Regression of serous macular detachment after intravitreal triamcinolone acetonide in patients with diabetic macular edema

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on serous macular detachment in eyes with diabetic macular edema. DESIGN: Interventional case series. METHODS: The study population comprised twenty eyes of 20 patients with diabetic macular edema (12 men, eight women), aged 48 to 76 years. The eligibility criteria for this study included clinically detectable macular edema in which the presence of serous macular detachment was documented by optical coherence tomography. After intravitreal injection of 0.1 ml (4 mg) triamcinolone acetonide, visual and anatomic responses were observed. RESULTS: In all eyes, after an injection of triamcinolone acetonide, macular edema and serous macular detachment regressed. At 3 and 6 months, macular edema and serous macular detachment had recurred in eight (40%) and nine eyes (45%), respectively. Patients with recurrence were re-treated. No eyes lost vision at 1 month, and all eyes showed improvement. At 3 months, no eyes had lost vision from baseline, and 17 eyes (85%) showed improvement. At 6 months, again no eyes had lost vision from baseline, and 16 eyes (80%) maintained improved visual acuity. CONCLUSION: Intravitreal triamcinolone acetonide is an effective treatment for serous macular detachment in patients with diabetic macular edema.     

Intravitreal triamcinolone acetonide for the treatment of cystoid macular edema secondary to Behçet disease

PURPOSE: To evaluate the safety and effectiveness of intravitreal triamcinolone acetonide in patients with cystoid macular edema (CME) associated with Beh?et disease. DESIGN: Interventional case series. METHODS: Ten eyes of 10 patients with CME from Beh?et disease made up the study population. All eyes had persistent CME despite medical treatment for at least 2 months. Intravitreal injection of 4 mg (0.1 ml) of triamcinolone acetonide was offered to treat macular edema. The visual and anatomic responses were observed. RESULTS: At 1-month follow-up, a reduction in mean foveal thickness of 37.4%, from 416 microm to 260.5 microm, was attained. At 3-month follow-up, mean foveal thickness was 286.2 microm and at 6 months, 263.7 microm. No eyes had lost vision at 1 month, and eight eyes (80%) showed improvement in visual acuity. At 3-month and 6-month follow-up, three eyes (30%) remained stable and the other eyes had maintained the improved acuity. CONCLUSION: Intravitreal triamcinolone acetonide is a promising therapeutic method for CME from Beh?et disease.     

Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion

PURPOSE: To assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO). METHODS: This prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT). RESULTS: There were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1-3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.     

Intravitreal triamcinolone acetonide for exudative age related macular degeneration

AIM: To evaluate the effect of intravitreal triamcinolone acetonide on the visual acuity of patients with exudative age related macular degeneration, to assess the duration of a possible effect, and to evaluate clinical side effects of the treatment. METHODS: The study included 67 patients (71 eyes) who presented with exudative age related macular degeneration of predominantly or total occult type (n = 68) or classic type (n = 3), and who received once, or repeatedly, an intravitreal injection of 25 mg of crystalline triamcinolone acetonide. Mean follow up time was 7.46 (SD 3.54) months (range 3.1-19.57 months). RESULTS: Visual acuity increased significantly (p <0.001) from 0.16 (0.11) to a mean maximum of 0.23 (0.17). Postoperative visual acuity was highest 1-3 months after the injection. 47 (66.2%) eyes gained in maximal visual acuity and 11 (15.5%) eyes lost in visual acuity. Intraocular pressure increased significantly (p <0.001) from 15.1 (3.1) mm Hg at baseline to a maximal value of 23.0 (8.25) mm Hg. At the end of follow up, intraocular pressure again decreased significantly (p<0.001) to 16.8 (4.9) mm Hg. No cases of postoperative infectious endophthalmitis, rhegmatogenous retinal detachment, or proliferative vitreoretinopathy occurred. Owing to a decrease in visual acuity after an initial increase, six patients received a second intravitreal triamcinolone acetonide injection after which visual acuity increased again in three eyes. CONCLUSIONS: Intravitreal injection of 25 mg of crystalline triamcinolone acetonide merits further study for the treatment of exudative age related macular degeneration.     

