Intravitreal triamcinolone acetonide versus bevacizumab therapy for macular edema associated with branch retinal vein occlusion

Purpose  

To compare visual outcomes after intravitreal triamcinolone acetonide (IVTA) injection and intravitreal bevacizumab (IVB) administration for treatment of macular edema associated with branch retinal vein occlusion (BRVO).     

Triamcinolone acetonide with vitrectomy for treatment of macular edema associated with branch retinal vein occlusion

PURPOSE: To review the efficacy of a combination of triamcinolone acetonide (TA) injection and pars plana vitrectomy (PPV) for the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Seventeen eyes with macular edema associated with BRVO underwent PPV with an intraoperative injection of TA (10 mg) into the vitreous cavity. Residual or recurrent macular edema was treated with postoperative sub-Tenon capsule injections of TA (20 mg). RESULTS: With PPV and an intraoperative injection of TA, 82% of eyes showed rapid reduction of macular edema; foveal thickness decreased from 507 +/- 115 microm preoperatively to 261 +/- 123 microm 2 months after surgery (P = 0.0041). However, 59% of eyes showed recurrence of macular edema during the follow-up period. Twelve eyes with residual or recurrent macular edema received sub-Tenon capsule injections of TA; of these eyes, 9 showed substantial reduction of macular edema. Foveal thickness decreased from 381 +/- 102 microm to 256 +/- 56 microm (P = 0.0076) 2 weeks after postoperative injections of TA. At the final visit, visual acuity (logMAR) improved from 0.74 +/- 0.40 preoperatively to 0.40 +/- 0.34 (P = 0.010). CONCLUSION: An intraoperative injection of TA in combination with PPV has the potential to facilitate the absorption of macular edema associated with BRVO. In addition, residual or recurrent macular edema can be treated with additional sub-Tenon capsule injections of TA.     

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.     

曲安奈德玻璃体注射治疗视网膜分支静脉阻塞继发黄斑水肿

目的观察玻璃体腔曲安奈德注射(intravitrealtriamcinoloneacetonide,IVTA)治疗视网膜分支静脉阻塞(branchretinalveinocclusion,BRVO)继发的黄斑水肿的近期疗效和安全性。方法对23例(23眼)BRVO继发的严重黄斑水肿患者,患眼行IVTA4mg/0.1ml,观察治疗前和治疗后1天、3天、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(opticcoherenttomography,OCT)测定黄斑区视网膜厚度变化。结果所有23眼中,有20眼(86.9%)视力提高,3眼(13.1%)视力不变。LogMAR视力治疗前为:0.75±0.48,治疗后一周、一个月、三个月时分别为:0.57±0.43;0.38±0.32;0.29±0.29。黄斑中心凹平均厚度治疗前为611±149μm,治疗后一周、一个月、三个月时分别为:325±129μm;208±55μm;173±38μm。治疗前后比较差异有统计学意义(P<0.01)。23眼中有3眼(13.1%)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。所有患眼未出现眼内炎、白内障、视网膜脱离、玻璃体出血等并发症。结论IVTA可以在短期内安全有效地治疗BRVO继发的黄斑水肿。     

Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the effect of early versus late intravitreal injection of triamcinolone in patients with macular edema due to branch retinal vein occlusion (BRVO). METHODS: Twenty eyes of 20 patients with macular edema from BRVO, including 10 with duration after onset of or 3 months, improvements in visual acuity and foveal thickness, though apparent at 1 month, were not maintained at 3 and 6 months post-triamcinolone. CONCLUSIONS: Intravitreal triamcinolone is more effective in patients with BRVO who are treated earlier.     

Trans-tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion remaining after vitrectomy

PURPOSE: To evaluate the effectiveness and safety of trans-Tenon retrobulbar triamcinolone injection for macular edema associated with branch retinal vein occlusion (BRVO) after vitrectomy. DESIGN: Prospective interventional case series. METHODS: The study included 20 eyes of 20 patients with BRVO, characterized by macular edema lasting more than 3 months after vitrectomy. Trans-Tenon retrobulbar injection of 40 mg triamcinolone was performed, and visual and anatomic responses were evaluated. RESULTS: Mean foveal thickness was 499.4 +/- 209.1 microm preoperatively, 281.8 +/- 110.1 microm at 2-week follow-up, and 196.9 +/- 92.1 microm at 6-month follow-up (P < .0001, at 2 weeks and 6 months, paired t test). Improvement of visual acuity by at least 0.2 logMAR (logarithm of the minimum angle of resolution) was seen in 14 (70%) of the 20 eyes. CONCLUSIONS: Trans-Tenon retrobulbar injection of triamcinolone may be an alternative for additional treatment of eyes with BRVO that remains after vitrectomy.     

曲安奈德与雷珠单抗治疗视网膜静脉阻塞继发黄斑水肿比较

目的： 比较曲安奈德(Triamcinolone Acetonide,TA)与雷珠单抗(Lucentis,LU)治疗视网膜静脉阻塞性黄斑水肿的临床疗效。

方法：回顾性分析40例最佳矫正视力(BCVA,小数视力)≤0.6,黄斑中心凹厚度(CMT)≥250μm的视网膜静脉阻塞性黄斑水肿患者,分别进行玻璃体腔注射TA(22例,4mg,0.1mL)或LU(18例,0.5mg,0.05mL)治疗。比较两种药物治疗前和治疗后1, 2wk; 1, 2, 3,6mo两组CMT与BCVA的改变情况

