الفهرس 
Triamcinolone acetonideOnly 14 pages are availabe for public view
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Abstract
Central Serous Retinopathy is a localized serous detachment of the posterior pole of the retina, occurring as a result of a focal defect in the RPE, which leads to fluid of choroidal origin leaking into the subretinal space, causing a detachment of the neurosensory retina from the RPE in the macular area.
The typical clinical picture is that of a male aged 20 years to 50 years, presenting with an acute onset of blurring of vision associated with metamorphopsia, micropsia, and a central scotoma. Fundus examination reveals a transparent blister at the posterior pole with a ring reflex, marking the limits of the elevated area. The diagnosis is confirmed by flourescein angiography that reveals one or more leaking points at the level of the RPE. Other modalities that may be used to confirm the diagnosis are ICG angiography, OCT and enface OCT.
Predisposing factors that have been reported to induce or aggravate CSCR include emotional stress, type A personality, hypertension, pregnancy, organ transplantation, Systemic Lupus Erythromatosis, increased levels of endogenous corticosteroids, treatment with corticosteroids and psychopharmacologic medication. CSCR resolves spontaneously within one to six months in 80- 90%, and visual prognosis is relatively good; but some patients tend to relapse and have permanent vision loss because of chronic and recurrent retinal detachments.
Prophylaxis or treatment of CSCR is not available except as focal thermal photocoagulation of extrafoveal leakage sites, and it is still uncertain whether this modality affects the final visual outcome. Other tried modalities of treatment include: photodynamic therapy, transpupillary thermotherapy, acetazolamide, beta-blockers, and most recently the anti-glucocorticoid Mifepristone that is showing beneficial promising results.
Intravitreal injection of triamcinolone acetonide is a relatively new therapeutic option for treatment of various intraocular diseases, such as diffuse diabetic macular oedema, retinal vein occlusion etc…TA is a long acting synthetic crystalline glucocorticoid that has been proved to be non-toxic to the intraocular tissue and effective in resolving the oedema. Intravitreal injection of TA has many complications like: elevation of intraocular pressure, posterior subcapsular cataract and the extremely rare post intraocular injection endophthalmitis.
For decades, corticosteroids have been used in ophthalmology to suppress intraocular inflammation and to reduce extravasation from the blood vessels. Corticosteroids have been tried in acute cases of CSCR via various routes of administration since the early 1950s, with contradictory results. It was found that the use of corticosteroids has been reported to be associated with the development of CSCR. Moreover, according to numerous reports, the use of corticosteroids in the treatment of various systemic diseases seemed to increase the prevalence of CSCR, regardless of route of administration, and resolution of the CSCR ensued upon decreasing or discontinuing the drug.
The exact pathophysiologic mechanism by which corticosteroids cause the development of CSCR is still not clear, though several hypotheses were suggested.
There are only few reports on the use of corticosteroids for treating CSCR (acute and chronic). Failure was documented in the two cases where the intra-muscular route was used. In another study, success was reported for five cases using the subconjunctival route, shortening the course of the disease in three of them. A third study on two cases using oral therapy showed no improvement and a fourth report on one case showed deterioration of the case, but it became better when the treatment was stopped. These reports would seem to suggest that the subconjunctival route in acute cases might shorten the course of the disease.
The studies reporting the success of IVTA in other conditions are devoid of CSCR as a complication. Only one case was reported of CSCR discovered following vitrectomy with IVTA for DME, after subsidence of postoperative vitreous haemorrhage.
There is only one case in the literature reported of CSCR being treated with IVTA. This was a longstanding case, in which the TA was given as a last resort. In this single case resolution did not occur until thirteen months later, which may be explained by the natural course of the disease, keeping in mind that TA remains up to 18 months in measurable concentrations after intravitreal injection.
In addition three studies showed resolution of serous macular detachments secondary to CRVO, BRVO and DME, after the use of IVTA. They hypothesized that this was due to its beneficial effect on RPE and blood retinal barrier.
Thus, Intravitreal triamcinolone therapy should therefore be investigated for a possible beneficial role in the treatment of chronic CSCR, and a controlled study is recommended to research this possibility.