Intravitreal triamcinolone acetonide in patients with macular oedema due to branch retinal vein occlusion: a pilot study

PURPOSE: To evaluate treatment of macular oedema due to branch retinal vein occlusion (BRVO) with intravitreal triamcinolone acetonide. METHODS: In a prospective case series, nine patients with macular oedema due to BRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included best-corrected visual acuity (BCVA) for distance and reading, intraocular pressure (IOP) measurement, fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and at 1 week, 1 month, 3 and 6 months postoperatively. RESULTS: Preoperative mean BCVAs were 1.3 +/- 0.8 for distance vision, and 1.1 +/- 0.3 for reading acuity, respectively. A significant improvement in reading acuity was observed until 1 month (0.7 +/- 0.4, p = 0.02). No significant reduction in mean macular thickness was observed. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to BRVO. However, the significant effect was not permanent and persisted for only 1 month.     

Intravitreal triamcinolone as primary treatment of cystoid macular edema secondary to branch retinal vein occlusion

PURPOSE: To describe six patients treated with intravitreal triamcinolone (IVT) as primary therapy for cystoid macular edema (CME) secondary to branch retinal vein occlusion (BRVO). METHODS: Retrospective case series. RESULTS: The age of the patients ranged from 53 years to 87 years (mean, 66 years). The time between BRVO and treatment with IVT ranged from 2.0 months to 4.7 months (mean, 3.5 months). Pretreatment visual acuity ranged from 20/40 to 6/200 (mean, 20/166). Length of follow-up ranged from 107 days to 175 days (mean, 149.5 days). Final visual acuity ranged from 20/40 to 3/200 (mean, 20/137). Three of six eyes showed improvement in vision. All three patients who did not have vision improvement were treated with a second injection. At the final follow-up visit, all six eyes had improved vision from baseline. Five (83.3%) of six eyes showed an improvement of > or = 2 lines of vision. One patient had a postoperative rise in intraocular pressure requiring a trabeculectomy. Final visual acuity in the 6 eyes ranged from 20/200 to 20/30 (mean, 20/106). CONCLUSION: IVT may be of potential use in treating CME due to BRVO, as either a primary or an adjunctive treatment modality. A prospective, randomized trial to clarify this role is warranted.     

Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

ABSTRACT: BACKGROUND: The influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO). Methods: Twenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (-) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded. Results: In both the SRD (-) group and the SRD (+) group, the mean macular thickness within the central 4degrees field and the 10degrees and 20degrees fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P<0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P<0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4degrees field and the 10degrees and 20degrees fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P<0.05). The trend profiles of macular thickness within the 10degrees and 20degrees fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4degrees field and the 10degrees and 20degrees fields of the occluded region. Conclusions: These results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.     

Intravitreal triamcinolone for the treatment of refractory macular edema in idiopathic intermediate or posterior uveitis

PURPOSE. Cystoid macular edema (CME) is the most significant cause of visual loss associated with idiopathic uveitis. The authors report on the use of intravitreal triamcinolone acetonide (IVTA) in a group of patients with macular edema due to idiopathic intermediate and posterior uveitis. METHODS. Retrospective, noncomparative, interventional case series. Thirty-three eyes were included with uveitic CME that was refractory to topical steroids, oral prednisone, or a combination thereof. Previous steroid treatment did not result in elevated intraocular pressure (IOP). The eyes received an intravitreal injection with 10 mg triamcinolone acetonide, after best-corrected visual acuity (BCVA) and fluorescein angiography (FA) were assessed. Ophthalmologic examination including FA was regularly performed during a 1-year follow-up period. RESULTS. Within 12 weeks after injection of IVTA, 50% of the eyes responded with an improvement in vision of more than two lines and 30% of the eyes reached an IOP of >/= 21 mmHg (p<0.01). All eyes with an elevated IOP responded well on topical antiglaucoma medication. After 12 months follow-up 40% of the eyes responded with an improvement in vision of more than two lines and 28% of the affected eyes underwent phacoemulsification during the follow-up. No other complications occurred within a year after the treatment. CONCLUSIONS. In macular edema due to idiopathic intermediate or posterior uveitis IVTA improves the visual acuity within the first 3 months. However, thereafter the visual acuity decreases again. Cataract and elevated IOP are common side effects.     

