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

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

Intravitreal triamcinolone acetonide injection in CRVO associated with Wegener's granulomatosis.

A 33-year-old man developed unilateral non-ischemic central retinal vein occlusion associated with systemic Wegener's granulomatosis. Four milligrams of triamcinolone acetonide was injected intravitreally twice 6 months apart in conjunction with ongoing systemic immunosuppressive therapy. No change was made in the systemic immunosuppressive regimen. Wegener's granulomatosis should be considered in the differential diagnosis of central retinal vein occlusion in the young age group and intravitreal triamcinolone acetonide is a good adjunct to systemic immunosuppressive therapy that eliminates the need for modifying the systemic treatment regimen.     

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

Purpose To evaluate by multifocal electroretinography (MFERG) and optical coherence tomography (OCT) the effectiveness of intravitreal use of bevacizumab (Avastin) in the treatment of macular edema due to central retinal vein occlusion (CRVO). Methods A total of 10 eyes of 10 patients (six males and four females) with macular edema due to CRVO were studied before and after intravitreal use of bevacizumab with MFERG and OCT. The post treatment follow-up was 3 months. Examination included measurement of best-corrected visual acuity (BCVA) for distance, measurement of intraocular pressure (IOP), fluorescein angiography, foveal-retinal thickness measurement by OCT, and MFERG recordings before treatment and 1 and 3 months after treatment. Results Before treatment, OCT shows an increase of the retinal thickness of the fovea. About 1 and 3 months after treatment the foveal thickness decreased to a significant level. The electrical responses in the fovea and parafovea of the MFERG recording depicted a significant improvement at 1 and 3 months after the injection. No patient manifested IOP increase. Conclusion The intravitreal use of bevacizumab may provide anatomical and functional amelioration of the macula in patients with macular edema due to CRVO. However, further study is needed in order to assess the treatment’s long-term efficacy.     

Intravitreal bevacizumab versus bevacizumab and 1 mg triamcinolone acetonide in eyes with bilateral diabetic macular edema

AIM: To Compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema. METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab (IVB group) was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide (IVTA-IVB group) was performed. Main outcomes were the central macular thickness (CMT) measured with optical coherence tomography (OCT), ETDRS visual acuity (VA) and intraocular pressure (IOP). RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 μm and 546.8±165.6 μm before injections; 430.4±133.2 μm and 363.7±105.3 μm at first month; 484.8±167.4 μm and 407.3±108.7 μm at 3rd month; 550.4±191.5 μm and 516.8±158 μm after 6mo respectively. Differences were significant at first and 3rd month (P?0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 at first month; 59±13.7 and 59.3±13.6 at 3rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant at first and 3rd and 6mo (P?0.05). There was no IOP difference. IVTA-IVB group gains best VA at 3rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo. CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.     

贝伐单抗单用与联合曲安奈德治疗糖尿病性黄斑水肿的疗效比较

目的：比较单用贝伐单抗与贝伐单抗联合曲安奈德治疗糖尿病黄斑水肿疗效。

方法：回顾性比较随机研究。对21例42眼黄斑水肿的糖尿病患者进行了评估。单眼内注射1.25 mg贝伐单抗(IVB 组),在同组的眼玻璃体内注射1.25 mg贝伐单抗和1 mg曲安奈德(IVTA-IVB 组)。使用光学相干断层扫描(OCT)、ETDRS视力和眼压测量黄斑中心厚度(CMT)。

结果：平均随访时间为4.7±1.5mo。在IVB组和IVTA-IVB组中,注射前平均CMT分别为494.7±114.4 μm,546.8±165.6 μm; 第一个月分别为430.4±133.2 μm,363.7±105.3 μm; 第三个月分别为484.8±167.4 μm,407.3±108.7 μm; 六个月后分别为550.4±191.5 μm,516.8±158 μm。第一个月和第三个月存在显著差异(P<0.05)。在IVB组和IVTA-IVB组中,注射前平均ETDRS视力数分别为57.1±13.5,48.9±13.9; 第一个月分别为2.2±14,58.8±12.1; 第三个月分别为59±13.7,59.3±13.6; 第六个月分别为55.6±14.9,55.5±8.7。第三个月和第六个月存在显著差异(P<0.05)。IOP无差异。第一次注射后IVTA-IVB组在第三个月时视力最佳并持续6个月,而IVB组在第一个月时视力最佳但仅持续了3个月。

