Bilateral cystoid macular edema due to Risperidone: Case report

Written by Hina Zahid Published On 2019-04-28T18:00:15+05:30 | Updated On 28 April 2019 6:00 PM IST

Dr Anna Kozlova at Department of Ophthalmology, State University of New York, Downstate Medical Center, USA and colleagues have reported a case of Bilateral cystoid macular edema due to Risperidone. The Case has been reported in the Journal of Medical Case Reports.

Cystoid macular edema (CME) develops with the accumulation of fluid in the macula, causing blurred or diminished central vision. It has a broad differential diagnosis that includes surgical, vascular, structural, and medication-related causes

The authors have reported a case of a 69-year-old African American woman who presented with gradually decreased and blurred the vision of approximately 1 year’s duration without other ocular symptoms. Her past medical history was significant for hypertension, schizophrenia, and depression with no history of diabetes. Her past ocular history was significant for uncomplicated cataract extraction of both eyes 2 years prior; primary open-angle glaucoma treated with latanoprost, brimonidine, and timolol in both eyes; and dry eye syndrome with past punctal plug placement. Medications included citalopram, risperidone, amlodipine, enalapril, and metoprolol. She reported no difficulty with medication compliance. Of note, an eye examination approximately 1 year prior to presentation showed 20/20 visual acuity bilaterally. A chart review revealed that she had been taking risperidone 2 mg/day for at least 3 years prior to presentation. Her dosage was increased by her psychiatrist 2 years prior to presentation to 3 mg/day, with ocular symptoms developing approximately 1 year after the dosage increase (or 1 year prior to presentation).

Visual acuity on presentation was 20/150 in her right eye and 20/200 in her left eye and intraocular pressures were within normal limits. An anterior segment examination showed decreased tear film, but was otherwise unremarkable. A posterior segment examination showed bilateral CME with no vitreous cells. FA demonstrated bilateral petaloid leakage (Fig. 1) and CME was confirmed by OCT (Fig. 2). The CME was suspected to be secondary to risperidone and a recommendation about the possible association between the risperidone and macular edema was made to our patient’s psychiatrist, who decreased risperidone dosage from 3 to 2 mg/day when she followed up with them 2 months later. Her psychiatry team expressed concern with fully eliminating her risperidone or switching to another agent and risking a breakthrough psychotic episode. Thus, the psychiatrist recommended to first attempt dose reduction. At 4-months follow-up, her CME resolved bilaterally (Fig. 2) and vision improved to 20/40 in both eyes. OCT imaging 6 and 12 months after this visit showed no recurrence of CME. She has had no new ocular complaints since dosage adjustments as per record review, and no edema was noted on funduscopic examination at the last follow-up 18 months after presentation.

Fig. 1

Fluorescein angiography of the right (a) and left (b) eye showing late petaloid leakage with a hot nerve in both eyes

Fig. 2

Spectral-domain optical coherence tomography horizontal line scans through the fovea showing cystoid macular edema and subretinal fluid in (a) right eye and (b) left eye on presentation. Spectral-domain optical coherence tomography following decreased dosing of risperidone showing resolved cystoid macular edema and subretinal fluid in the (c) right eye and (d) left eye at 4-months follow-up

For further reference log on to :

https://doi.org/10.1186/s13256-019-1978-y

blurred visionbrimonidinecitalopramCMEcystoid macular edemadepressiondiabetesFluorescein angiographyHypertensionJournal of Medical Case ReportlatanoprostmetoprololOCTOCT imagingOpen angle glaucomaschizophrenia

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Hina Zahid