Can a Patient with Retinitis Pigmentosa Take Prednisone?
Yes, patients with retinitis pigmentosa can take prednisone and other corticosteroids, but only when specifically indicated for complications like cystoid macular edema (CME), and with careful monitoring for steroid-induced glaucoma, which these patients are particularly susceptible to developing. 1, 2
Primary Indication: Cystoid Macular Edema
- Corticosteroids are used as second-line therapy for CME in retinitis pigmentosa patients who fail first-line carbonic anhydrase inhibitors (oral acetazolamide or topical dorzolamide/brinzolamide). 1
- Intravitreal corticosteroids (triamcinolone acetonide and sustained-release dexamethasone implants) have demonstrated effectiveness in improving CME secondary to retinitis pigmentosa when carbonic anhydrase inhibitors are ineffective. 1
- Oral corticosteroids like deflazacort have also shown efficacy for CME in this population. 1
Critical Safety Concerns
Patients with retinitis pigmentosa have heightened susceptibility to steroid-induced glaucoma (SIG), making intraocular pressure monitoring absolutely essential. 2
- Two siblings with retinitis pigmentosa and PDE6B gene mutations developed steroid-induced glaucoma requiring maximal medical therapy and ultimately seton implants after receiving intravitreal steroid injections for CME. 2
- A female patient with RPGR gene mutation developed SIG after topical steroids prescribed post-cataract surgery. 2
- Intraocular pressure elevations are particularly common with intravitreal corticosteroids and corticosteroid implants. 3
Monitoring Protocol
- Check intraocular pressure at baseline, day 1 month, and 3 months after corticosteroid initiation, then regularly throughout treatment. 4
- Statistically significant IOP increases occur most commonly in the first 3 months of treatment. 4
- Intraocular pressure evaluation remains of utmost importance in the follow-up of patients with retinitis pigmentosa receiving any form of corticosteroid therapy. 2
Treatment Limitations
- The efficacy of intravitreal triamcinolone appears limited over time, with rebound CME commonly occurring regardless of treatment choice. 1, 4
- Further treatment may be necessary after 6 months to maintain anatomical results. 4
- While central macular thickness may improve, best-corrected visual acuity changes are often not statistically significant. 4
Alternative Approaches
Before considering corticosteroids, always trial carbonic anhydrase inhibitors first:
- Oral acetazolamide has the strongest clinical basis and should be first-line treatment for CME in retinitis pigmentosa. 1
- Topical dorzolamide is appropriate for patients intolerant to oral acetazolamide side effects. 1
Key Clinical Pitfall
Never initiate corticosteroid therapy without establishing a rigorous IOP monitoring schedule, as patients with retinitis pigmentosa may develop severe, treatment-resistant glaucoma requiring surgical intervention. 2 The association between retinitis pigmentosa and steroid-induced glaucoma represents a dangerous liaison that can compound visual disability in an already vulnerable population.