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.     

Early treatment of severe cystoid macular edema in central retinal vein occlusion with posterior sub-tenon triamcinolone acetonide

PURPOSE: To evaluate the clinical outcomes of posterior sub-Tenon (PST) injection of triamcinolone acetonide (TA) in the early treatment of severe cystoid macular edema (CME) in central retinal vein occlusion (CRVO). METHODS: In a noncomparative, prospective study, 18 eyes of 18 patients with severe CME (central macular thickness, CMT >450 microm) secondary to recent-onset CRVO (the onset of symptoms < or =4 weeks) and a decrease in visual acuity (< or =80 letters of Early Treatment Diabetic Retinopathy Study [ETDRS] scores, 20/50) were included. PST injection of 40 mg of TA was given under topic anesthesia. All patients received three biweekly injections and were evaluated at baseline and at 1 day, 1, 2, 4, 6, and 8 weeks, and 3, 6, and 9 months after injection. The main outcome measures were ETDRS scores, CMT, intraocular pressure (IOP), cataract progression, and frequency of complications. RESULTS: The mean age of the 18 patients was 61.17 years (range, 24-81 years) and the mean duration of symptoms was 15.28 days (range, 9-28 days). Eight eyes were diagnosed with ischemic CRVO and 10 eyes with nonischemic CRVO. Mean baseline ETDRS visual acuity (VA) score was 36.89 +/- 18.22 in all affected eye. There was a significant improvement in VA at 1, 3, 6, and 9 months of follow-up. The mean VA at these time points were 46.61 +/- 20.21, 58.11 +/- 22.19, 59.39 +/- 22.98, and 58.67 +/- 23.27 (all P < 0.001), respectively. Both nonischemic and ischemic eyes benefited with a statistically significant VA improvement at each time point. A comparison of the gain in VA between two subgroups was not significant at 1 and 3 months (P > 0.05), but was statistically significant at 6 and 9 months (P = 0.009 and 0.008, respectively). VA gain of 10 or more letters was found in all nonischemic eyes (10/10) and 3 ischemic eyes (3/8) at the 9-month follow-up. Two ischemic eyes were found to have no gain of letters in VA at the 9-month follow-up. The mean baseline CMT for all eyes was 566 +/- 42 microm. There was a 29% reduction with a mean CMT of 404 +/- 49 microm (P < 0.001) at 1 month, 51% reduction with a mean CMT of 278 +/- 40 microm (P < 0.001) at 3 months, 61% reduction with a mean CMT of 222 +/- 56 microm (P < 0.001) at 6 months, and 63% reduction with a mean CMT of 210 +/- 30 microm (P < 0.001) at 9 months. Both nonischemic and ischemic eyes demonstrated a statistically significant reduction in CMT (all P < 0.001). A comparison of the reduction in CMT between these two subgroups was not significant at each visit (all P > 0.05). For both subgroups, there was no statistically significant difference in IOP change at baseline, 1 week, 1, 3, 6, and 9 months of follow-up. Only two patients required topic antiglaucoma drops for elevated IOP. Three patients developed a recurrence of CME accompanied with visual decrease. No cataract progression or other complications were observed. CONCLUSIONS: PST injection of TA is effective in reversing CME and improving visual acuity in recent-onset CRVO in the first 9 months. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO. Early treatment may be better for visual improvement before longstanding macular edema results in irreversible photoreceptor damage. Further study with longer follow-up period is necessary.     

A review on vasohibin and ocular neovascularization

AIM: To evaluate and compare the incidences of ocular hypertension and severe intraocular pressure (IOP) elevation after posterior subtenon injection of triamcinolone acetonide (PSTA) for various diseases.METHODS: Totally 179 eyes that had received PSTA for diabetic macular edema, pseudophakic cystoid macular edema, branch retinal vein occlusion, central retinal vein occlusion (CRVO), choroidal neovascularization or noninfectious uveitis were retrospectively enrolled. The primary outcomes included ocular hypertension defined as an IOP >21 mm Hg, and severe IOP elevation defined as a rise of 10 mm Hg or more in IOP compared with baseline. Cox regression models were used to analyze the hazard ratios (HRs) among different diseases.RESULTS: After PSTA, the mean IOPs from month 1 to month 6 all significantly increased (P<0.05). Ocular hypertension occurred in 30.7% of eyes (median time: 8wk), and severe IOP elevation occurred in 16.2% of eyes (median time: 9wk). Patients receiving PSTA for CRVO or uveitis had a significantly higher risk for ocular hypertension (HR=3.049, P=0.004 for CRVO; HR=5.464, P=0.019 for uveitis) and severe IOP elevation (HR=2.913, P=0.034 for CRVO; HR=7.650, P=0.009 for uveitis). CONCLUSION: IOP significantly increased within 6mo after PSTA, with the onset of ocular hypertension happening mostly at 2 to 3mo. Patients of CRVO or noninfectious uveitis had a higher risk of ocular hypertension or severe IOP elevation after PSTA and should be monitored for IOP more carefully.     