结果：两组在治疗后视力明显提高,术后各时间点均较术前具有显著改变(P<0.05), TA组治疗后1mo视力最好(BCVA,logMAR=0.30±0.20),LU组治疗后2mo视力最好(BCVA,logMAR=0.21±0.10),两组在治疗后黄斑水肿明显减轻,CMT明显降低,术后各时间点均具有统计学意义(P<0.05),两组治疗后2mo时黄斑水肿程度最低(TA组CMT=274.45±141.81μm,LU组CMT=225.83±22.86μm)。BCVA(小数视力)与CMT呈负相关。各项指标两组间均无统计学差异。

结论： 玻璃体腔注射TA及LU治疗视网膜静脉阻塞性黄斑水肿均可减轻黄斑水肿和改善视力,两者治疗效果无显著差异。     

曲安奈德玻璃体腔注射治疗视网膜分支静脉阻塞继发黄斑水肿

目的:观察玻璃体腔注射曲安奈德(tviamcinolone ace-tonide,TA)治疗视网膜分支静脉阻塞(branch retinal vein occusion,BRVO)继发黄斑水肿的疗效。方法:经眼底检查、荧光眼底血管造影(FFA)、光学相干断层扫描(OCT)检查确诊的BRVO继发黄斑水肿22例(22眼)行玻璃体腔曲安奈德注射,治疗后随访(4.2±0.4)mo,对比治疗前及治疗后1,3mo视力、眼压、眼底、FFA表现、OCT所显示黄斑水肿高度以及黄斑中心凹阈值。结果:治疗的22眼中19眼(82%)视力明显提高,3眼(14%)视力不变,治疗前平均视力0.10±0.06,治疗后1,3mo平均视力分别为0.25±0.12、0.28±0.13,黄斑中心凹厚度(OCT)治疗前平均厚度(519.0±137.5)μm,治疗后1,3mo平均厚度分别为(256.4±68.3)μm、(239.4±52.2)μm,黄斑中心凹阈值(dB):治疗前(18.8±4.2)dB,治疗后1,3mo分别为(24.0±6.0)dB、(24.6±5.2)dB,治疗前后比较差异有统计学意义(P<0.01)。22眼中有6眼(27%)治疗后暂时性眼压升高,经局部抗青光眼药物治疗后恢复正常。5例(23%)患者2次注药。结论:玻璃体腔注射TA在短期内可有效改善BRVO继发黄斑水肿,但也要注意对原发病治疗。     

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：比较玻璃体腔注射曲安奈德和传统方法治疗视网膜静脉阻塞黄斑水肿的疗效。方法：共有21例因视网膜静脉阻塞导致黄斑水肿的患者纳入此项临床研究。接受治疗前所有的患者均进行了全面的眼科检查，并随机分为两组。实验组9例患者进行玻璃体腔注射4mg曲安奈德治疗；对照组12例患者接受传统方法治疗。结果：治疗前，对照组视力（logMAR）为1．20±0．38，而实验组为1．64±0．31。治疗后1mo，对照组的视力改善到0．98±0．54（logMAR），而曲安奈德治疗组改善到0．87±0．61（logMAR）。实验组和对照组之间视力改善有显著差异（P〈0．01）。结论：研究结果显示，尽管实验组和对照组的患者视力均有改善，但治疗视网膜静脉阻塞黄斑水肿，玻璃体腔注射曲安奈德比传统方法更有效。     

玻璃体腔注射曲安奈德治疗视网膜静脉阻塞黄斑水肿(英文)

目的:比较玻璃体腔注射曲安奈德和传统方法治疗视网膜静脉阻塞黄斑水肿的疗效。方法:共有21例因视网膜静脉阻塞导致黄斑水肿的患者纳入此项临床研究。接受治疗前所有的患者均进行了全面的眼科检查,并随机分为两组。实验组9例患者进行玻璃体腔注射4mg曲安奈德治疗;对照组12例患者接受传统方法治疗。结果:治疗前,对照组视力(logMAR)为1.20±0.38,而实验组为1.64±0.31。治疗后1mo,对照组的视力改善到0.98±0.54(logMAR),而曲安奈德治疗组改善到0.87±0.61(logMAR)。实验组和对照组之间视力改善有显著差异(P<0.01)。结论:研究结果显示,尽管实验组和对照组的患者视力均有改善,但治疗视网膜静脉阻塞黄斑水肿,玻璃体腔注射曲安奈德比传统方法更有效。     

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.     

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.     

Arteriovenous crossing sheathotomy versus intravitreal triamcinolone acetonide injection for treatment of macular edema associated with branch retinal vein occlusion

PURPOSE: To compare the functional and anatomical outcomes of arteriovenous (AV) sheathotomy and intravitreal triamcinolone acetonide (IVTA) injection in the treatment of macular edema associated with branch retinal vein occlusion (BRVO). METHODS: Forty eyes of 40 patients with macular edema secondary to BRVO were randomized into two treatment groups. A total of 20 patients received AV sheathotomy (sheathotomy group), and the second group of 20 patients was treated with IVTA (IVTA group). Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) score, total macular volume measured, and foveal thickness by 3rd generation optical coherence tomography (OCT3) were evaluated as main outcome measurements. RESULTS: The average changes in ETDRS scores, total macular volumes, and foveal thicknesses compared to baseline values, were significant 3 months and 6 months after treatment in both groups (P < 0.05, paired t-test), but only the IVTA group showed significant improvements 1 month after treatment. The between-group differences in average ETDRS score, total macular volume, and foveal thickness changes were significantly better at 1 month after treatment in the ITVA group (P = 0.026, P < 0.001, P = 0.001, respectively, Student's t-test), at which time IVTA patients had better vision and anatomical outcomes than did those in the sheathotomy group. CONCLUSIONS: After either AV sheathotomy or IVTA treatment, patients with macular edema secondary to BRVO showed similar functional and anatomical outcomes 6 months later. When the cost and the risks of vitreoretinal surgery are considered, IVTA treatment may be a better treatment option, as the drug yields better short-term outcomes.     

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.