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.     

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 treatment of persistent macular oedema in branch retinal vein occlusion

BACKGROUND: To evaluate the efficacy of intravitreal triamcinolone acetonide injection on persistent macular oedema in branch retinal vein occlusion that fails to respond to previous laser photocoagulation. MATERIAL AND METHODS: A total of 19 eyes of 19 patients with persistent macular oedema due to branch retinal vein occlusion were treated with 8 mg/0.2 ml of intravitreal triamcinolone acetonide injection. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular oedema map values of Heidelberg Retinal Tomograph II (HRT II) before and after intravitreal triamcinolone injection. RESULTS: The mean follow-up time was 6.2+/-1.0 months. The mean baseline best-corrected logarithm of minimal angle of resolution (LogMAR) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.01+/-0.16. After treatment, it was 0.55+/-0.22 at the 1-month, 0.56+/-0.22 at 3-month, and 0.62+/-0.22 at the last visits and the differences were statistically significant when compared with baseline values (for each, P<0.001). The mean oedema map values on HRT II significantly decreased by 28.5% at 1-month, 23.8% at 3-month, and 23.8% at the last visit when compared with preinjection values (for each, P<0.001). Intraocular pressure elevation exceeding 21 mmHg was observed in 26.3% of eyes at 1-month, 15.7% at 3-month, and 5.2% at the last visit, but was controlled with topical anti-glaucomatous medications in all eyes. CONCLUSION: Intravitreal triamcinolone acetonide application is a promising approach in the treatment of persistent macular oedema due to branch retinal vein occlusion non-respondent to laser photocoagulation.     

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.     

Relation between reduction of foveal thickness and visual acuity in diabetic macular edema treated with intravitreal triamcinolone

PURPOSE: To evaluate the correlation between improvement in visual acuity and the reduction of foveal thickness after a single intravitreal injection of 4 mg of triamcinolone in diabetic macular edema. DESIGN: Prospective, interventional, nonrandomized clinical trial. METHOD: Patients: In a prospective study 24 eyes with diabetic macular edema were treated with an intravitreal injection of 4 mg of triamcinolone acetonide. Main Outcome Measures: Best-corrected logMAR visual acuity and optical coherence tomography were performed at baseline and 3 months after the treatment. RESULTS: At baseline the average foveal thickness was 462 +/- 154 microm (95% confidence interval, 397-527 microm) and at 3 months 257 +/-114 microm (95% confidence interval, 209-305 microm) (P < .0001). The best-corrected logMAR average visual acuity was 60.5 +/- 10.5 (95% confidence interval, 56.0-65.0) ETDRS letters at baseline compared with 65.5 +/- 11.1 (95% confidence interval, 60.8-70.1) 3 months after the injection (P = .0001). There was no correlation between the improvement in visual acuity and the reduction of foveal thickness (r = 0.054, P = .8), but there was a correlation between reduction in foveal thickness and the age of the patients (r = 0.53, P = .008). CONCLUSION: A single injection of 4 mg of intravitreal triamcinolone acetonide effectively reduces the foveal thickness in diabetic macular edema and improves visual acuity, but there does not appear to be a strong correlation between the reduction of foveal thickness and the improvement in visual acuity.     

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.     

玻切内界膜撕除联合玻璃体腔内注射曲安奈德治疗顽固性黄斑水肿疗效观察

目的 评价玻切(玻璃体切割)内界膜撕除联合玻璃体腔内注射曲安奈德治疗顽固性黄斑水肿的疗效.方法 取18例(22只眼)继发于糖尿病视网膜病变的顽固性黄斑水肿患者行玻切、内界膜撕除联合玻璃体腔内曲安奈德注射治疗,术后随访9～12月,比较患者术前、术后视力改善及黄斑水肿消退情况.结果 术后患眼视力和黄斑水肿均明显改善,经治疗的22只眼中15只眼(68.19%)视力提高2行或2行以上,7只眼(31.81%)视力不变;术后9个月时,最佳矫正视力从术前的0.07±0.05增加到0.14±0.06(t=5.26,P=0.000).OCT结果显示:黄斑水肿明显消退者有20只眼,占90.91%,2只眼水肿消退不明显,占9.09%.黄斑中心凹厚度从术前的(554.18±140.14)μm降至(291.45±95.38)μm(t=7.23,P =0.000).其中有6只患眼的黄斑中心凹厚度恢复至正常水平.结论 玻切、内界膜撕除联合玻璃体腔内注射曲安奈德治疗顽固性黄斑水肿安全、有效.

