A prospective randomised trial of different doses of intravitreal triamcinolone for diabetic macular oedema

OBJECTIVE: To compare the safety and efficacy of different doses of intravitreal triamcinolone (ivTA) in treating clinically significant diabetic macular oedema (CSMO). METHODS: 63 eyes of 63 patients with CSMO and central foveal thickness (CFT) of > or =250 microm on optical coherence tomography were randomised to receive 4 mg (n = 23), 6 mg (n = 20) or 8 mg (n = 20) ivTA. Patients were followed up for 6 months, and changes in best-corrected visual acuity (BCVA), optical coherence tomography CFT, standardised change in macular thickness (SCMT), and side effects such as intraocular pressure and cataractogenesis were compared between the three groups. RESULTS: After ivTA injection, improvements of BCVA and CFT occurred in all groups. The mean BCVA improvement at 6 months was significantly higher for the 8 mg group compared with the 4 mg group, with 9.9 and 3.1 improvement in letters on the Early Treatment of Diabetic Retinopathy Study chart, respectively (p = 0.047). The mean SCMT at 6 months for the 4, 6 and 8 mg groups was 28.7%, 42.3% and 60.5%, respectively (p = 0.06). The proportion of eyes with SCMT > or =75% at 6 months was higher in the 8 mg group, but the difference failed to reach significance (p = 0.06). Ocular hypertensive responses (>21 mm Hg) occurred in 39%, 30% and 55% of eyes in the 4, 6, and 8 mg groups, respectively (p = 0.27). CONCLUSIONS: Higher doses of ivTA may prolong the duration of visual benefit in diabetic CSMO and seemed to result in more sustained reduction in macular oedema. Further studies are warranted to investigate the optimum dose of ivTA in treating diabetic CSMO.     

Decreasing efficacy of repeated intravitreal triamcinolone injections in diabetic macular oedema

BACKGROUND/AIM: Intravitreal triamcinolone (IVTA) results in transient improvements in diabetic macular oedema (DMO), necessitating repeated injections. The authors report a case series of 10 eyes of 10 patients with DMO, who received a repeat injection of 4 mg IVTA, at least 26 weeks after the first injection of the same dose. METHOD: Pre-injection and at 2, 4, 9, and 17 weeks post-injection, best corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography, after the first and repeat injections, were compared using paired t test. Side effects were monitored. RESULTS: BCVA, CFT, intraocular pressure (IOP), and cataract scores were not significantly different before initial and repeat injections (given at 32.5 (SD 3.5) weeks after the first injection). Transient improvements of BCVA and CFT were achieved after both injections. However, after the repeat injection, the BCVA was significantly worse at all time points (p<0.05) and so were the best achieved CFT and the CFT at 4 weeks post-injection (p = 0.034 and 0.011 respectively), compared with the initial injection. Post-injection maximum IOPs and increase in cataract scores were not significantly different between the two injections. CONCLUSION: A repeat injection of 4 mg of IVTA may not be as effective as an initial injection for the treatment of DMO.     

Effect of a single intravitreal bevacizumab injection on different optical coherence tomographic patterns of diabetic macular oedema

Purpose

The aim of this study is to compare the therapeutic effect of a single intravitreal bevacizumab (IVB) injection in eyes with diabetic macular oedema (DMO) of different patterns determined by optical coherence tomography (OCT).

Methods

Medical records of patients who had a single IVB injection for DMO were analysed retrospectively. Eyes with a clinically significant DMO and a central foveal thickness (CFT) of 250 μm or more determined by OCT were included in the analysis. Best-corrected visual acuity (BCVA), CFT and total macular volume values before and after the injection were recorded. Eyes were divided into sponge-like diffuse retinal thickening (DRT), cystoid macular oedema (CMO) and serous retinal detachment (SRD) groups according to the morphology on OCT.

Results

A total of 92 eyes (42 with DRT, 31 with CMO and 19 with SRD) were included in the study. There was no statistically significant variation between three groups regarding the change in BCVA (P=0.695). CMO and SRD groups had greater reductions in their mean CFT, and the amount of reduction showed statistically significant variation between three groups (P=0.048). However, no statistically significant difference was found between groups in terms of percentage of change in CFT (P=0.278).