Serous macular detachment combined with branch retinal vein occlusion

PURPOSE: To report frequency, clinical characteristics, treatment, and the complications of branch retinal vein occlusion (BRVO) with serous macular detachment. PATIENTS AND METHODS: We retrospectively studied 22 eyes of 22 patients in 111 eyes with acute BRVO, whose eyes had serous macular detachment that was detected by optical coherence tomography (OCT). Fluorescein angiography was conducted in 19 of the 22 eyes. Fourteen of the 22 eyes underwent scatter laser photocoagulation of the BRVO area. We observed serial OCT findings before and after treatment. RESULTS: Approximately 20% of the BRVO eyes had serous macular detachment. The superotemporal vein was occluded in 15 eyes and the inferotemporal vein was involved in 7 eyes. Four eyes were ischemic and 15 eyes were not ischemic. Extensive dye leakage was observed in the BRVO area in all examined eyes (19 eyes). The occlusion area of perifoveal capillary network ranged from 5 to 60%, with an average of 40%. OCT demonstrated pure serous macular detachment in 13 eyes and the remaining 9 eyes had both serous macular detachment and cystoid macular edema(CME). The occlusion area of perifoveal capillaries in these 9 eyes was more than 20%. Serous macular detachment was resolved in 11 of 14 eyes (80%) 6 months after laser treatment. The average period for resolution of macular detachment was 3.4 months after treatment. Visual acuity was improved more than 2 lines in 8 of the treated 11 eyes (73%). Hard exudates appeared in the posterior fundus in 13 of 14 treated eyes (93%) and in 16 of the total of 22 eyes (73%) in the follow-up period. Massive macular hard exudates and ensuing macular atrophy resulted in poor visual outcome. CONCLUSIONS: Serous macular detachment is one of the patterns of macular edema in BRVO. OCT is an essential tool to detect it. Leakage from the entire BRVO area seems to travel via subretinal space by gravity or other factors and may form serous detachment in the macular area. Laser photocoagulation is indicated for early resolution of serous macular detachment. The major complication of serous detachment is the deposit of macular hard exudates, which may result in poor visual outcome.     

Exacerbation of central serous chorioretinopathy following intravitreal triamcinolone injection

Background  This report describes a case of central serous chorioretinopathy following intravitreal triamcinolone acetonide injection. Methods  A 42-year-old man presented with a 4-month history of decreased visual acuity (0.4) in his left eye. The left eye demonstrated macular edema due to branch retinal vein occlusion. Triamcinolone acetonide 4 mg/ 0.1 mL was injected intravitreally to treat the macular edema. Results  Pigmentary retinal discoloration, retinal pigment epithelium leakage and a slight neurosensorial detachment with cystoid macular edema at the temporal macula were present prior to intravitreal triamcinolone injection. Three weeks after injection, visual acuity had decreased to 0.2 and metamorphopsies appeared in the left eye. A sharply demarcated serous macular elevation and a progressively increasing hyperfluorescence of the pre-existing leakage point led to the diagnosis of “exacerbation of the pre-existing asymptomatic central serous chorioretinopathy” following intravitreal triamcinolone injection. Macular elevation spontaneously resolved by the 4th month post-injection. At the 6th month, the patient experienced recurrence of a small serous detachment at the temporal macula. Conclusion  Central serous chorioretinopathy exacerbation may arise as a complication of intravitreal triamcinolone acetonide injection.     

Intravitreal triamcinolone in the treatment of serous retinal detachment in Vogt-Koyanagi-Harada syndrome

PURPOSE: To report the use of intravitreal injection of triamcinolone acetonide during the acute phase of Vogt-Koyanagi-Harada disease. DESIGN: Prospective interventional case series. METHODS: Three eyes from two patients at the acute phase of Vogt-Koyanagi-Harada disease with serous retinal detachments were treated with a 4-mg intravitreal injection of triamcinolone acetonide. The following variables were evaluated: visual acuity, intraocular pressure, and height of the serous retinal detachment using optical coherence tomography. RESULTS: The optical coherence tomography images showed a marked decrease in the retinal detachment in the first week after the injection with subsequent return to normal retinal thickness in all eyes. CONCLUSIONS: Intravitreal triamcinolone acetonide provides short-term improvement in visual acuity and serous retinal detachments associated with Vogt-Koyanagi-Harada disease. These findings should be followed by future studies to evaluate long-term effects.     