结论：6个月后发现,IVTA-IVB组较IVB组疗效显著,且无激素依赖性并发症。     

玻璃体内注射贝伐单抗和贝伐单抗/曲安奈德联合用药治疗糖尿病性黄斑水肿疗效及安全性差异的荟萃分析

目的综合评价玻璃体内注射贝伐单抗(IVB)和贝伐单抗/曲安奈德联合用药(IVB/IVT)两种方案治疗糖尿病性黄斑水肿的疗效与安全性的差异。方法检索Medline(1966～2011年)、EMbase(1966～2010年)、Cochrane图书馆(2010年)及中国生物医学文献数据库CBM(1979～2010年)有关贝伐单抗和贝伐单抗/曲安奈德联合用药对比治疗糖尿病性黄斑水肿的临床对照研究文献资料。采用Cochrane系统评价的方法 ,按照纳入和排除标准限定,通过Jadad评分量表进行文献质量评估后,使用RevMan5.1统计软件进行Meta分析,以获得二者治疗糖尿病性黄斑水肿的疗效及安全性是否有差异的相关证据。结果本研究纳入IVB和IVB/IVT对比治疗糖尿病性黄斑水肿的临床对照研究共4篇(321眼)。Meta分析结果显示,IVB组与IVB/IVT组患者的中央黄斑厚度降低幅度的差异为-28.72μm(95%CI,-90.68～33.25μm),差异无统计学意义(P=0.36);最佳矫正视力(以LogMAR视力计算)提高幅度的差异为-0.03(95%CI,-0.14～0.09),差异也无统计学意义(P=0.65)。IVB/IVT治疗组发生不良反应的比例是单纯IVB治疗组的2.44倍(95%CI,1.28～4.55倍),差异有显著统计学意义(P=0.006)。结论两种方案治疗糖尿病性黄斑水肿时,在降低中央黄斑厚度和提高最佳矫正视力方面疗效相仿;而单纯IVB治疗的安全性优于IVB/IVT联合治疗,但尚需更多前瞻性大样本的临床随机对照试验数据支持。     

Periarteritis nodosa and thrombotic thrombocytopenic purpura with serous retinal detachment in siblings.

Periarteritis nodosa and thrombotic thrombocytopenic purpura in siblings is reported. In both patients a localised serous retinal detachment and lesions of the retinal pigment epithelium had developed owing to choroidal vascular obstruction. These cases support the suggested possible relationship between the two conditions.     

Ocular involvement in thrombotic thrombocytopenic purpura: the angiographic and histopathological features

We report two cases of thrombotic thrombocytopenic purpura (TTP). The first case illustrates the clinical findings and fluorescein angiographic features of this disease, notably the serous macular detachments and focal areas of choriocapillaris occlusion. The second case demonstrates a more severe case of TTP, with neurologic complications that led to death; histopathological examination of the eyes showed serous retinal detachments and choriocapillaris occlusion, with electron microscopic evidence of intravascular fibrin-platelet thrombi.     

Bromfenac alone or with single intravitreal injection of bevacizumab or triamcinolone acetonide for treatment of uveitic macular edema

Purpose

To evaluate the efficacy of bromfenac drops alone or with a single intravitreal injection of bevacizumab (IVB) or triamcinolone acetonide (IVTA) in the treatment of uveitic macular edema (UME).

Design

Comparative case series.

Study Participant

Sixty-seven eyes (of 55 patients) with UME that received either bromfenac drops alone (n?=?34), IVB plus bromfenac (n?=?21) or IVTA plus bromfenac (n?=?12).

Methods

Chart review of patients at the Massachusetts Eye Research and Surgery Institution (MERSI) was done. Eyes that received either bromfenac drops alone (Br), IVB plus bromfenac (IVB/Br) or IVTA plus bromfenac (IVTA/Br), with follow-up of up to 3 months, were included.

Main Outcome Measure

Visual acuity.

Results

There was no statistically significant effect seen in VA or CMT in the Br group, with 17 of 34 eyes (50 %) needing re-injection before 3 months of follow-up. Mean change in CMT at 4 weeks for the Br group was 5.06 µm. Compared to baseline, both the IVTA/Br and IVB/Br groups showed significant decrease in CMT and improvement in VA at 1 and 3 months follow-up. There was also a continuous decrease in CMT up to 3 months of follow-up with the IVTA/Br group, which was found to be significant in comparison with the IVB/Br group; this trend was not seen in the IVB/Br group at 3 months. The greatest mean change in CMT at 1 month was seen in the IVTA/Br group (154.33 ±178.22 µm), and this was statistically significant in comparison with the other groups (p?=?<0.0001). However, in terms of mean change in VA, there was no change in the Br group (0.01?±?0.11 VA logMAR), and only 0.12?±?0.19 and 0.15?±?0.20 in the IVB/Br and IVTA/Br groups, respectively.

Conclusion

IVB and IVTA are both effective in improving VA and decreasing CMT up to 3 months. Bromfenac is ineffective alone for UME treatment, but may have a synergistic effect with IVTA in reducing CMT up to 3 months of follow-up.     