曲安奈德玻璃体注射治疗视网膜中央静脉阻塞继发黄斑水肿

目的 观察玻璃体腔曲安奈德注射(intravitreal triamcinolone acetonide,IVTA)治疗视网膜中央静脉阻塞(central retinal vein occlusion,CRVO)继发的黄斑水肿的近期疗效和并发症.方法 对30例(30只眼)CRVO继发的严重黄斑水肿患者,患眼行IVTA 4mg/0.1ml,观察治疗前和治疗后1 d、3 d、1周、1个月、3个月时患者的最佳矫正视力、眼压、眼内炎性反应、晶体、眼底改变,光学相干断层扫描(optic coherenttomography,OCT)测定黄斑区视网膜厚度变化.结果 30只眼中,有22只眼(73%)视力提高,3只眼(10%)视力不变,2只眼(7%)继发性青光眼,2只眼(7%)并发性白内障,1只眼(3%)视网膜脱离.LogMAR视力治疗前为0.78±0.50,治疗后1周、1个月、3个月时分别为0.62±0.48,0.45±0.37,0.31±0.28.黄斑中心凹平均厚度治疗前为(589±132)μm,治疗后1周、1个月、3个月时分别为:(341±122)μm;(201±61)μm;(162±41)μm.治疗前后比较差异有统计学意义(P＜0.01).30只眼中有5只眼(17%)治疗后暂时性眼压轻度升高,经局部药物短期治疗后恢复正常;2只眼(7%)继发性青光眼,给与小梁切除术治疗;2只眼(7%)并发性白内障;1只眼(3%)视网膜脱离,给与激光光凝治疗.结论 IVTA可以在短期内有效地治疗CRVO继发的黄斑水肿,但其并发症不容忽视.     

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 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.     

Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion

PURPOSE: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for ischemic macular edema associated with branch retinal vein occlusion (BRVO) and foveal ischemia. DESIGN: Prospective interventional case series. METHODS: setting: Clinical practice. study population: Eighteen eyes of 18 patients with macular edema associated with BRVO and foveal ischemia. intervention: Four mg IVTA. main outcome measures: Visual acuity (VA), optical coherence tomography, macular thickness measurements, and treatment-related complications. RESULTS: The mean duration of BRVO before treatment was 14 months. All patients were followed for a minimum of nine months, and 12 patients completed 12 months follow-up. The mean logarithm of the minimum angle of resolution (logMAR) VA improved significantly from 0.81 +/- 0.36 at baseline to 0.65 +/- 0.30 at one month (P = .03) but did not vary significantly from baseline at three, six, nine, and 12 months. Macular thickness improved significantly in all eyes from a mean of 400 +/- 134 mum preinjection, to 228 +/- 58 mum at one month (P < .01) and 256 +/- 121 mum at three months (P < .01) but did not vary significantly from baseline at six, nine, and 12 months. Eight eyes developed posterior subcapsular cataract, intraocular pressure (IOP) exceeded 21 mm Hg in four eyes, and two eyes developed vitreomacular traction during follow-up. CONCLUSIONS: IVTA is effective in reducing ischemic macular edema associated with BRVO and foveal capillary nonperfusion. This reduction is often associated with a temporary improvement in VA. Raised IOP and development of posterior subcapsular cataract are disadvantages of this treatment.     