Intravitreal Triamcinolone Acetonide for Macular Edema in HLA-B27 Negative Ankylosing Spondylitis

We report a case of a human leukocyte antigen B27 (HLA-B27)-negative patient with cystoid macular edema (CME) and ankylosing spondylitis (AS) after treatment with triamcinolone acetonide. The patient complained of deterioration of visual acuity of the right eye during the last 10 days. At presentation visual acuity of the right eye was 0.2, and the ophthalmic examination did not reveal any sign of active uveitis. Fluorescein angiography (FA) and ocular coherent tomography (OCT) showed CME. The left eye was normal with a visual acuity of 0.9. Eight weeks after intravitreal injection of triamcinolone acetonide, visual acuity improved to 0.8 and OCT revealed regression of macular edema. Six months later no recurrence was observed. Our case report indicates for the first time that CME may occur in AS independently of the presence of HLA-B27 and intraocular inflammation. Intravitreal use of triamcinolone acetonide can reduce macular edema and restore visual acuity.     

Intravitreal triamcinolone as a primary therapy in diabetic macular oedema

PURPOSE: To evaluate the effect of intravitreal triamcinolone in eyes with diabetic macular oedema that had no previous laser treatment. METHODS: In all, 12 eyes of 12 patients with diabetic retinopathy, aged 47-70 years (mean 59.2), made up the study. All the eyes had persistent diabetic macular oedema despite having received medical treatment for at least 3 months. In this consecutive case series, none of the eyes received previous laser photocoagulation. Intravitreal injection of 0.1 ml (4 mg) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed as well as complications related to the injection procedure and corticosteroid medication. RESULTS: The follow-up period was between 6 and 10 months (mean 7.9 months) and all eyes completed 6 months of follow-up. Macular oedema was documented for an average of 3.5 months (ranged 3-5 months) before intravitreal corticosteroid injection. Baseline mean central macular thickness was 448.6 microm. At 1 month follow-up, a reduction in mean central macular thickness of 40.8% from 448.6 microm to 265.4 microm was obtained. At 3 and 6 months follow-up, mean central macular thicknesses, were 310 mum and 294.5 mum, respectively. No eyes lost vision at 1 month and 10 eyes (83.2%) showed improvement. At 3 months, no eyes lost vision from baseline and 8 eyes (66.6%) showed improvement. At 6 months, again no eyes lost vision from baseline and 10 eyes (83.2%) maintained improved visual acuity. CONCLUSIONS: Intravitreal triamcinolone is a promising therapeutic method in eyes with diabetic macular oedema without previous application of laser treatment. Further study with longer follow-up and large series is warranted to assess the long-term efficacy and safety and the need for retreatment.     

Intravitreal triamcinolone acetonide for treatment of cystoid macular oedema in patients with retinitis pigmentosa

PURPOSE: To evaluate the anatomic and visual outcomes of intravitreal triamcinolone acetonide injection in patients with cystoid macular oedema (CMO) secondary to retinitis pigmentosa (RP). METHODS: Five eyes of five patients with CMO secondary to RP, aged 25-41 years (mean 33.2 years) made up the study population. All eyes had persistent CMO despite medical treatment with 250 mg of oral acetazolamide twice daily for 1 month. Intravitreal injection of 4 mg (0.1 ml) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed, as well as complications related to the injection procedure and corticosteroid medication. RESULTS: Follow-up periods varied between 6 and 8 months (mean 6.8 months); all patients completed 6 months of follow-up. After intravitreal triamcinolone acetonide injection all patients showed good anatomic response. The baseline median central macular thickness was 418 microm (range 376-626 microm). At 1 month, the median central macular thickness had decreased to 224 microm (range 214-326 microm). At 3 and 6 months, the median central macular thicknesses were 275 microm (range 215-584 microm) and 312 microm (range 239-521 microm), respectively. Recurrent CMO was found in one patient at the 3-month follow-up and in two patients at the 6-month follow-up. Retreatment was performed in these patients. At the 1-month follow-up, no patient was found to have lost vision and two patients showed improvement. At the 3- and 6-month follow-ups, no patient had lost vision from baseline but no patient had maintained their improved visual acuity (VA). CONCLUSIONS: In our small series, all patients showed an anatomic improvement in CMO after intravitreal injection of triamcinolone acetonide. However, in three out of five patients, despite good anatomic results, no improvement in VA was achieved. Because of the limitations of this pilot study, it is difficult to explain why no improvement in VA was achieved despite good anatomic results in some patients. Further study with longer follow-up periods and larger series is warranted to assess the efficacy of the treatment.     

