Correspondence

Treatment of Cystoid Macular Edema with Octreotide

N Engl J Med 1998; 338:624-626February 26, 1998

Article

To the Editor:

Idiopathic cystoid macular edema is an uncommon form of retinal edema that is refractory to treatment with drugs such as acetazolamide1 that are used in patients with other types of macular edema.2,3 We describe the beneficial effect of octreotide in a patient with this disorder.

A 21-year-old man was found to have moderate color-vision defects at routine examination. One year later, he noticed blurred vision. His visual acuity was 20/50 in the right eye and 20/40 in the left eye (Snellen chart). Because he had bilateral cystoid macular edema, he was treated with diclofenac eye drops, peribulbar injections of betamethasone, acetazolamide, and enalapril without beneficial effect on the edema or visual acuity. His visual acuity slowly deteriorated in the subsequent years. When we examined the patient three years after he first noted blurring of his vision, his visual acuity was 20/100 in each eye, the macular regions showed large cystoid lesions (Figure 1AFigure 1Photographs and Angiograms of the Left Retina before and after Treatment with Octreotide.), and there was no intraocular inflammation (anterior chamber flare or cells, vitreous cells, vascular sheathing, exudates, or pars planitis). He had no family history of macular edema. Fluorescein angiography showed accumulation of dye in the cystoid lesions (Figure 1B and Figure 1C). Because the previous therapy had failed to correct the problem, the patient was treated with octreotide, 100 μg subcutaneously three times daily, after he gave informed consent. He noted visual improvement after six weeks, and when tested after eight weeks his visual acuity was 20/40 in the right eye and 20/50 in the left eye. Ophthalmoscopically, the cysts had dried. The injections were stopped four weeks later, because there was no further improvement.

Within two weeks the patient noticed increased reading difficulty, his visual acuity was 20/50 in each eye, and some fluid was observed ophthalmoscopically. Treatment with 100 μg of octreotide subcutaneously once daily was resumed. Three months later the patient's visual acuity was 20/40 in each eye; fluorescein angiography showed some foveal fluorescein leakage (Figure 1D, Figure 1E, and Figure 1F). He stopped treatment a second time; after four weeks his visual acuity was 20/70 in the right eye and 20/50 in the left eye. Octreotide therapy was resumed, and four weeks later his visual acuity was 20/40 in each eye. The patient had no side effects from the treatment. The decreased macular edema during treatment with octreotide, the recurrence after stopping treatment, and the response after restarting it suggest that the changes were due to octreotide.

The mechanism of inhibition of macular edema by octreotide is not known. It may act directly on the capillary endothelial cells or through inhibition of growth hormone and production of insulin-like growth factor I.4,5 On the basis of our results, we suggest that octreotide be evaluated in patients with other types of macular edema.

Robert W.A.M. Kuijpers, M.D., Ph.D.
University Hospital Rotterdam, 3015 GD Rotterdam, the Netherlands

Seerp Baarsma, M.D.
Eye Hospital Rotterdam, 3011 BH Rotterdam, the Netherlands

P. Martin van Hagen, M.D., Ph.D.
University Hospital Rotterdam, 3015 GD Rotterdam, the Netherlands

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   Tom Missotten, Jan A.M. van Laar, Theo L. van der Loos, Paul L.A. van Daele, Robert W.A.M. Kuijpers, G. Seerp Baarsma, P. Martin van Hagen. (2007) Octreotide Long-Acting Repeatable for the Treatment of Chronic Macular Edema in Uveitis. American Journal of Ophthalmology 144:6, 838-843.e1
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   E. Chantelau, J. Frystyk. (2005) Progression of diabetic retinopathy during improved metabolic control may be treated with reduced insulin dosage and/or somatostatin analogue administration – a case report. Growth Hormone & IGF Research 15:2, 130-135
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   Thekla Papadaki, Ioannis Zacharopoulos, Barbara Iaccheri, Tito Fiore, C. Stephen Foster. (2005) Somatostatin for Uveitic Cystoid Macular Edema (CME). Ocular Immunology and Inflammation 13:6, 469-470
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   Maria Concepcion Hernaez-Ortega, Enrique Soto-Pedre, Juan Jose Beitia Martin. (2004) Sandostatin LAR for cystoid diabetic macular edema: a 1-year experience. Diabetes Research and Clinical Practice 64:1, 71-72
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   P Gargiulo, C Giusti, D Pietrobono, D La Torre, D Diacono, G Tamburrano. (2004) Diabetes mellitus and retinopathy. Digestive and Liver Disease 36, S101-S105
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   Bernhard O Boehm. (2003) The therapeutic potential of somatostatin receptor ligands in the treatment of obesity and diabetes. Expert Opinion on Investigational Drugs 12:9, 1501-1509
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    Kyriaki Thermos. (2003) Functional mapping of somatostatin receptors in the retina: a review. Vision Research 43:17, 1805-1815
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    U. Celiker, N. Ilhan, I. Ozercan, T. Demir, H. Celiker. (2002) Octreotide reduces ischaemia-reperfusion injury in the retina. Acta Ophthalmologica Scandinavica 80:4, 395-400
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    Bernhard O. Boehm, Robert H. Lustig. (2002) Use of somatostatin receptor ligands in obesity and diabetic complications. Best Practice & Research Clinical Gastroenterology 16:3, 493-509
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