Abstract：

Objective To evaluate the effect of pars plana vitrectomy with removal of the internal limiting membrane addition to intravitreal triamcinolone acetonide injection in eyes with refractory macular edema secondary to diabetic retinopathy.Methods Eighteen patients (22 eyes) with refractory macular edema which was secondary to diabetic retinopathy underwent pars plana vitrectomy with removal of the internal limiting membrane addition to intravitreal triamcinolone acetonide injection, Followed-up for 9-12 months.Preoperative and postoperative changes in macular edema and visual acuity were compared.Results The visual acuity and macular edema were significantly improved after treatment.Visual acuity improved by two or more lines in 15 eyes (68.19%) and remained stable in 7 eyes (31.81%).The mean preoperative visual acuity was 0.07± 0.05.The visual acuity improved to 0.14± 0.06 (t=5.26, P =0.000).OCT showed that macular edema had weakened significantly in 20 eyes (90.91%), remained stable in 2 eyes (9.09%).Central macular thickness was 554.18+/-140.14μ m at baseline and 291.45+/-95.38μ m at 12-month follow-up, showed that macular edema decreased obviously (t =7.23, P =0.000).Addition to that, central macular thickness in 6 eyes returned to normal levels.Conclusions Pars plana vitrectomy with removal of the internal limiting membrane addition to intravitreal triamcinolone acetonide injection for refractory macular edema is safe and effective.     

Alterations in central retinal sensitivity after intravitreal triamcinolone injection for diffuse diabetic macular edema

PURPOSE: To evaluate alterations in central retinal sensitivity following intravitreal triamcinolone injection in patients with diffuse diabetic macular edema that persisted after laser treatment. METHODS: Fourteen eyes of 14 patients that received 4 mg 0.1 cc intravitreal triamcinolone underwent macular threshold test using computerized visual field analyzer before and after 1, 2, 3, and 5 months of triamcinolone injection. Pre- and postinjection values of total defect depth, total threshold, and best-corrected visual acuity were compared and correlated. RESULTS: At the last follow-up, compared to baseline, visual acuity improved from 1.4+/-0.4 (logMAR, mean +/- standard deviation) to 1.0+/0.4 (p=0.01). Total defect depth tended to recover from 148+/-64 dB to 121+/-48 dB (p=0.12), and total threshold tended to increase from 241+/-87 dB to 271+/-68 dB (p=0.16), but these values did not reach significance. There was a significant correlation between baseline and 5 months postinjection values of total defect depth (rho=0.60, p=0.02), and of total threshold of light sensitivity (rho=0.55, p=0.04). CONCLUSIONS: Best-corrected visual acuity was found improved in patients with diabetic macular edema 5 months after triamcinolone injection. Improvement in central retinal sensitivity did not reach significant level at the last follow-up. Macular threshold test may be a valuable tool in the follow- up of patients with diffuse diabetic macular edema after intravitreal triamcinolone injection.     

Intravitreal triamcinolone acetonide: valuation of retinal thickness changes measured by optical coherence tomography in diffuse diabetic macular edema

PURPOSE: The authors studied the efficacy of intravitreal triamcinolone acetonide in a case series of patients with diffuse diabetic macular edema without evidence of vitreous-macular traction refractory to laser photocoagulation. METHODS: Six eyes with clinically diffuse diabetic macular edema that failed to respond to at least two previous sessions of laser photocoagulation were included. The mean age of selected patients was 72.5+/-13.8 years, with a preoperative best-corrected visual acuity reduced to 1.48+/-0.18 logMar and a mean baseline intraocular pressure (IOP) of 15.17+/-2.64 mmHg. The authors also studied macular thickness measured by optical coherence tomography (OCT 2000 scanner, Humphrey Instruments, San Leandro, CA) - in the preoperative period it was 640.8+/-171.1 microm - and the fluorangiographic (Heidelberg Retina Angiograph, Heidelberg Engineering GmbH, Heidelberg, Germany) patterns, which showed pooling in tardy phases and leakage. Mean follow-up was 4 months. RESULTS: In each patient the authors observed a significant improvement, both functionally and anatomically. Mean best-corrected visual acuity increased in the postoperative period to 0.94+/-0.53 logMar. No patient showed decline of visual acuity at the end of follow-up. Base line macular thickness was reduced in the postoperative period to 312.2+/-157.65 microm measured by OCT and fluorangiographic patterns showed a reduction of pooling and of leakage. The most common complications described in the literature were not observed and the increase of mean IOP in the postoperative period to 18.76+/-5.72 mmHg was not significant. CONCLUSIONS: Intravitreal triamcinolone acetonide may decrease macular edema and improve visual acuity in eyes with diffuse diabetic macular edema.     

Follow-up after intravitreal triamcinolone acetonide for diabetic macular edema

PURPOSE: To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema. METHODS: The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 +/- 6.2 months. RESULTS: Visual acuity improved significantly (p<0.001) from 0.89 +/- 0.33 logMAR to a best minimum of 0.65 +/- 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, respectively. Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p<0.001), 2 months (p<0.001), 3 months (p<0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure >21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected. CONCLUSIONS: The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.     