Conclusion

CMO and SRD subtypes are associated with a greater reduction in the CFT than the DRT subtype. Although the change in BCVA was not significantly different between groups, the DRT group showed markedly better visual improvement in proportion to the decrease in CFT.     

Phacoemulsification with intravitreal triamcinolone in patients with cataract and coexisting diabetic macular oedema: a 6-month prospective pilot study

AIMS: To assess the safety and efficacy of phacoemulsification with intravitreal triamcinolone (ivTA) injection in diabetics with cataract and clinically significant macular oedema (CSMO). METHODS: A total of 19 eyes of 15 consecutive diabetic patients with cataract and CSMO were prospectively recruited. Patients underwent phacoemulsification and intraocular lens implantation with 4 mg ivTA injection at completion of surgery. Patients were followed up on day 1, then weekly for 1 month, and thereafter monthly until 6 months postoperatively. Best corrected visual acuity (BCVA), central macular thickness (CMT) measured by optical coherence tomography, and adverse events were recorded. RESULTS: In total, 17 eyes completed 6 months of follow-up. In all, 58.8% showed improvement in BCVA of >or=2 lines, with statistically significant improvement in mean Snellen BCVA of 2.4 lines at 6 months. The peak BCVA was achieved at 4 months. The mean CMT decreased from a baseline of 449 microm to a minimum of 321+/-148 microm (28.5% reduction) achieved at 2 months, with statistically significant reduction at all postoperative time intervals until 6 months. Of 17 eyes, 4 (23.5%) developed transiently elevated intraocular pressure that normalised by 6 months in all but one patient. No injection- or surgery-related complications were encountered. CONCLUSIONS: Phacoemulsification with concurrent 4 mg ivTA injection appears to be a safe option for managing diabetics with cataract and CSMO. However, large-scaled randomised controlled trials are necessary for delineating the relative contributions of cataract removal and CMT reduction to visual improvement. Moreover, the transient effect on CMT may warrant further studies to determine optimal timing and dosage of further ivTA injections.     

Comparing intravitreal triamcinolone acetonide and bevacizumab injections for the treatment of diabetic macular oedema: a randomized double‐blind study

Purpose: To compare the effect of a single intravitreal injection of triamcinolone acetonide and bevacizumab in reducing macular thickness, which was measured by optical coherence tomography (OCT) in patients with diabetic macular oedema (DMO). Methods: The patients received a single intravitreal injection of 1.25 mg bevacizumab in one randomly selected eye and 4.0 mg triamcinolone acetonide in the contralateral eye. Central foveal thickness measurement (CFT) with OCT was taken at the initial visit and at the 4‐week, 12‐week and 24‐week visits. Results: Eleven patients (22 eyes) were enrolled and statistically analysed. CFT reduced in the eyes treated with triamcinolone and those treated with bevacizumab in weeks 4 and 12 (p < 0.05). At the 24‐week follow‐up, no significant difference was noted, relative to the initial visit. Comparing the two groups treated with different drugs, a statistically significant difference in CFT in weeks 4 and 12 was noted, with a more significant reduction in triamcinolone‐treated eyes (p < 0.05). Regarding visual acuity (VA), patients treated with triamcinolone had improvement in VA at 4‐week (p = 0.02) and 12‐week follow‐up (p = 0.01), while the group treated with bevacizumab had VA improvement at 4 ‐week follow‐up (p = 0.02). Among the eyes treated with triamcinolone, intraocular pressure (IOP) measurement of more than 21 mmHg was found in three eyes (27.3%). Conclusions: Intravitreal triamcinolone proved to be more efficient in reducing DMO, providing longer lasting visual improvement, relative to bevacizumab. Eyes treated with triamcinolone had the highest percentage increase in IOP. Further studies are needed to corroborate these findings.     