Intravitreal triamcinolone for macular oedema: efficacy in relation to aetiology

PURPOSE: To evaluate the efficacy and safety of intravitreal triamcinolone in patients with macular oedema of varying aetiology. METHODS: Two milligrams of intravitreal triamcinolone acetonide was injected into 34 eyes with persistent macular oedema (17 eyes with macula oedema secondary to posterior uveitis, 13 eyes with diabetic retinopathy, and four with pseudophakic macular oedema). Best corrected visual acuity was determined and transfoveal optical coherence tomography performed after 1 week, 1 month, 3 months and 6 months. RESULTS: Treatment improved visual acuity and subjective visual quality, and reduced foveal thickness in eyes with posterior uveitis and eyes with macular oedema secondary to diabetic retinopathy. Eyes treated for pseudophakic cystoid macular oedema demonstrated no improvement. A total of 32% of patients experienced a significant post-injection increase in intraocular pressure. Endophthalmitis, rhegmatogenous retinal detachment and cataract were absent. CONCLUSION: Intravitreal triamcinolone appears to induce marked a improvement in macular oedema secondary to non-infectious uveitis and diabetic retinopathy.     

Intravitreal triamcinolone acetonide for the treatment of chronic pseudophakic cystoid macular oedema

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide for chronic pseudophakic cystoid macular oedema (CME) resistant to medical treatment. METHODS: Six eyes of six patients with chronic pseudophakic CME, aged 58-74 years (average 66 years), made up the study population. All eyes had persistent CME despite having received medical treatment for at least 3 months. Intravitreal injection of 4 mg (0.1 ml) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed as well as potential complications related to the injection procedure and corticosteroid medication. RESULTS: The follow-up period was between 6 and 10 months (mean 8.5 months). Baseline central macular thickness averaged 504 microm. At 1 month, a reduction in the mean central macular thickness of 52% from 504 microm to 264 microm was obtained. At 3 and 6 months, the mean central macular thicknesses were 240 microm and 232 microm, respectively. Five of the six eyes maintained a visual gain of 15 or more letters from baseline at 6 months. During follow-up no patient had intraocular pressure (IOP) exceeding 21 mmHg. No injection-related complications were encountered. CONCLUSIONS: Intravitreal triamcinolone acetonide is a promising therapeutic method for chronic pseudophakic CME resistant to medical treatment. Further study with a longer follow-up period and larger series is warranted to assess the treatment's longterm efficacy and safety and the need for retreatment.     

Inter-eye difference in diabetic macular edema after unilateral intravitreal injection of triamcinolone acetonide

