ABSTRACT
AIM: To do the assesement of the effects of repeated parabulbar application of triamcinolone acetonide ( TA ) on uveitic macular edema ( ME ) with and without epiretinal membranes ( ERM) obtained via high resolution optical coherence tomography( OCT) parameters ( central and average macular thicknesses, and volume) and their correlation with visual efficiency. ● METHODS: This study depicts treatment results obtained for 140 eyes in patients with uveitic macular edema divided into two groups based on absence or presence of epiretinal membranes. Three repeated doses of triamcinolone acetonide ( 40 mg each ) were parabulbarlly applied every 3-4wk, and besides which all patients also received local treatment of nonsteroidal anti-inflammatory drugs. Patients′ visual efficiency, intraocular pressure, and high resolution spectral domain optical coherence tomography ( SD-OCT ) examination was performed. ●RESULTS: Best results were achieved in patients with macular edema without epiretinal membranes where average values for average thickness, volume, and central field thickness were statistically significantly lower than the same values at the beginning of treatment. Following treatment of eyes with macular edema in a group with ERM, besides decreased values of volume and average thickness, there was also increased central field thickness. Overall, from initial examination to treatment completion, there was no statistically significant change of intraocular pressure and central field thickness, but there was statistically significant decrease in average thickness, volume, while visual efficiency statistically increased. ln both groups visual efficiency highly correlated with central field thickness. ● CONCLUSION: Repeated parabulbar application of triamcinolone acetonide had better outcome on uveitic macular edema without epiretinal membranes being present.
ABSTRACT
Aim: To present clinical picture and treatment of anterior idiopathic necrotizing scleritis. Methods: Clinical and laboratory examination; B-scan ultrasound; tissue biopsy and histological analysis, were performed. Results: Herewith we depict a case of 74 year old man, with unilateral granulomatous, anterior, necrotizing scleritis. Etiology has, through extensive testing, both laboratorial and clinical, not been proven and thus the patient has been classified as having idiopathic scleritis. Complications on both anterior (anterior uveitis) and posterior (subretinal granulomatous infiltrates with localized retinal detachment) segments of the eye are a consequence of granulomatous necrotizing scleritis. Both tissue biopsy of granulomatous scleral infiltrates and histological analysis showed that this is the case of granulomatous, partially necrotizing scleritis with some elements of vasculitis. Progression of granulomatous scleral infiltrates into the eye has also been shown through clinical examination and B-scan ultrasound, and depicted subretinal lesion of medium reflectivity that is in contact with the epibulbar lesion. Retinal detachment in this area had progressed and required excessive laser photocoagulation barrage and resulted in absorption of subretinal fluid. Positive therapeutic outcome was achieved through the use Methotrexate and corticosteroids. Conclusion: Granulomatous infiltrates that spread towards the subretinal space and result in localized retinal detachment are a rare complication that may occur during the evolution of necrotizing scleritis and require regular monitoring and followup. Treatment, both pharmaceutical and laser photocoagulation, should be adjusted in order to affect progression and prevent possible complications of the disease.