Macular function after intravitreal triamcinolone acetonide injection for diabetic macular oedema

Purpose: We aimed to evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on macular function in patients with diabetic macular oedema (DMO). Methods: Eleven eyes in 11 patients with DMO were enrolled. In each eye, at baseline and at 30 days after IVTA injection, logMAR visual acuity (VA), macular sensitivity, fixation stability and fixation location by MP‐1 microperimetry and optical coherence tomography (OCT) foveal thickness were assessed. Results: Thirty days after IVTA injection, eyes with DMO showed a significant (p < 0.001) reduction in foveal thickness and significant (p < 0.01) increases in logMAR VA and MP‐1 retinal sensitivity (p < 0.001). There was also significant (p = 0.046) improvement in fixation location and some improvement in fixation stability, although the latter was not significant (p = 0.08). Conclusions: In eyes with DMO, short‐term improvement in retinal sensitivity and fixation properties can be achieved by IVTA injection.     

Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion

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

Intravitreal triamcinolone and laser photocoagulation for retinal angiomatous proliferation

BACKGROUND: Recently, the entity of retinal angiomatous proliferation (RAP) as a subtype of exudative age-related macular degeneration was described, but no treatment options have been established as yet. The only two therapeutic modalities being discussed are surgical lysis of the feeding arteriole and draining venule, and the use of photodynamic therapy combined with intravitreal triamcinolone injection. AIM: To examine focal laser treatment of early extrafoveal intraretinal neovascularisation of RAP. METHODS: Prospective case series. We included 13 consecutive patients with an extrafoveal RAP stage I lesion. All patients underwent a complete ophthalmic examination, including fluorescein angiography and optical coherence tomography (OCT) III before treatment and at 2 weeks, 1, 2 and 4 months afterwards. In cases with marked macular oedema (>350 mum retinal thickening in OCT III, r = 12), intravitreal injection of 4 mg triamcinolone was given before focal laser treatment to reduce the oedema. RESULTS: This case series indicates anatomical improvement or stabilisation in patients with an extrafoveal RAP lesion after treatment. Initial visual acuity ranged from 0.1 to 0.6 on the Snellen chart. By calculating logarithmic values, visual acuity was seen to be improved in five cases (2 to 5 log lines), deteriorated in four cases (-2 to 5 log lines) and stabilised in four cases (-1 to +1 log line change). Exudation on fluorescein angiography was stopped in 11 cases. CONCLUSIONS: This preliminary case series suggests laser photocoagulation combined with prior intravitreal triamcinolone injection as a viable treatment option for RAP stage I. In cases with marked macular oedema, intravitreal triamcinolone injection improved visual acuity. For long-term stabilisation, additional laser treatment is mandatory. These preliminary results warrant a more detailed prospective clinical trial.     

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.     

Improved visual acuity and macular thickness 1 week after intravitreal triamcinolone for diabetic macular oedema

PURPOSE: To evaluate the clinical and volumetric improvement 1 week after an injection of intravitreal triamcinolone acetonide in eyes with diabetic macular oedema. METHODS: Seven phakic eyes of seven diabetic patients diagnosed with clinically significant macular oedema were treated with a single 4-mg intravitreal injection of triamcinolone acetonide (0.1 ml). LogMAR best corrected visual acuity (logMAR BCVA), best corrected reading ability (RA), and central macular thickness (CMT) with optical coherence tomography (OCT) were assessed prior and 1 week subsequent to treatment. RESULTS: Mean improvement in logMAR BCVA was 0.146 (P=0.03). Mean reduction in CMT was 150.9 mum (P=0.02, Wilcoxon signed-rank test). Mean improvement in RA was 3 lines. CONCLUSION: Reduction in macular oedema was demonstrated on OCT at 1 week, in most cases associated with improvement in central visual function, in particular, reading ability. Total resolution of diabetic macular oedema may occur at 1 week following intravitreal steroid injection.     

Effects of repeated injection of intravitreal triamcinolone on macular oedema in central retinal vein occlusion

Purpose: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO). Methods: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best‐corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired‐t test. Side‐effects were monitored. Results: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow‐up, BCVA and CFT were significantly different compared to pre‐injection values in the same group (P = 0.032, 0.049 in the initial‐injection group and P = 0.001, 0.008 in the repeat‐injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time‐point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post‐injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study. Conclusion: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.     