PURPOSE: To report on visual outcome of patients receiving intravitreal triamcinolone acetonide for treatment of diffuse diabetic macular edema. DESIGN: Prospective, comparative clinical interventional study. METHODS: Setting: Institutional. patient population: The study included 25 consecutive patients (50 eyes) with bilateral diabetic macular edema. Intervention procedure: Unilateral intravitreal injection of about 20 mg triamcinolone acetonide into the eye (study group) more severely affected by diabetic maculopathy. The contralateral eyes served as control group. Mean follow-up was 7.1 +/- 4.1 months. MAIN OUTCOME MEASURE: Visual acuity, intraocular pressure. RESULTS: In the study group, visual acuity increased significantly (P < or = .001) by 3.0 +/- 2.6 Snellen lines to a peak at two to six months after the injection, and decreased significantly (P = .001) towards the end of follow up. At the end of follow-up, visual acuity was higher, not significantly (P = .18) higher, than at baseline. An increase in visual acuity was found in 23 eyes (92%). In the control group, differences between visual acuity at baseline and at any of the re-examinations during follow-up were not significant (P > .10). In an intra-individual inter-eye comparison, gain in visual acuity was significantly (P < .05) higher in the injected eyes, for the measurements obtained up to four months after injection. CONCLUSIONS: Intravitreal triamcinolone acetonide may temporarily increase visual acuity in eyes with diabetic macular edema.     

Dosage dependency of intravitreal triamcinolone acetonide as treatment for diabetic macular oedema

AIM: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular oedema. METHODS: The prospective, randomised, double masked, clinical interventional study included 27 eyes (27 patients) with diffuse diabetic macular oedema. They were randomly divided into three study groups receiving an intravitreal injection of filtered triamcinolone acetonide of about 2 mg (n = 8 eyes), 5 mg (n = 10), or 13 mg (n = 9), respectively. Dosage measurement was performed before filtration. Mean follow up was 6.6 (SD 2.4) months (3-12 months). Main outcome measures were visual acuity and intraocular pressure. RESULTS: Maximal increase in visual acuity was significantly (p = 0.046; 95% CI: 0.032 to 2.99; r = 0.38) correlated with the dosage of intravitreal triamcinolone acetonide. Additionally, the duration of the effect of intravitreal triamcinolone acetonide increased significantly with the dosage of intravitreal triamcinolone acetonide (r = 0.45; p = 0.014). Increase in intraocular pressure during follow up was statistically not significantly associated with the dosage used (p = 0.77). CONCLUSIONS: In patients with diffuse diabetic macular oedema receiving intravitreal triamcinolone acetonide, treatment response may last longer and be more pronounced with a dosage of 13 mg than in lower doses of 5 mg or 2 mg. Triamcinolone acetonide induced increase in intraocular pressure may not be markedly associated with the dosage used.     

Branch retinal vein occlusion treated by intravitreal triamcinolone

CLINICAL CASES: Five eyes with branch retinal vein occlusion (BRVO) were treated with intravitreal injection of 4 mg of triamcinolone. Four cases showed good visual acuity and macular thickness evolution after one dose. The remaining one case suffered a relapse three months later. Therefore a second injection was performed in that case. DISCUSSION: Several treatments have been suggested to manage macular edema in BRVO. Intravitreal triamcinolone may be a therapeutic option to increase visual acuity and decrease macular thickness in patients with macular edema secondary to BRVO.     

Intravitreal triamcinolone acetonide treatment of macular edema associated with central retinal vein occlusion

PURPOSE: To evaluate treatment of macular edema associated with central retinal vein occlusion (CRVO) using intravitreal triamcinolone acetonide. METHODS: Retrospective review of data for 29 eyes of 29 patients with CRVO and macular edema treated with intravitreal triamcinolone acetonide. Initial visual acuity, intraocular pressure, and history of glaucoma were recorded. Final visual acuity, intraocular pressure, and adverse events were recorded during the treatment period. RESULTS: Twenty-nine eyes were treated with intravitreal injection. The mean follow-up was 348 days. The median initial Early Treatment Diabetic Retinopathy Study visual acuity was 20/250 (median logMAR, 1.1). The median visual acuity 3 months after injection was 20/125 (median logMAR, 0.8). This difference was statistically significant. The median final visual acuity was 20/250 (median logMAR, 1.1). This difference in visual acuity was not statistically significant. Elevated intraocular pressure, excluding that related to neovascularization, occurred in 5 of 22 patients. Subgroup analysis revealed that patients who received multiple injections had better outcomes. CONCLUSION: Intravitreal triamcinolone acetonide may improve vision transiently but does not appear to result in a sustained visual acuity benefit for patients with macular edema associated with CRVO. Repeated injections may be necessary. The risk of glaucoma is significant, and additional study is required to further characterize this and other risks.