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ARTICLE
Year : 1970  |  Volume : 18  |  Issue : 2  |  Page : 75-77

Entodon therapy in central serous retinopathy


Anantapur, (A.P.), India

Correspondence Address:
G Radhakrishna Murthy
Anantapur, (A.P.)
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Murthy G R. Entodon therapy in central serous retinopathy. Indian J Ophthalmol 1970;18:75-7

How to cite this URL:
Murthy G R. Entodon therapy in central serous retinopathy. Indian J Ophthalmol [serial online] 1970 [cited 2019 Dec 7];18:75-7. Available from: http://www.ijo.in/text.asp?1970/18/2/75/35067

Central Serous retinopathy is an ophthalmic entity characterised clini­cally by sudden fall of vision in one or both the eyes, perception of a cen­tral grey or black spot and micropsia and metamorphopsia leading to the tell-tale evidence of macular stippling after passage of time, with a marked tendency for recurrence; ophthalmos­copically by oedema or swelling of macular area with a circular, oval or irregular light reflex, indistinct or ab­sent foveal reflex, rarely small haemor­rhages near macular vessels; perime­trically by relative central scotoma for form and colour, and rarely by an absolute scotoma. That the aetiology and pathology are still far from satis­factory is evident from the variety of names suggested, viz., Central angio­spastic retinopathy by Gifford and Marquardt, pre-retinal oedema by Guist, Chorioretinitis centralis Serosa by Kitahara, retinitis centralis angione­urotica of Horniker, etc. Because of this uncertainty in aetiology, there are several lines of treatment followed. In all such conditions, Iodides have been used by ophthalmologists since over a century. The mode of action of iodi­des is believed to be to aid and hasten the absorption of exudates and hae­morrhages.

Iodides have been used both in the inorganic and organic forms. Inor­ganic iodine salts have certain dis­advantages, viz., onset of gastric dis­turbances, fodism in sensitive patients, reactions due to disturbances of the colloidal equilibrium, severe pain of the injections when given parenterally and delayed therapeutic action when given orally. On the other hand, organic iodine preparations have the drawback that the firm linkage of iodine and car­bon in their structure allows only slow release of iodine in the tissues which may be inadequate for therapeutic pur­poses. To obviate this difficulty, the organic iodine compound - Entodon - has been prepared in which the iodine is not attached to carbon but to nitrogen, which leads to a uniform and rapid liberation of iodine in the tissues. Entodon is chemically. 20% solution of hexamethyl-diamino-iso-propanol­di-iodide containing 0.118 g of iodine per ml and is administered either in­travenously or intramuscularly. The demonstration of iodine in saliva with­in two minutes and in urine within 5 to 15 minutes after intravenous injec­tion of Entodon is a clear evidence for the rapidity of its action.


  Materials and Methods Top


The present clinical study is report­ed because of the remarkable clinical improvement - both functionally and structurally - even in delayed cases of central serous retinopathy. Six cases of central serous retinopathy in various stages of the disease, were treated with Entodon and the results studied. All of them gave the typical history of sudden diminution of vision of one eye and ophthalmoscopic examination re­vealed beyond doubt the characteristic fundus picture with the typical glisten­ing ring surrounding the macular area. The detailed laboratory investigations did not reveal anything specific but for positive V.D.R.L. in one case and rai­sed E.S.R. in two cases. Dental sepsis was found and eradicated in one case. All these cases were started on Strepto­penicillin, BI and B12 parenterally and Betamethasone and B Complex orally. After this preliminary treatment, there was found to be only partial improve­ment of vision. Then, the patients were given a course of 10 injections of Entodon 1 ampoule intravenously or deep intragluteally on alternate days. There was very rapid clinical improve­ment even during the period of treat­ment and normal or near-normal vision was restored in all the cases within a period of 4 to 8 weeks.