Arteriovenous sheathotomy for persistent macular edema in branch retinal vein occlusion

PURPOSE: To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. METHODS: Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. RESULTS: The mean preoperative BCVA (log MAR) were 0.79 +/- 0.29 and postoperative BCVA (log MAR) at 3 months was 0.57 +/- 0.33. And improvement of visual acuity > or = 2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22 +/- 76.83 microm (510-737 microm) and postoperative fovea thickness was 217.60 +/- 47.33 microm (164-285 microm). CONCLUSIONS: Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.     

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

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

Short-term effects of intravitreal triamcinolone on retinal vascular leakage and trunk vessel diameters in diabetic macular oedema

PURPOSE: To assess retinal vascular permeability and vessel diameter changes after intravitreal triamcinolone acetonide (IVTA) injection in eyes with persistent foveal thickening after photocoagulation for diabetic macular oedema (DMO). METHODS: We calculated the blood-retinal barrier permeability as measured by vitreous fluorophotometry, artery and venous vessel diameter at the temporal vascular arcades as measured on digital fundus photos, and retinal thickness as measured by optical coherence tomography. Seven patients with type 2 diabetes and DMO were examined immediately before and 1 week after IVTA 2 mg. The study was designed as an open-label interventional case series using the fellow eyes as untreated controls. RESULTS: One week after IVTA, we observed that, compared with baseline values, blood-retinal barrier permeability had decreased to 27.2 +/- 3.6% (p < 0.0001), retinal artery diameter had decreased to 94.9 +/- 0.02% (p = 0.05), retinal vein diameter had decreased to 89.2 +/- 0.03% (p = 0.02) and foveal thickness had decreased to 68.7 +/- 6.9% (p = 0.004). Visual acuity (VA) improved by 7.4 +/- 2.2 letters (p = 0.01). No significant change was observed in control eyes except that mean VA deteriorated by 2.6 +/- 0.9 letters (p = 0.03). Changes in permeability were closely correlated to changes in retinal thickness (R = 0.84) and venoule diameter (R = 0.93) in treated eyes. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide in eyes with DMO is followed by a marked reduction in retinal vascular leakage and a concomitant reduction in retinal vessel calibre.     

Intravitreal ranibizumab for macular oedema secondary to retinal vein occlusion: a retrospective study of 34 eyes

Purpose: To evaluate the efficacy and the safety of intravitreal ranibizumab injection (Lucentis) in eyes with macular oedema secondary to central retinal vein occlusion (CRVO) or branch retinal vein occlusion (BRVO). Methods: The files of consecutive patients (34 eyes, 15 CRVO, 19 BRVO) were retrospectively analysed. Intravitreal injections of 0.5 mg ranibizumab were administered; retreatment was based on acuity visual changes and optical coherence tomography findings. Patients received 2–4 injections (mean, 2.1). Mean follow‐up was 7 months. Results: After the first injection, mean best‐corrected visual acuity (BCVA) improved from 20/160 to 20/80 and mean central retinal thickness (CRT) decreased significantly from 549 to 301 μm (p < 0.01). For each injection, BCVA improvement was on average nine letters (p < 0.01) and macular oedema reduction was 195 μm CRT (p < 0.01). The decrease in CRT was similar in CRVO and BRVO, but the improvement in BCVA was larger in BRVO. No local or systemic adverse effect was detected. Final visual acuity was correlated to initial visual acuity and to visual acuity measured after the first injection. The change in CRT was correlated to the number of injections and to initial CRT. Conclusion: Intravitreal injections of ranibizumab appeared to be a safe and effective option in the treatment of macular oedema secondary to retinal vein occlusion. Nevertheless, because the natural course has demonstrated a possible improvement in vision in almost one quarter of affected eyes at 3 years, further controlled and prospective studies are necessary to compare this treatment to the natural course with a longer follow‐up.     

Prospective comparisons of intravitreal injections of triamcinolone acetonide and bevacizumab for macular oedema due to branch retinal vein occlusion

Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO). Design: Prospective, comparative, randomized, interventional clinical trial. Methods: Forty‐three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4‐mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25‐mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best‐corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months. Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow‐up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure–lowering medications. Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO.     

