Retrobulbar triamcinolone for inflammatory choroidal neovascularization in pregnancy
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CASE REPORT
Open Access
Retrobulbar triamcinolone for inflammatory choroidal neovascularization in pregnancy Emilia Maggio*, Maurizio Mete, Antonio Polito, Gloria Parrozzani and Grazia Pertile
Abstract Background: Choroidal neovascularization (CNV) in pregnancy has rarely been described. A differential diagnosis between inflammatory, idiopathic, and myopic CNV may be challenging. Moreover, there is no consensus on management, and therapeutic options may be further limited by patient and physician concerns about potential risk to the fetus. Herein, we report a case of inflammatory CNV during pregnancy and describe a previously unreported management approach with retrobulbar triamcinolone injections. Case presentation: A 36-year-old woman presented with vision loss and metamorphopsia in her right eye while 21 weeks pregnant. She was diagnosed with an inflammatory CNV based on the following multimodal imaging findings: a type 2 lesion with the “pitchfork sign” on OCT, along with the absence of tomographic signs of myopic CNV, and the presence on autofluorescence of multiple hyper-autofluorescent spots, interpreted as focal areas of inflammation at the level of the outer retina and inner choroid. The patient refused oral corticosteroids and any intravitreal injection therapies. Therefore, she was treated with two trans-Tenon’s retrobulbar injections of triamcinolone acetonide after explaining the procedure and acquiring consent. The treatment resulted in a regression of inflammatory signs and a reduction of neovascular activity. No adverse events occurred for the mother or the baby, neither during the pregnancy nor after delivery. Conclusion: Inflammatory CNV may be rarely associated with pregnancy. The correct diagnosis is crucial to allow the consideration of all possible management options. To the best of our knowledge, this is the first reported case of treatment with retrobulbar triamcinolone injections. This may represent a suitable therapeutic option in the absence of any other therapeutic approaches. Keywords: Inflammatory choroidal neovascularization, Pregnancy, Retrobulbar triamcinolone injection
Background Choroidal neovascularization (CNV) may represent a vision-threatening complication of inflammatory eye diseases [1, 2]. It is thought to be caused by a local angiogenic stimulus related to inflammation, or result from a degenerative disruption in the retinal pigment epithelium (RPE)-Bruch’s membrane complex [2]. Inflammatory CNV has been described in a variety of inflammatory eye disorders, including infectious and non-infectious uveitis, serpiginous choroiditis, presumed * Correspondence: [email protected] IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5 - Negrar, 37024 Verona, Italy
ocular histoplasmosis syndrome, Vogt-Koyanagi-Harada disease, and White-Dot Syndromes (WDS) such as multifocal choroiditis, punctate inner choroiditis, and multiple evanescent white dot syndrome [2, 3]. It has rarely been described in association with pregnancy, either in conjunction or not with the aforem
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