Intravitreal triamcinolone acetonide for diabetic macular edema

PURPOSE: Intravitreal injection of triamcinolone acetonide has been advocated to treat exudative diabetic macular edema. The purpose of the study was to evaluate the clinical outcome of an intravitreal injection of triamcinolone acetonide as treatment for diffuse diabetic macular edema. METHODS: This study was a retrospective, interventional, clinical case series examining 210 eyes of 174 patients who received an intravitreal injection of 1 or 4 mg of triamcinolone acetonide for treatment of diffuse diabetic macular edema. Inclusion criteria were clinically significant macular edema, visual acuity loss, and leakage shown by fluorescein angiography. Main outcome measures were visual acuity and intraocular pressure. Mean follow-up time +/- SD was 6.6 +/- 3.1 months. RESULTS: In the study group, visual acuity improved significantly (P < 0.001) from a median of 20/200 (mean logMAR, 0.92) at baseline to 20/80 (mean logMAR, 0.82) at 6 months. Mean intraocular pressure +/- SD increased from 15.4 +/- 3.4 mmHg (median, 16 mmHg; range, 6-26 mmHg) to a maximal value of 20.4 +/- 6.2 mmHg (median, 19 mmHg; range, 12-51 mmHg) during the follow-up period. Complications included culture-negative sterile endophthalmitis in six cases and cataract extraction in five eyes. CONCLUSIONS: Intravitreal injection of 1 to 4 mg of triamcinolone acetonide may benefit patients by improving visual acuity in eyes with clinically significant diabetic macular edema. This study did not provide significant evidence to justify its routine use in clinical practice for all patients with diabetic macular edema. A randomized clinical trial on this issue would provide more conclusive evidence and help identify those patients most likely to benefit from intravitreal triamcinolone acetonide.     

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 bevacizumab (Avastin) treatment of macular edema in central retinal vein occlusion: a short-term study

PURPOSE: To report the short term anatomic and visual acuity response after intravitreal injection of bevacizumab (Avastin, Genentech) in patients with macular edema due to central retinal vein occlusion (CRVO). METHODS: The authors conducted a retrospective study of patients with macular edema due to CRVO who were treated with at least one intravitreal injection of bevacizumab 1.25 mg in 0.05 mL. Patients underwent Snellen visual acuity testing, optical coherence tomography (OCT) imaging, and ophthalmoscopic examination at baseline and follow-up visits. RESULTS: There were 16 eyes of 15 consecutive patients with a mean age of 76.1 years (SD 9.8 years). Intravitreal triamcinolone had been previously administered to 9 patients, but all of these patients either had no improvement or had excessive intraocular pressure caused by the triamcinolone. The patients received a mean of 2.8 injections of bevacizumab per eye. No adverse events were observed, including endophthalmitis, clinically evident inflammation, increased intraocular pressure, retinal tears, retinal detachment, or thromboembolic events in any patient. The mean central macular thickness at baseline was 887 microm and decreased to a mean of 372 microm at month 1 (P < 0.001). The mean baseline acuity was 20/600 (logMAR = 1.48) and the mean acuity at month 1 was 20/200 (logMAR = 1.05), a difference that was highly significant (P = 0.001). At last follow-up, a mean of 3 months after the first injection, the mean visual acuity was 20/138 (logMAR = 0.84), which was significantly better than baseline (P < 0.001). Visual acuity improvement, defined as a halving of the visual angle, was seen in 14 of the 16 eyes. CONCLUSION: Initial treatment results of patients with macular edema secondary to CRVO did not reveal any short-term safety concerns. Intravitreal bevacizumab resulted in a significant decrease in macular edema and improvement in visual acuity. The number of patients in this pilot study was limited and the follow-up is too short to make any specific treatment recommendations, but the favorable short-term results suggest further study is needed.     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

Treatment of central retinal vein occlusion with triamcinolone acetonide: an optical coherence tomography study

