Efficiency of combined therapy of cystoid macular edema in children with inflammatory and noninflammatory retinal diseases

AIM: To evaluate the effectiveness of combined anti-inflammatory and local dehydration therapy for CME in children with retinitis pigmentosa or uveitis of different etiologies.

MATERIAL AND METHODS: The study included two groups of children with cystic macular edema. In Group 1 CME developed against the background of retinitis pigmentosa, in group 2 against the background of uveitis. All children underwent subtenon injection of a prolonged steroid and instillations of carbonic anhydrase inhibitors 4 times a day. The results were evaluated after 1 month.

RESULTS: As a part of the ongoing therapy, all children received subtenon injections of long-acting corticosteroids and 4-times/day instillation of a carboanhydrase inhibitor for 1 month. Based on the present results, a tendency to increase the BCVA by 1–2 lines was noted in children with CME because of retinitis pigmentosa and in those with CME with uveitis. When assessing the thickness of the macular zone using optical coherence tomography, a significant difference was recorded relative to children with CME because the uveal process responded significantly better to the therapy. Thus, a significantly higher rate of resorption was demonstrated in macular edema.

CONCLUSION: The present results emphasize the importance of understanding the etiology of CME. The treatment of such children should be strictly pathogenetically directed. The combination of topical anti-inflammatory and dehydration therapy is the preferred choice of treatment for children with CME due to uveitis. This approach helps reduce cytokine inflammatory reactions, the activity of the inflammatory process, and the amount of fluid in the retina. In retinitis pigmentosa, the effect of photoreceptor decay products is weakly affected by anti-inflammatory therapy, and the dehydration therapy is short-term. Therefore, it is worthwhile to search for other ways to normalize the profile of the macular zone.