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Suggest treatment for cystoid macular edema of eye

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Dr. Dadapeer K

Ophthalmologist

Practicing since :2003

Answered : 5709 Questions

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Posted on Tue, 12 Aug 2014 in Vision and Eye Disorders
Question: My mother (56 -nor Blood sugar patient neither BP) who is suffering from Cystoid Macular epidemic (CME) since 2010, and taking treatment for eye TB effect (by AKT4 - 2 months after viewing result of TB gold test- Positive, Angiotensin Converting Enzyme, Serum-72, which is creating too much side effect as weakness, Acidity, unbalance digestion system, skin reaction etc. after 25 days) and in between doctor wants to start Omnacortil (40 mg) which have very dangerous side effect (even permanent also).
NCT 11.2 6/24 +2 on date 20-7-2014
13.4 6/36
In his past history he has already taken 6-7 injection in his both eyes as: PST Kenacart and PIT Tricot (as doctor says in eye and inside eye) and Nepanac, Pedforte drop continuously.
Now after completing 4 years treatment there is no positive response in eyes but temporary relief just for few months while injecting in eyes as said above.
Now what to do? I don’t want to treat one thing on the cause of other.
Please, kindly help me. If we may stop the problem to increase, this would also be very much helpful for me.
May I try in Ayurveda ???????????????????
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
She needs steroids and anti-tubercular drugs.

Detailed Answer:
Hello
Welcome to Health care magic.

I am Dr. Dadapeer K, an ophthalmologist and I answer health problems related to eye.

I reviewed the history and the documents attached with the question.

These examination reports show posterior uveitis. Cystoid macular edema is a common complication following posterior uveitis.

The treatment advised by your doctor in the form of omanocortil, steroid drug is correct. This is required for control of the inflammation of the eye.

Most of the uveitis cases are because of association with underlying infection like tuberculosis, allergy or systemic diseases.
Since there is a family history of tuberculosis your doctor has started a trial anti tubercular drugs.

She needs to undergo systemic evaluation and tests to find out the underlying cause and treatment accordingly.

Uveitis often runs a long course with recurrent exacerbations and cause complications like cystoid macular edema which are responsible for loss of vision.

In the past also she has taken steroid injections and used steroid eye drops, but these steroids will treat only the symptom without treating the underlying cause. Till the cause is not treated the disease comes back with recurrent attacks.
Hence ideally all cases of uveitis requires treatment by the use of steroid drugs and treatment of the underlying cause for complete cure.

Since the disease is active as far as my knowledge goes there are no effective treatment for this. For age related problems like age related macular degeneration ayurveda treatment do work.

Hence she needs to undergo evaluation to find out the associated cause and treatment of it for complete cure.
She needs few more investigations like fundus fluorescein angiography for confirmation of cystoid macular edema.

Steroid drugs do cause side effects but when used in a dose of 50 mg tapering side effects are rare and if any can be managed by regular monitoring.

Hence my advice is to continue treatment as advised by your doctor as it looks to be in right direction now.

Hope I have answered your question and the information is helpful to you.

Thank you
with regards
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Dadapeer K 18 hours later
Ist As you suggested to follow the Doctor with Omnacortil (40 mg) and tapering side effects are rare and if any can be managed by regular monitoring. But feedback as I read online is too horrible.
2nd during treatment of anti-tubercular drugs (AKT-4, already completed 24 days out of 2 months) she found SGOT-47 and SGPT-37, Is it reversible after the completion of course or I have to consult with doctor??
3rd May I try Ayurveda with suggested steroid eye drops (Ped forte and Navenac), along with rest 36 days of anti-tubercular drugs (AKT-4, already completed 24 days out of 2 months) along with Pranayama under supervision. Since here in XXXXXXX we have word's best Authentic Ayurveda Doctors. So Can I try it first for 2 months if we seem no relief we surely move toward to Omnacortil (40 mg). Please let me do this, since it looks safe (since Ayurveda have no side effects) and further while completing the anti-tubercular drugs course we can move to Omnacortil (40 mg) with less side effets.
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
Need to consult doctor to rule out liver damage.

Detailed Answer:
Hello

Thank you for the follow up question.

Ideally speaking corticosteroids like omnacortil should be started after 1-2 weeks of treatment by antitubercular drugs for best results. Hence it is better to start steroids now. Waiting for another 36 days may not be a good idea as this can increase the eye inflammation. However if the level of eye inflammation is mild or less you can do that.
Hence before taking any decision do consult and clarify with your treating doctor.

Coming to the levels of SGOT and SGPT ideally they have to be monitored during treatment with antitubercualr drugs to prevent liver toxicity caused by the drugs.
Still they are within the permissable limits, however if they are increased as compared to the levels before starting the drug, you need to consult your doctor to check for liver damage and possible substitution or stopping of the offending drug.

Hence I advice you to follow up with your doctor to look for liver damage secondary to use of antitubercular drugs and timing of starting of corticosteroids.

Hope the information is helpful to you.

Thank you
with regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dadapeer K 2 hours later
Since we are chasing this disease and treatment from four years so I want to confirm before next step, so I’m again troubling you:-
1- What should my mother have to intake in his food to control lever damage SGOT and SGPT or control the damage?
2- How could I know the inflammation level as it is mild/ verse through OCT or as you preferred "fundus fluorescein angiography"? Can it may be retained with the help of suggested steroid eye drops (Ped forte and Navenac). Since meantime i want to increase calcium level (vitamin D) in her body to bear the side effect of omnacortil.
doctor
Answered by Dr. Dadapeer K 1 hour later
Brief Answer:
Inflammation level can be made out by examination.

Detailed Answer:
Hello
Thank you for the follow up questions.
Coming to your questions.

1. Fatty foods should be better avoided in case of damage to liver.
However here we require to monitor levels of SGOT and SGPT and if they are increasing need to stop or substitute the offending drugs, in this case anti tubercular drugs.
Since she needs the antitubercular drugs for two months she needs to be under frequent examination to look for liver toxic effects of these drugs.

2. The severity of inflammation can be made out by fundus examination by your ophthalmologist.
Topical steroids like prednisolone acetate can control the inflammation. However if the inflammation is severe oral steroid drugs may be required.

Hope I have answered your questions and the information is helpful to you.

Thank you
With regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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