Central retinal vein occlusion is one of the most common retinal vascular disorders. Many patients have decreased visual acuity as a result of macular edema. We report a retrospective review of 8 patients at the University of Wisconsin with macular edema from CRVO who were treated with an intravitreal injection of triamcinolone acetonide. Optical coherence tomography (OCT) was used to help assess the effect of this intervention. Mean baseline visual acuity was 20/500. Mean visual acuity at the 3-month follow up was 20/220. The average gain in visual acuity was 3.3 lines (range -1 to +10). Four of 8 patients experienced a visual acuity gain of 2 or more lines at the 3-month follow up. Four of 8 patients were unchanged (within 2 lines of baseline) at the 3-month follow up. No patient had a decrease in visual acuity (2 or more line decrease from baseline). Seven of 8 patients had complete resolution of macular edema on clinical examination at the 3-month follow up. No adverse effects such as cataract, glaucoma, retinal detachment or endophthalmitis were noted. We conclude that intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. Optical coherence tomography demonstrated significant anatomic improvement in the majority of patients with macular edema due to CRVO treated with intravitreal injection of triamcinolone acetonide.     

曲安奈德球内注射与经Tenon囊球后注射治疗视网膜静脉阻塞黄斑水肿的对比性研究

目的:对比曲安奈德(triamcinolone acetonide,TA)玻璃体内注射和经Tenon囊球后注射治疗视网膜静脉阻塞黄斑水肿的有效性及安全性。方法:视网膜静脉阻塞黄斑水肿患者114例(114眼),男72眼,女42眼。曲安奈德球内注射治疗66例(66眼),男43眼,女23眼;曲安奈德Tenon囊球后注射治疗48例(48眼),男29眼,女19眼,对两组患者通过观察视力、眼压、光相干断层成像术(optic coherence tomagraphy,OCT)检查,比较两种治疗途径的治疗结果,随访1mo。结果:曲安奈德(TA)玻璃体内注射治疗前后结果比较,各时期无论视力及OCT检查结果均有显著性差异(P<0.01),但其致眼压升高的副作用也较为明显,发生率与国内报道基本相近。曲安奈德Tenon囊球后注射治疗前后比较,无论视力及OCT检查结果均有显著性差异(P<0.01),但其副作用较少。两组患者治疗后各时期OCT检查结果的纵向比较有统计学意义(P<0.05)。结论:曲安奈德(TA)玻璃体内注射和Tenon囊球后注射均对治疗视网膜静脉阻塞黄斑水肿有效,前者疗效更加理想,但副作用明显。后者副作用较少,可反复注射,在治疗复发性黄斑水肿中可联合使用以达到治疗目的。     

Duration of the effect of intravitreal triamcinolone acetonide as treatment for diffuse diabetic macular edema

PURPOSE: To evaluate the duration of the effect of intravitreal triamcinolone acetonide on visual acuity in patients with diffuse diabetic macular edema. DESIGN: Clinical interventional case series. METHODS: Subjects were 31 patients (38 eyes) with diffuse diabetic macular edema who received an intravitreal injection of 20- to 25-mg triamcinolone acetonide. Mean follow-up time was 13.2 +/- 6.0 months (6.03-25.2 months). RESULTS: Visual acuity and intraocular pressure began to increase significantly (P =.003) within the first week, reaching a plateaulike maximum at 1 to 7 months postinjection, returning to baseline values 8 to 9 months postinjection. CONCLUSIONS: The effect of an intravitreal injection of approximately 20- to 25-mg triamcinolone acetonide in patients with diffuse diabetic macular edema lasts approximately 7 to 8 months. This information may be helpful in determining the optimal dosage of intravitreal triamcinolone acetonide for the treatment of diffuse diabetic macular edema.     

Intravitreal triamcinolone acetonide for cystoid macular edema in nonischemic central retinal vein occlusion