  Case Reports Top


CASE 1: Mrs. S. D., a housewife, aged 28, reported on 26.5.67 and complained of sudden loss of vision of right eye on 19.4.67. She noticed it suddenly while reading, when she found that she could see nothing with the right eye when she closed her left eye. She immediately consulted a local doctor who advised her Vitamin B 12 therapy and check-up after a month. As she found no improvement, she consulted the author. External examination of either eye did not re­veal any abnormality. Her vision was: R. E. V. Counting fingers at 1/4 metre. L. E. V: 6/5. Fundus examination clinched the diagnosis of central serous retinopathy right eye. Dental, E. N. T. and gynaecological examinations did not reveal any septic foci. V. D. R. L. was weak positive and E. S. R. 10 mm after 1 hour. The re­sults of all other investigations were normal. She was given

(i) a course of 5 injections of Streptopeni­cillin followed by P. A. M. 2 cc. I. M. daily for 10 days

(ii) Intramuscular B 1 (100 mgm), B 12 (1000 mg.) and B 6 injections on alternate days.

(iii) Oral Betamethasone in taper­ing doses;

(iv) Nicotinic acid x 250 mgm. tablets: one a day.

(v) B Complex Forte with Vita­min C capsules: one a day.

On 24.6.67 her vision in right eye improved to 6/18. She was advised to continue (iv) and (v) and have (vi) Entodon 1 amp. deep intraglute­ally on alternate days for 10 injections. On 1.8.67 her R. E. V. was 6/9, when she was asked to continue iv and v only. When she came for check-up on 30.8.1967, her R. E. V. was 6/5 and fundus revealed fine macular stippling only.

CASE 2: Mr. S. G. R., 22, male, noticed diminution of vision of both eyes suddenly on 25.11.67 when he tried to read newspaper in the morn­ing. He had headache for two days preceding the fall of vision but he had no other complaint before. He came for consultation on 27.11.67, when his visual acuity was R. E. V. 6/12, LEV: C. F. ½ M and both fundi showed macular oedema and stippling surroun­ded by a glistening ring, though the changes were more pronounced in the left eye. None of the investigations gave positive results, nor was there any evidence of any focal sepsis. He was given (i) Streptopenicillin (ii) B 1 B 12 B 6 and (iii) Oral Betamethasone. On 2.12.67, his vision was R. E. V.: 6/12; L. E. V. 6/36. He was then put on (iv) Nicotinic acid tablets (v) B Complex .Forte tablets and (vi) En­todon 1 amp. I. V. on alternate days.

Even after the fifth injection of Ento­don, the vision improved to 6/6 in both the eyes and after completion of the course his vision was 6/5 in both the eyes. The fundi showed complete disappearance of oedema leaving be­hind only fine stippling of macula.

CASE 3: Mr. A. R., male 43, re­ported on 4.12.67 with the complaint of fall of vision of sudden onset a month ago. He had divergent squint of right eye since childhood which had a vision of 2 metres only. His L. E. V. was 6/60 and funduscopy revealed central serous retinopathy left eye. He was advised to have (iv), (v) and (vi) above. He returned only once for check-up after a fortnight when his L. E. V. had improved to 6/9.

CASE 4: Mr. S. N., 33, male, ap­peared on 4.11.67 with a vision of 6/12 both eyes with the typical fundus picture.

He was administered (iv), (v) and (vi). After a month, his vision im­proved to 6/9 in right eye and 6/6 in left eye.

CASE 5: Mr. P. R., 35, male, com­plained on 5.4.68 of dimness of vision of right eye of 3 days duration. His vision was: R. E. V. 6/24 and L. E. V. 6/5. He was given (i), (ii), (iii) and (vi). His R. E. V. was 6/5 on 30.4.68.

CASE 6: Mr. I. M., 30, male, re­ported on 11.11.68 complaining of sudden fall of vision of right eye of 2 days duration. His R. E. V. was C. F. 5M and L. E. V. 6/6. He was given (i), (ii ) and (iii) but his R. E. V. was 6/60 only on 26.11.68. Then, he was started on (iv), (v) and (vi). His R. E. V. improved to 6/12 on 14.12.68 and 6/6 on 6.1.69.


  Discussion Top


In all the six cases studied, Entodon therapy resulted in remarkable clinical improvement whether it was given after, with or without antibiotics. Treatment with antibiotics, B 1 , B 12 combination, nicotinic acid and B Complex either alone or in combina­tion has not produced such good re­sults. As improvement in visual acuity as well as fundus picture has been ob­tained in all the cases, Entodon the­rapy is considered to be of definite value in the treatment of central ser­ous retinopathy.


  Acknowledgements Top


The author is grateful to M/s. Ba­yer (India) Ltd., for the samples of Entodon supplied from time to time for the clinical trials.




 

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