Intravitreal triamcinolone acetonide in patients with macular oedema due to central retinal vein occlusion

PURPOSE: To evaluate treatment of macular oedema due to central retinal vein occlusion (CRVO) with intravitreal triamcinolone acetonide. METHODS: In a prospective case series, 13 patients with macular oedema due to non-ischaemic CRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included assessment of best corrected visual acuity (BCVA) for distance and reading, measurement of intraocular pressure (IOP), fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and 1 week, 1 month, 3, 6 and 9 months postoperatively. RESULTS: Preoperative mean BCVA was 0.9 +/- 0.4 for distance vision and 1.0 +/- 0.3 for reading acuity, respectively. A significant improvement in distance VA (0.5 +/- 0.3, p < 0.001) and reading acuity (0.7 +/- 0.3, p = 0.03) was observed until 3 months and 6 months, respectively. Mean macular thickness was significantly reduced until 9 months postoperatively. CONCLUSION: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to CRVO. However, the significant effect was not permanent and persisted for a maximum of 6 months.     

曲安奈德联合激光光凝治疗视网膜静脉阻塞继发黄斑水肿

目的：观察玻璃体腔内曲安奈德( trialcinolone acetonide, TA)注射联合黄斑格栅样光凝治疗视网膜静脉阻塞引起黄斑水肿的疗效分析。
　　方法：检眼镜、眼底血管造影( FFA )、光学相干断层扫描( OCT)检查证实的由视网膜静脉阻塞引起的黄斑水肿患者35例35眼,玻璃体内注射TA 2lg,1~4wk内黄斑水肿减轻后行黄斑格栅样光凝,随访6lo,观察视力、眼压、晶状体,OCT 观察黄斑厚度改变,FFA 观察眼底毛细血管渗漏情况。
　　结果：视网膜中央静脉阻塞( central retinal vein occlusion, CRVO)中非缺血型10眼,缺血型14眼;视网膜分支静脉阻塞( branch retinal vein occlusion, BRVO)中非缺血型4眼,缺血型7眼。最终视力提高者19眼,不变者11眼,比术前降低者5眼。 OCT检查黄斑中心凹形态恢复正常者9眼,FFA提示黄斑区荧光素渗漏与术前相比消失或明显减轻;黄斑囊样水肿明显改善者21眼,FFA 提示渗漏比术前减轻;无改善者5眼,FFA 提示黄斑区渗漏比术前加重或不变。
　　结论：玻璃体腔内注射TA 2 lg联合黄斑格栅样光凝治疗视网膜静脉阻塞继发黄斑水肿,可以明显减轻由静脉阻塞引起的黄斑水肿,并提高患者视力,是一种有效可行的方法。     

Intravitreal triamcinolone acetonide as primary treatment for diffuse diabetic macular edema: a prospective noncomparative interventional case series

PURPOSE: To evaluate the efficacy and safety of one intravitreal injection of 25 mg of triamcinolone acetonide as primary treatment for diffuse diabetic macular edema. METHODS: Intravitreal triamcinolone acetonide injection was performed in 30 eyes with previously untreated diabetic macular edema. The main outcome measures were logMAR visual acuity (VA) and central macular thickness (CMT) at 1, 3, and 6 months. A secondary outcome was intraocular pressure progression. RESULTS: Visual acuity results for 30 eyes that had a follow-up of at least 6 months are presented. Twenty of them were followed up to 10.1+/-2.38 months. Preoperatively, VA was 0.54+/-0.27. At 1, 3, and 6 months follow-up, VA was 0.44+/-0.29 (p=0.001), 0.43+/-0.28 (p=0.001), and 0.45+/-0.29 (p=0.006), respectively. Preoperatively, CMT was 417.3+/-143.5 microm. At 1, 3, and 6 months follow-up, CMT was 277.3 +74.0 microm (p<0.0001), 279.6+/-94.4 microm (p<0.0001), and 297.07+/-114.87 microm (p=0.002), respectively. For the 20 eyes with a follow-up of 10.1+/-2.38 months, VA was 0.5+/-0.25 and 0.50+/-0.32 at baseline and at the last follow-up visit, respectively (p>0.05). Preoperatively, intraocular pressure (IOP) was 15.13+/-1.48 mmHg. IOP was 18.26+/-2.71 mmHg, 20.07+/-4.27 mmHg, and 20.4+/-6.18 mmHg, at 1, 3, and 6 months, respectively (p<0.0001). Four eyes underwent uncomplicated filtrating surgery for intractable glaucoma. CONCLUSIONS: Intravitreal triamcinolone as primary treatment effectively increases VA and reduces CMT due to diffuse diabetic macular edema. Longer follow-up and randomized clinical trial are warranted. Safety results highlight the need to further study the relationship between triamcinolone and intraocular pressure.     