PURPOSE: The effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema from central retinal vein occlusion (CRVO) was investigated. DESIGN: A noncomparative, prospective, interventional case series. METHODS: In a clinical practice, 18 patients were enrolled with nonischemic CRVO and cystoid macular edema. Two milligrams of triamcinolone acetonide were injected into the vitreous of only one eye from each patient. The outcome measures were 1-mm mean central retinal thickness on optical coherence tomography and visual acuity. RESULTS: Mean duration of symptoms before surgery was 2 months (SD, 1.3 months). Ten patients required repeated injections for recurrent cystoid macular edema (mean, 1.8 injections). Mean visual acuity significantly improved from 20/300 to 20/166 (P = .007) at 1 month, 20/100 (P = .0005) at 2 months, 20/130 (P = .007) at 3 months, and 20/150 (P = .02) at 6 months but deteriorated again to 20/270 (not significant) at 12 months. There was a significant improvement in retinal thickness from presentation 518 microm, to 363 microm (P = .03) at 1 month, 304 microm (P = .04) at 2 months, and 353 microm (P = .01) at 3 months but not from presentation at 6 months (mean, 383 microm) and 12 months (mean, 406 microm). Eleven patients suffered intraocular pressure rises requiring intervention. Intravitreal triamcinolone acetonide did not prevent collateral circulation formation, which was seen in 10 patients. CONCLUSION: Intravitreal corticosteroid injection is very effective in reversing cystoid macular edema and improving visual acuity in recent-onset nonischemic CRVO in the first 6 months, but this is unfortunately not sustained at 1 year.     

Intravitreal triamcinolone acetonide in eyes with cystoid macular edema associated with central retinal vein occlusion

PURPOSE: To evaluate treatment of cystoid macular edema associated with central retinal vein occlusion with intravitreal triamcinolone acetonide. METHODS: This study included 10 eyes of nine patients with perfused central retinal vein occlusion with visual acuity of 20/50 or worse. Following baseline evaluation, including best-corrected visual acuity, intraocular pressure (IOP), fluorescein angiography, and volumetric optical coherence tomography (VOCT), triamcinolone acetonide (4 mg in 0.1 ml) was injected into the vitreous cavity. RESULTS: Mean duration from the time of diagnosis to the intravitreal injection was 15.4 months. All 10 eyes demonstrated biomicroscopic improvement in cystoid macular edema with corresponding improvement in VOCT measurements from a mean of 4.2 mm(3) preinjection to a mean of 2.6 mm(3) at last follow-up (P <.001). Mean best-corrected visual acuity improved from 58 letters (range, 37-72) at baseline to 78 letters (range, 50-100 letters) at last follow-up (average, 4.8 months). The visual acuity improvement was statistically significant (P =.01). Six eyes (60%) were > or =20/50. There were no significant complications. Three eyes (30%) without previous history of glaucoma required initiation of topical aqueous suppressant therapy for IOP elevation at last follow-up. One eye with a previous history of open-angle glaucoma required a trabeculectomy. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide appears to be effective in reducing cystoid macular edema associated with central retinal vein occlusion. This reduction often corresponded to an improvement in visual acuity. Further evaluation is warranted to assess its safety and efficacy in these eyes.     

Two-year results of intravitreal triamcinolone acetonide injection for the treatment of diabetic macular edema

Purpose To investigate 2-year results of intravitreal triamcinolone acetonide injection for the treatment of diffuse diabetic macular edema unresponsive to previous laser photocoagulation. Method The study included 75 eyes of 75 diabetic patients with clinically significant diffuse macular edema that had failed to respond to previous laser photocoagulation. An intravitreal injection of triamcinolone acetonide at the dose of 4 mg/0.1 ml was administered. Best-corrected visual acuity was measured as the logarithm of the minimum angle of resolution (logMAR), and central macular thickness was obtained by optical coherence tomography at each visit. Intraocular pressure and lenticular status were also evaluated. Differences among measurements were evaluated by Friedman two-way analysis of variance by ranks. Mean follow-up period was 24.7 ± 5.9 months. Results The mean central macular thickness, which was obtained 3 days, 1 month, 3 months, 6 months, 9 months, 12 months, 18 months and 24 months postoperatively, was significantly different from the baseline measurement (P < 0.001). Mean best-corrected logMAR visual acuity improved significantly from baseline at the 1- month and 3-month follow-up intervals (P < 0.05), but there was no significant change at the 6- month, 9-month, 12-month, 18-month or 24-month follow-up periods (P > 0.05). During the follow-up, 29 (38.7%) eyes received re-injection of intravitreal triamcinolone. Twenty-one (28%) eyes developed intraocular pressure values higher than 21 mmHg, and 18 (24%) eyes developed cataract. Thirteen (17.3%) eyes required cataract and/or glaucoma surgery. Conclusions In refractory diabetic macular edema, intravitreal triamcinolone effectively reduces foveal thickness and improves visual acuity in the short term, but with the extended follow-up, the number of recurrences and steroid-related complications were shown to increase. Nevertheless, it may be a therapeutic option in some patients that do not respond to previous laser photocoagulation.     