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 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.     

白内障超声乳化联合玻璃体注射曲安奈德治疗白内障合并糖尿病性黄斑水肿

目的 探讨通过一次性手术在白内障超声乳化联合人丁晶状体植入术结束时行玻璃体腔注射曲安奈德(TA),治疗白内障合并糖尿病性黄斑囊样水肿的安全性和有效性.方法 对27例32只眼实施白内障超声乳化联合人工晶状体植入及玻璃体腔注射曲安奈德4mg/0.1ml,手术前和手术后1d,7d.1月,3月,6月观察患者的最佳矫正视力(BCVA),眼压,光学相干断层扫描(optic coherent tomography,OCT)测量黄斑中央凹厚度(centralfoveal thickness,CFT)的变化.结果 32只眼平均LogMarbcva与术前相比均有显著提高(P<0.05).手术后1周,1月,3月,6月CFT平均厚度与手术前相比,差别有统计学意义(P<0.05).32只眼中有6只眼(18.8%)于术后1月出现暂时性眼压升高,予局部用药后缓解.没有出现视网膜脱离和眼内炎等严重并发症.结论 在一次手术中采用白内障超声乳化联合TA治疗伴有糖尿病性黄斑水肿的白内障是安全、有效且合理的.     

Intravitreal cortisone injection for refractory diffuse diabetic macular edema

PURPOSE: The purpose of this study was to evaluate the safety and efficacy of intravitreal triamcinolone acetonide injection in patients with diffuse diabetic macular edema. We also compared the effect of intravitreal triamcinolone with macular grid laser photocoagulation in macular edema. PATIENTS AND METHODS: Thirty patients with diabetic diffuse macular edema unresponsive to grid laser photocoagulation for at least 4 months received 0.1 ml (4 mg/ml) intravitreal triamcinolone acetonide (Kenakort-A) injection as treatment. This study group was compared with a control group of 30 patients (30 eyes) who had undergone grid laser macular coagulation. Mean follow-up time was 17 months (range 14-24 months) in the study group and 19 months (range 16-24 months) in the control group. RESULTS: In the study group, mean improvement in visual acuity measured 3.8, 3.4, 0.9 and 0.2 Snellen lines at the follow-up intervals of 1, 3, 6 and 12 months, respectively. Improvement in visual acuity was statistically significant only at 1 month (p = 0.002) and 3 months (p = 0.003) after injection. Visual acuity was significantly (p < 0.05) better in the study group than the control group at 1 and 3 months. Overall, 6 of 30 eyes (20%) required a second injection and 3 eyes (10%) a third due to regression in visual acuity. Towards the end of the follow-up period, the visual acuity decreased to almost baseline levels. Elevation of intraocular pressure was found in 4 patients and controlled with topical antiglaucomatosis treatment. Sterile endophthalmitis was detected in only one eye. No eye exhibited cataract progression during the follow-up period. CONCLUSION: Intravitreal injection of triamcinolone may be beneficial for temporarily increasing visual acuity in patients with diabetic diffuse macular edema who are unresponsive even to grid laser photocoagulation. But the regression of visual acuity looks inevitable in the long term after injection. Therefore, repeated injections with/without increasing doses might be required for the stabilization of visual acuity.     

Dose Dependent Effects of Intravitreal Triamcinolone Acetonide on Diffuse Diabetic Macular Edema

Purpose

To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular edema.

Methods

In a retrospective study, 44 eyes with diffuse diabetic macular edema were treated with an intravitreal injection of 4 mg (n=12 eyes), 8 mg (n=17) or 25 mg (n=15) of triamcinolone acetonide (TA). Optical coherence tomography, best-corrected logMAR visual acuity and Goldmann tonometry were performed at baseline, 1 week, and 1, 3, 6, 9 and 12 months after treatment. Mean follow-up was 9.8 months (standard deviation=2.3) with a range of 5-12 months.

Results

The duration of intravitreal TA effects on macular thickness and visual acuity increased with increasing dosage. An observed increase in intraocular pressure induced by TA was not significantly associated with dosage.

Conclusions

In patients with diffuse diabetic macular edema who receive intravitreal TA, effects may last longer after a dosage of 25 mg, than after lower doses of 8 mg or 4 mg.     