绿激光联合曲安奈德治疗视网膜中央静脉阻塞的评估

目的:评价绿激光联合曲安奈德在视网膜中央静脉阻塞中的疗效。方法:2006-01/2007-10收治视网膜中央静脉阻塞的44例(49眼),随机分为绿激光联合曲安奈德为治疗组和单纯激光治疗为对照组,随访3mo,比较两组患者视力改善和黄斑水肿消退的情况。结果:两组患者治疗后视力及黄斑水肿均有明显改善,但前者效果优于后者,P<0.05。结论:绿激光联合曲安奈德治疗视网膜中央静脉阻塞在较短时间内即可促进黄斑水肿消退,提高患者视力。     

Frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide

PURPOSE: To evaluate the frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide in elderly patients. METHODS: This clinical interventional case series study included 144 phakic eyes that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide for diffuse diabetic macular edema (n=42 eyes), exudative age-related macular degeneration (n=98), and branch retinal vein occlusion (n=4). Mean age was 72.3-/+8.9 years. Mean follow-up was 11.0-/+6.8 months (median, 8.8 months; range, 3 to 35.5 months). Reinjections were carried out in 12 (8.3%) eyes. RESULTS: Cataract surgery was performed in 20 (13.9%) eyes 17.4-/+9.1 months (median, 12.7 months; range, 8.0 to 35.5 months) after the first intravitreal injection. Out of the 20 eyes undergoing cataract surgery, 19 (95%) eyes had received one intravitreal injection, and 1 (5%) eye had received two previous injections. CONCLUSIONS: In the elderly population of patients with exudative age-related macular degeneration, diffuse diabetic macular edema, or branch retinal vein occlusion, intravitreal high-dosage injection of triamcinolone acetonide leads to clinically significant cataract with eventual cataract surgery in about 15% to 20% of eyes within about 1 year after the intravitreal injection.     

Different Dosages of Intravitreal Triamcinolone Acetonide Injections for Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose:.To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion.(CRVO).in a sample of Chinese patients from Shaanxi province. Methods:.The 50 eyes from 50 patients were separated into three TA treatment groups:.17 patients were given 4 mg/0.1 ml,.19 patients were given 8 mg/0.2 ml,.and 14 patients were given 16 mg/0.4 ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Results:.Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection,.macular edema recurred at 2-4 months in the low-dose group.(4 mg),.at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg)..No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16 mg TA,.if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. Conclusion: A low dosage of TA (4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO..A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.     

Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases

Intravitreal triamcinolone acetonide (IVTA) has increasingly been applied as treatment for various intraocular neovascular and oedematous diseases. Comparing the various diseases with respect to effect and side-effects of the treatment, the best response in terms of gain in visual acuity (VA) has been achieved for intraretinal oedematous diseases such as diffuse diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion and pseudophakic cystoid macular oedema. In eyes with various types of non-infectious uveitis, including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, VA increased and the degree of intraocular inflammation decreased. Some studies have suggested that intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischaemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration (AMD), particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure (IOP) and may stabilize the eye. The complications of intravitreal triamcinolone therapy include: secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high IOP leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% of elderly patients within 1 year of injection; postoperative infectious endophthalmitis occurring at a rate of about one per 1000; non-infectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudo-endophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other intraocular surgeries, including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated if the resultant benefits decrease after the initial IVTA injection. In non-vitrectomized eyes, the duration of the effect and side-effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. So far, it has remained unclear whether the solvent agent should be removed, and if so, how.     

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.     