Intravitreal triamcinolone treatment for macular edema associated with central retinal vein occlusion and hemiretinal vein occlusion

PURPOSE: To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). METHODS: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n = 21) and HRVO (n = 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre- and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. RESULTS: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n = 23] 635 vs. 352 mum, respectively; P < 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, -3-7) over the course of the study period. Ten eyes gained > or =2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P = 0.24). None of the eyes of diabetic patients (n = 6) or patients with ischemic CRVO (n = 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P = 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P = 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n = 16] 20/133 vs. 20/67, respectively; P < 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P = 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. CONCLUSIONS: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.     

One-year safety and efficacy of intravitreal triamcinolone acetonide for the management of macular edema secondary to central retinal vein occlusion

PURPOSE: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) as treatment for macular edema associated with central retinal vein occlusion (CRVO). METHODS: A retrospective review was performed of data for 40 consecutive patients (40 eyes) with CRVO and macular edema treated with IVTA at the Bascom Palmer Eye Institute (Miami, FL). RESULTS: Median duration of symptoms before the first injection was 3 months (range, 1 day to 8 years). Median Snellen visual acuity was 20/400 at baseline (range, 20/60 to light perception; n = 40), 20/300 at 1 month (P = 0.010; n = 37), 20/300 at 3 months (P = 0.007; n = 33), 20/400 at 6 months (P = 0.726; n = 28), and 8/200 at 1 year (P = 0.569; n = 17). Vision improved by > or =3 lines in 21% of eyes at 1 month, 27% at 3 months, 14% at 6 months, and 12% at 1 year. Visual acuity was unchanged from baseline in 71% of eyes at 6 months and 1 year. By 1 year, 50% of eyes received more than one injection (mean = 1.6 injections; range 1-4 injections). Overall, intraocular pressure increased by > or =10 mmHg in 24% of eyes at 1 year. Trabeculectomy was performed on 2 of 12 eyes with preexisting open-angle glaucoma. CONCLUSION: IVTA can substantially improve vision in some patients, but most patients have stable visual acuity compared with baseline at 1 year despite repeated injections.     

A comparative study between intravitreal triamcinolone and bevacizumab for macular edema due to central retinal vein occlusion with poor vision

Aim:

To compare the effect of intravitreal bevacizumab and triamcinolone in patients with macular edema after central retinal vein occlusion (CRVO), presenting with poor visual acuity.

Materials and Methods:

It was a retrospective, comparative case series of 38 consecutive eyes, with macular edema secondary to CRVO, with 20/200 or worse vision, which were treated primarily either with intravitreal bevacizumab (1.25 mg; 24 eyes) or intravitreal triamcinolone (4 mg; 14 eyes). During follow-up, 3.6 ± 0.8 re-injections of bevacizumab and 2.4 ± 0.5 re-injections of triamcinolone were administered (P = 0.080). The main outcome measures were the best-corrected visual acuity and the central macular thickness by optical coherence tomography during 12 months of follow-up.

Results:

At 12 months, visual acuity (logMAR) was changed from 1.03 ± 0.39 (baseline) to 0.92 ± 0.39 (P = 0.374) and the central macular thickness was reduced from a baseline of 713.6 ± 179.3 µm to 310.8 ± 205.2 µm (P = 0.000). Neither the bevacizumab nor triamcinolone groups varied significantly in visual acuity and central macular thickness at 1, 3, 6, and 12 months after treatment. Neovascular glaucoma developed in two of the 14 eyes (14%) in the triamcinolone group.

Conclusion:

In patients with CRVO and poor vision, intravitreal bevacizumab and intravitreal triamcinolone were associated with a reduction in macular edema; however, neither treatment achieved significant visual acuity improvement by the 12-month follow-up.     

