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Correspondence to Professor Pedro Cuevas, [email protected]
Case presentation
nA 75-year-old woman, who underwent bilateral cataract surgery 2 years ago, presented with a 6-month history of poor vision, and referred a great reduction of visual acuity in her right phakic eye. Ophthalmic examination includes best-corrected Snellen visual acuity test and optical coherence tomography (OCT). Visual acuity was 0.05 and OCT scan showed typical features of cystoid macular oedema (CME) (figure 1A). After approval of our Institution Ethical Committee, the patient signed an informed consent form, which included a comprehensive description of dobesilate and the proposed procedure. The patient received an intravitreal solution of dobesilate (150 μl) under sterile conditions, following the International Guidelines for intravitreal injections1 in her right eye. Dobesilate was administered as a 12.5% solution of diethylammonium 2.5-dihydroxybenzenesulphonate (etamsylate; Dicynone Sanofi-Aventis, Paris, France). After 6 days of treatment vision acuity was improved (0.4) and the structural changes in the fovea resolved with resolution of the intraretinal cystic spaces (figure 1B). Intraocular pressure was 14 mm Hg before treatment, raised to 28 mm Hg after 2 min of injection and returned to baseline 24 h after. No ocular side effects were observed during treatment. The patient was clinically stable on a 10-week follow-up after injection.
Discussion
nCME is a common cause of visual loss that is the result of cystic accumulation of extracellular intraretinal fluid predominantly in the outer plexiform and inner nuclear layers of the retina, as a result of the breakdown of the blood retinal barrier.2 Common causes of CME are postsurgical (cataract, glaucoma and laser surgeries), intraocular inflammatory diseases, medications, diabetic retinopathy, genetic chorioretinal dystrophy (choroideraemia) and retinal vein occlusions.34 Acute CME, defined as oedema of less than 4 months duration, often resolved spontaneously, while CME that persists for 4 months...