giratnom atrofijom praćen je oslabljenom vidnom oštrinom. Unatoč intenzivnom liječenju edem makule perzistira te je vidljiva daljnja progresija atrofičnih žarišta na periferiji fundusa. Smanjenje koncentracija ornitina u plazmi bitan je preduvjet za usporenje progresije bolesti i odgađanje trajnog gubitka vidne funkcije.

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