The efficacy of intravitreal triamcinolone acetonide on macular edema in branch retinal vein occlusion

PURPOSE: To evaluate the effectiveness of intravitreal triamcinolone acetonide as primary treatment of macular edema in branch retinal vein occlusion. METHODS: Fifteen eyes of 15 patients with macular edema due to branch retinal vein occlusion (Group 1) who received 8 mg/0.2 ml of intravitreal triamcinolone injection as primary treatment were retrospectively evaluated. The control group (Group 2) consisted of 19 eyes of 19 patients who had received laser treatment for macular edema. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular edema map values of Heidelberg Retinal Tomograph II. RESULTS: In Group 1, mean visual acuity improved significantly from a mean logMAR (logarithm of minimal angle of resolution) value of 0.98+/-0.19 at baseline to a maximum of 0.24+/-0.24 during a mean follow-up time of 6.3 months. In the control group, the mean baseline log-MAR visual acuity before laser treatment was 1.02+/-0.22, and it was 0.50+/-0.28 at 6-month examinations. Mean improvement in visual acuity at 1-, 3-, and 6-month examinations was significantly higher in Group 1 when compared with the control group (for each, p<0.001). The mean edema map value of Group 1 significantly decreased by 40% at 6-month examinations when compared with preinjection value (p<0.001). In Group 1, mean increase in intraocular pressure elevation was 19.8% at the 1-month, 26.9% at 3-month, and 5.7% at 6-month visits, but intraocular pressures were under control with topical antiglaucomatous medications. CONCLUSIONS: Intravitreal triamcinolone acetonide injection may be a new and promising approach as initial therapy for macular edema due to branch retinal vein occlusion.     

Intraocular triamcinolone acetonide for pseudophakic cystoid macular edema: optical coherence tomography and multifocal electroretinography study

PURPOSE: To evaluate pseudophakic cystoid macular edema (CME) by optical coherence tomography (OCT) and multifocal electroretinography (mf-ERG) and determine the efficacy of intravitreal triamcinolone acetonide injections. METHODS: In this nonrandomized retrospective study, 14 eyes of 14 patients with persistent pseudophakic CME were treated with triamcinolone acetonide injection and were followed up for 1 year. All patients underwent complete ophthalmologic examination including determination of best-corrected visual acuity, slit-lamp examination, tonometry, and funduscopy. Results of OCT and mf-ERG were also recorded before and after the injection. RESULTS: Visual acuity and mf-ERG values increased in all patients after intravitreal triamcinolone acetonide injections. OCT showed improvement of the retinal thickness in the macular area. Temporary increase of intraocular pressure was controlled with topical use of antiglaucoma drops. CONCLUSION: Intravitreal triamcinolone acetonide injection is a promising therapeutic tool for chronic pseudophakic edema resistant to other medical treatment. However, further study is needed to assess the treatment's long-term efficacy, its safety, and the need for retreatment.     

Intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema

PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.     

Intravitreal triamcinolone acetonide for persisting cystoid macular edema after penetrating keratoplasty

PURPOSE: The intravitreal application of triamcinolone acetonide as treatment of long-standing, therapy-resistant cystoid macular edema after penetrating keratoplasty is reported. METHODS: A 44-year-old patient showed therapy-resistant cystoid macular edema for 2 years after repeated penetrating keratoplasty was performed as treatment of keratoconus. The crystalline lens was clear. The patient received an intravitreal injection of approximately 20 mg of triamcinolone acetonide. Preinjection visual acuity measured 20/80. RESULTS: Within the first 4 weeks after the injection, dense cataract developed necessitating cataract surgery. After phakoemulsification, visual acuity improved to 20/50. Optical coherent tomography and fluorescein angiography showed an almost complete resolution of cystoid macular edema. Ten months after the injection, visual acuity remained at 20/50, and intraocular pressure measured 15 mm Hg without antiglaucomatous therapy taken. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide may be an additional tool in the treatment of therapy-resistant cystoid macular edema after penetrating keratoplasty. After intravitreal injection of triamcinolone acetonide, cataract may rapidly develop in eyes that have been intensively treated, topically and systemically, by corticosteroids for several years.     