玻璃体内注射曲安奈德治疗视网膜中央静脉 阻塞引起的黄斑囊样水肿

目的观察玻璃体内注射曲安奈德（TA）治疗视网膜中央静脉阻塞（CRVO）引起黄斑囊样水肿（CME）的疗效和安全性。方法14例CRVO所致CME患者14只眼玻璃体内注入40 mg/ml的TA0.1 ml。治疗前后均进行最佳矫正视力、眼压、裂隙灯显微镜、荧光素眼底血管造影（FFA）和光相干断层扫描（OCT）检查。随诊观察10.0～22.4个月，平均随诊观察时间为15.9个月。结果治疗前平均视力为0.1。治疗1、3个月时，100%的患眼视力提高，其中，视力≥0.2者分别为71.4%和63.6%，视力≥0.5者分别为42.9%和27.3%。此后，部分患者视力下降，最终随诊时视力≥0.2者占28.6%，≥0.5者占7.1%，与治疗前比较，71.4%的患眼视力有不同程度的提高，28.6%的患眼视力下降。治疗后1个月时，OCT检查显示黄斑水肿完全消退10只眼，占71.43%，水肿明显减轻4只眼，占28.57%。最终随诊时，OCT检查显示黄斑水肿完全消退4只眼，减轻9只眼，加重1只眼。7只眼在注射药物后1周～6个月期间先后出现不同程度的高眼压，眼压达到22.3～ 40.1 mm Hg（1 mm Hg = 0.133 kPa），在最终随诊时7只眼出现了晶状体后囊膜下混浊的并发性白内障。结论玻璃体内注射TA短期内能有效改善黄斑水肿和明显提高视力，部分治疗眼出现高眼压；远期观察黄斑水肿的复发率和晶状体后囊膜下混浊的发生率均较高。(中华眼底病杂志,2005,21:213-216)     

玻璃体腔注射曲安奈德治疗视网膜静脉阻塞黄斑水肿

目的:评价玻璃体腔注射曲安奈德治疗视网膜静脉阻塞合并黄斑水肿的疗效及并发症。方法:患者30例30眼玻璃体腔注射曲安奈德4mg治疗视网膜静脉阻塞合并黄斑水肿,观察治疗前、后的最佳矫正视力、眼压、裂隙灯显微镜检查、眼底荧光血管造影和光学相干断层扫描的变化,采用SPSS 12.0软件进行统计学分析。结果:所有患者手术后视力均显著提高,平均黄斑中心凹厚度(CMT)显著减少。病程、年龄、注射前CMT及视网膜静脉阻塞的类型和视力预后无相关性,注射前视力与注射后末次视力呈正相关。结论:玻璃体腔注射曲安奈德治疗视网膜静脉阻塞合并黄斑水肿简单、安全、易操作,短期内可以迅速减轻黄斑水肿,最终的视力预后取决于治疗前的视力,部分患者在注射后3 ～6mo可能复发。     

Vitrectomy for macular edema combined with retinal vein occlusion

This study was performed in order to evaluate the effect of vitrectomy in eyes with retinal vein occlusion associated with macular edema. Twenty-nine years eyes (27 patients) with branch retinal vein occlusion (BRVO), and 14 eyes (13 patients) with central retinal vein occlusion (CRVO) both associated with macular edema underwent phacoemulsification, intraocular lens implantation, pars plana vitrectomy and peeling of the posterior hyaloid membrane. Follow-up ranged from 12 to 32 months. Macular edema was reduced, and visual improvement was observed (p < 0.0001 in BRVO, p = 0.0257 in CRVO, paired t-test). Visual outcome was better in eyes with better visual acuity before surgery. Early vitrectomy may be recommended for retinal vein occlusion associated with macular edema. This revised version was published online in July 2006 with corrections to the Cover Date.     

Retina tomography after vitrectomy for macular edema of central retinal vein occlusion

PURPOSE AND OBJECTIVE: To report retina tomography after vitrectomy for macular edema in central retinal vein occlusion (CRVO). PATIENTS AND METHODS: Five patients with macular edema caused by CRVO were examined using optical coherence tomography (OCT) through their clinical courses. RESULTS: The retinal thickness through the fixation was reduced in all 5 eyes. Preoperatively, the retina thickness at the foveola was more than 500 microm in three eyes and more than 1000 microm in 2 eyes. The retina thickness was reduced to 311+80 microm within two weeks on average. Visual acuity was improved by two or more lines in 3 of 5 eyes. CONCLUSION: Vitrectomy is worthy of consideration when macular edemas are prolonged in patients of CRVO. OCT is a useful instrument for management and treatment of macular edema.     

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.