Intravitreal triamcinolone for macular oedema: efficacy in relation to aetiology

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

玻璃体腔注射曲安奈德联合激光治疗视网膜黄斑分支静脉阻塞黄斑水肿

目的:观察玻璃体腔注射曲安奈德(triamcinolone ace-tonide,TA)联合激光治疗视网膜黄斑分支静脉阻塞黄斑水肿的临床疗效。方法:将经过视力、眼压、眼底检查、眼底彩色照相、荧光素眼底血管造影(FFA)、光相干断层扫描(OCT)检查确诊的164例164眼视网膜黄斑分支静脉阻塞伴黄斑水肿患者纳入治疗。男90例90眼,女74例74眼,年龄20～80(平均59.7)岁。矫正视力0.02～0.6,logMAR视力为0.778±0.347。病程3d～2a。平均眼压15.22mmHg(1mmHg=0.133kPa)。FFA检查黄斑区晚期均有荧光素蓄积;OCT示平均黄斑中心凹视网膜厚度442.41±74.07μm。表面麻醉下给予4mgTA玻璃体腔注射,2wk后进行黄斑区光凝治疗。治疗后第1,3,6mo随访。结果:164例患者治疗后1,3,6mo的平均logMAR最佳矫正视力(BCVA)分别提高至0.49±0.34,0.44±0.34,0.43±0.33,与治疗前比较,差异均有统计学意义。治疗后6mo视力提高135眼(82.3%),其中视力提高≥2者103眼(62.8%);治疗后1,3,6moFFA检查黄斑区晚期荧光素蓄积均有减轻或消失,治疗后1,3,6mo,OCT检查平均黄斑中心凹视网膜厚度分别为253.99±63.99μm,239.84±53.74μm,234.55±51.32μm;与治疗前比较,差异均有统计学意义。治疗后6mo,黄斑水肿改善者147眼(89.6%)。玻璃体腔注药后3d之内有4眼发生假性眼内炎,观察及治疗后恢复至可行激光治疗,治疗后3mo时有11眼眼压高于正常,用药后均恢复至正常范围。结论:玻璃体腔注射TA联合激光治疗视网膜黄斑分支静脉阻塞引起的黄斑水肿疗效较好,明显提高视力,改善视功能,促使黄斑水肿消退或减轻。     

Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

PURPOSE: In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA. METHODS: Data on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as 'improved' (two or more Snellen lines gained) or 'nonimproved' (unchanged or worsened). Comparative demographic data and pre- and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software. RESULTS: Of 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity ('good', 'moderate', or 'poor') and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P=0.04) or diffuse leakage on fluorescein angiography (P=0.02), respectively, and in significantly more pseudophakic than phakic eyes (P=0.046). Conclusions: Pseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.     

Treatment of central retinal vein occlusion-related macular edema with intravitreal bevacizumab (Avastin): preliminary results

PURPOSE: To assess the safety and efficacy of treatment of macular edema secondary to central retinal vein occlusion (CRVO) with intravitreal bevacizumab. PATIENTS AND METHOD: The ongoing prospective study included 8 consecutive patients (8 eyes) with macular edema secondary to CRVO (6 non ischemic and 2 ischemic), treated with intravitreal injection of 1.25 mg (0.05 mL) of bevacizumab. Main outcome was best corrected visual acuity (BCVA) and central foveal thickness (CFT) measured by optical coherence tomography monthly during one year. Retreatment criteria include decrease of BCVA, persistence of macular edema on angiograms and increase of CFT. RESULTS: Mean age of the eight patients was 68 years (range: 50-82 years). Mean duration of symptoms before injection was 98 days (range: 3-289). Mean follow-up was 3.25 months. At baseline, mean BCVA was 0.84 logMar and mean baseline CFT was 771 microm. Mean BCVA was 0.36 and mean CFT thickness was 275 microm (n = 8) at month 1, 0.41 and 411 microm at month 2 (n = 7), 0.3 and 344 microm at month 3 (n = 6), 0.3 and 397 microm at month 4 (n = 5), respectively. In 75 % of patients, a single injection was not sufficient, and retreatment needed. No serious adverse events were observed. CONCLUSIONS: Treatment of macular edema secondary to CRVO with intravitreal bevacizumab injection of 1.25 mg was well tolerated and associated with marked macular thickness reduction and BCVA improvement in all patients. A trend towards reduction of foveal thickness and improvement of visual acuity was observed in both acute and chronic CRVO.