Intraocular triamcinolone acetonide for macular edema due to CRVO. A multifocal-ERG and OCT study

Purpose To investigate the effectiveness of intravitreal triamcinolone acetonide in the treatment of cystoid macular edema due to central retinal vein occlusion (CRVO). A noncomparative, prospective, interventional case series. Methods In this study 15 eyes of 15 patients (9 males and 6 females) with macular edema due to non-ischemic CRVO were treated with intravitreal injection of 4 mg triamcinolone acetonide and followed-up for 1 year. Examination included measurement of best-corrected visual acuity (BCVA) for distance, measurement of intraocular pressure (IOP), fluorescein angiography, foveal retinal thickness measurement by optical coherence tomography (OCT), and multifocal electroretinography recordings (MFERG) preoperatively 3, 6 and 12 months postoperatively. Results The visual acuity increased to a significant degree at 3 months, to a smaller degree at 6 months but at 12 months there was no significant improvement. The OCT macula thickness improved to a significant level all the follow-up period but with less significance at 12 months. The MFERG recordings from the fovea showed significant improvement at 3 and 6 months. The MFERG from the parafovea area showed significant improvement at 3 and 6 and to a smaller degree at 12 months. The intraocular pressure increased at 3 and 6 months but returned to pretreatment level at 12 months. Conclusion Intravitreal injection of triamcinolone acetonide leads to a significant improvement of mean VA in patients with macular edema due to CRVO. However, this significant effect is not permanent and persists for a maximum of 3–6 months. Thereafter all the indexes tend to deteriorate.     

Intravitreal versus retrobulbar injections of triamcinolone for macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the short-term effect of intravitreal versus retrobulbar injection of triamcinolone acetonide for the treatment of macular edema caused by branch retinal vein occlusion. DESIGN: Randomized clinical trial. METHODS: Sixty eyes of 60 patients who had macular edema associated with branch retinal vein occlusion were randomly assigned to receive a single intravitreal injection (4 mg) or repeated retrobulbar injections (40 mg, three times) of triamcinolone. These injections (first injection in the retrobulbar group) were given approximately 1 week after focal laser photocoagulation. Using optical coherence tomography, the central retinal (foveal) thickness and total macular volume were measured before and at 1 and 3 months after injection. Visual acuity, intraocular pressure, and the incidence of reinjection were also examined. Fifty-two patients (86.7%) completed the 3-month follow-up. RESULTS: The mean foveal thickness and total macular volume decreased significantly after either intravitreal or repeated retrobulbar triamcinolone injections. Foveal thickness and macular volume were significantly less after intravitreal injection than after repeated retrobulbar injections, although there had been no significant differences at baseline. The percent reductions in foveal thickness and macular volume were also greater after intravitreal injection than after retrobulbar injections. Improvement in visual acuity was significantly better after intravitreal injection than after the retrobulbar injections. The incidence of intraocular pressure rise (to > or =20 mm Hg) was greater in the intravitreal group than in the retrobulbar group, but this was readily controlled by the use of antiglaucoma medications. After completion of the 3-month follow-up, 24 patients (46.2%) underwent reinjection. The need for reinjections was significantly greater in the retrobulbar group than in the intravitreal group (P = .0001). CONCLUSIONS: A single intravitreal injection of triamcinolone is significantly more effective than are repeated retrobulbar injections in reducing macular edema associated with branch retinal vein occlusion, and leads to greater improvement in visual acuity.     

A spreadsheet template for the analysis of optical coherence tomography in the longitudinal management of diabetic macular edema.

BACKGROUND AND OBJECTIVE: To provide a tool for analyzing optical coherence tomography data in patients with diabetic macular edema. PATIENTS AND METHODS: Retrospective series of 206 patients with diabetic macular edema involving at least one eye and receiving focal laser photocoagulation, intravitreal triamcinolone acetonide injection, or vitrectomy, membrane peeling, and intravitreal triamcinolone acetonide injection, and of untreated fellow eyes without diabetic macular edema. Main outcome measures included foveal subfield mean thickness and thickening relative to normal (microns), total macular volume and its increase relative to normal (mm3), visual acuity (Snellen decimal), and intraocular pressure (mm Hg). RESULTS: The authors demonstrate a graphical display of data based on a spreadsheet template for the longitudinal management of diabetic macular edema. Complex relationships of ocular response and interventions are concisely displayed. CONCLUSION: A graphical display of optical coherence tomography, visual acuity, and intraocular pressure data is a practical aid in the management of diabetic macular edema.