Intravitreal triamcinolone acetonide in refractory pseudophakic cystoid macular edema: functional and anatomic results

PURPOSE: To evaluate safety and efficacy of intravitreal triamcinolone acetonide (TAAC) injections in the treatment of refractory pseudophakic cystoid macular edema (CME). METHODS: Seven eyes of six patients (age range: 50-74) with pseudophakic CME resistant to standard treatment received intravitreal injections of 4 mg of TAAC with all vehicle. Mean preinjection duration of CME was 18.3 months. A mean of 2.1+/-1.2 (range 1 to 4) treatments were performed in four eyes (57.1 %) when visual acuity deteriorated towards baseline levels. Visual acuity assessment, optical coherence tomography (OCT), and fluorescein angiography (FFA) were performed pre- and postoperatively to evaluate results of TAAC injections. Intraocular pressure (IOP) and complications related to treatment were assessed. RESULTS: After 11.1+/-3.9 months, mean best-corrected visual acuity (BCVA) increased (p =0.019) from 20/132 to a best value of 20/38. Mean macular thickness decreased from 517.29+/-146.98 mm to a best value of 263.71+/-83.13 mm (p=0.0018). Area of fluorescein leakage decreased (p<0.0001) from 11.84+/-0.93 mm2 at baseline to a minimal value of 3.86+/-0.98 mm2. The anatomic and functional improvement appeared after 1 month from the intravitreal injection and persisted through at least 3 months of follow-up. At the end of follow-up BCVA, macular thickness, and area of fluorescein leakage did not differ from baseline. Four eyes (57.1 %) developed IOP values higher than 21 mmHg, controlled by topical treatment. Two patients developed an endophthalmitis-like reaction. CONCLUSIONS: Intravitreal TAAC was relatively safe and effective in resistant cases of pseudophakic CME with a temporary beneficial effect on visual acuity and macular edema.     

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 diffuse diabetic macular oedema: 6-month results of a prospective controlled trial

PURPOSE: To evaluate prospectively the efficacy and safety of one intravitreal injection of 4 mg triamcinolone acetonide for refractory diffuse diabetic macular edema. METHODS: Seventeen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation. In all patients, one eye was injected, and the other served as a control. The intervention consisted in intravitreal injection of 4 mg triamcinolone acetonide. The main outcome measure was central macular thickness (CMT) at 4, 12 and 24 weeks, measured by Optical Coherence Tomography. Secondary outcomes were Early Treatment Diabetic Rentinopathy Study (ETDRS) scores, intraocular pressure and cataract PROGRESSION. RESULTS: Before injection, mean +/- SD CMT was 566.4 +/- 182.4 mum in injected eyes. Four, 12, and 24 weeks after injection, it was 228.4 +/- 47.5 mum, 210.9 +/- 87.2 mum and 358.5 +/- 160.5 mum respectively. CMT was significantly lower in injected eyes vs. control eyes except 24 weeks after injection because of a recurrence of macular edema in 9/17 injected eyes. Mean +/- SD gain in ETDRS score was significantly better in injected eyes vs. control eyes 4, 12 and 24 weeks after TA injection. In 9 of the 17 injected eyes, intraocular pressure exceeded 24 mmHg and was controlled by topical medication. CONCLUSION: In the short-term, intravitreal injection of triamcinolone effectively reduces macular thickening due to diffuse diabetic macular edema and improves visual acuity in most cases. The long-term effect of this treatment and predictive factors of visual recovery remain to be elucidated.     

Intravitreal triamcinolone injection for chronic diffuse diabetic macular oedema

PURPOSE: To determine the efficacy and safety of intravitreal triamcinolone in chronic diffuse diabetic macular oedema. METHODS: This prospective, interventional consecutive case series study consisted of 59 eyes (36 patients) with chronic diffuse diabetic macular oedema, which received an intravitreal injection of 4 mg triamcinolone acetonide. The results were evaluated by clinical examination and fluorescein angiography. Potential complications such as a rise in intraocular pressure, cataract progression and endophthalmitis were recorded. RESULTS: All patients completed at least 6 months follow up. The mean visual acuity improved significantly from 0.17 +/- 3.4 to a maximum of 0.30 +/- 3.3 at the third postinjection month (P < 0.01). Mean improvements in visual acuity measured were 2.15 +/- 1.66, 2.42 +/- 2.66, 1.13 +/- 2.74, 0.96 +/- 2.01 and 0.08 +/- 2.34 lines at the 1, 3, 6, 9 and 12 months follow-up intervals, respectively. In all eyes in fluorescein angiography, macular oedema was resolved (63%) or decreased (37%) during the follow up. However, the macular oedema reached the pretreatment level in 29 (49%) of the eyes at 6 months and 15 of 21 eyes (71%) at 9 months after injection. Intraocular pressure exceeded 21 mmHg in 10 eyes, which were controlled by topical medication. Four eyes showed cataract progression. Endophthalmitis was not observed in any of the eyes. CONCLUSIONS: Intravitreal injection of 4 mg triamcinolone acetonide appears to be an effective and relatively safe therapeutic method for diffuse diabetic macular oedema. Further studies are warranted to assess the long-term efficacy, safety and the need for reinjection.     

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.