Photodynamic therapy combined with intravitreal bevacizumab and sub-tenon triamcinolone acetonide injections for age-related macular degeneration

Purpose

To report the results of triple therapy with photodynamic therapy (PDT) (PDT combined with intravitreal injection of bevacizumab (IVB) and sub-tenon injection of triamcinolone acetonide (STTA)) for the treatment of age-related macular degeneration (AMD) in Japanese patients.

Methods

This retrospective case series included 38 eyes of 38 patients with exudative AMD treated with PDT combined with IVB (1.25 mg) and STTA (40 mg). Retreatment was performed in the same manner with intervals of at least 3 months. All patients had been treatment naïve, with a follow-up period of 12 months. Best-corrected visual acuity (BCVA), macular retinal thickness (MRT) on optical coherence tomography, and the number of treatments were analyzed.

Results

The mean logarithm of the minimum angle of resolution BCVA in patients treated with PDT triple therapy was 0.86 ± 0.55 at baseline and 0.62 ± 0.55 at 12 months (p < 0.001). The mean MRT was 554.0 ± 202.6 μm at baseline and 205.1 ± 78.6 μm at 12 months (p < 0.001). During the 1-year follow-up, the average number of PDT triple therapy (treatments per patient) was 1.1. No complications, for example increase in intraocular pressure, cataract, or endophthalmitis, were observed.

Conclusions

In AMD patients, PDT triple therapy significantly improved visual acuity with a minimum number of treatments and a low risk of complications during the 1-year follow-up.

     

Bevacizumab联合玻璃体切割及曲安奈德治疗增殖性糖尿病视网膜病变的观察

目的 通过观察Bevacizumab联合玻璃体切除、曲安奈德治疗增殖性糖尿病视网膜病变(PDR)的视功能恢复及并发症发生情况,回顾性对比分析三联疗法治疗PDR的临床效果和优势.方法 PDR患者共98例(98只眼),实验组PDR52例(52只眼),对照组PDR46例(46只眼),全身检查无手术禁忌证,两组均采用标准三通道玻璃体切除术、剥膜、眼内光凝.实验组均在患者知情情况下术前玻璃体腔注射贝伐单抗Avastin l.25 mg,第7天行玻璃体切除术,术毕关闭穿刺口前注入曲安奈德2 mg.对照组仅在术毕关闭穿刺口前玻璃体腔注入曲安奈德2 mg.对比观察两组手术操作时间,术后眼压(IOP),黄斑区厚度及最佳矫正视力.结果 在行玻璃体切除、剥膜过程中,实验组剥膜较容易,出血明显减少,对照组剥膜相对较困难,耗时,两组手术时间相比差异有统计学意义(t=28.50,P=0.000).术后l周、1、3、6个月两组眼压比较差异无统计学意(t=0.664,0.852,0.742,0.110,P=0.515,0.406,0.468,0.914).术后2周两组相比黄斑区厚度差异有统计学意义(t=5.665,P=0.000).术后1、3、6月各时间点黄斑区厚度实验组与对照组相比差异无统计学意义(t=0.590,0.984,1.292,P＝0.563,0.388,0.213).术后末次随访视力与术前相比均有不同程度的提高,实验组≤0.02 12例,≤0.05 11例,≤0.3 16例,＞0.3 13例;对照组≤0.02 11例;≤0.05 12例,≤0.3 14例,＞0.3 9例.结论 术前玻璃体腔注射Bevacizumab有助于易化手术操作,容易薄膜,减少术中出血,联合曲安奈德玻璃体腔注射有效减轻术后玻璃体腔及前房反应,减轻黄斑水肿,有利于视功能的恢复.     

Photodynamic monotherapy or combination treatment with intravitreal triamcinolone acetonide, bevacizumab or ranibizumab for choroidal neovascularization associated with pathological myopia

This retrospective, interventional case series analyses treatment outcomes in eyes with choroidal neovascularization (CNV) secondary to pathological myopia, managed with photodynamic therapy, (PDT), (Group 1, N = 11), PDT and intravitreal triamcinolone acetonide (4 mg/0.1ml) (Group 2, N = 3), PDT and intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab 1.25 mg/0.05 ml, ranibizumab 0.5 mg/0.05 ml and reduced-fluence PDT and intravitreal ranibizumab 0.5 mg/0.05 ml (Group 3, N=12). All the patients underwent PDT. Intravitreal injections were repeated as required. SPSS 14 software was used to evaluate the data. Wilcoxon signed ranks test was used to evaluate pre- and post-treatment vision. The Kruskal-Wallis test was used for comparison between the groups. All the groups were statistically comparable. All the eyes showed complete regression of CNV, with a minimum follow-up of six months. All groups had visual improvement; significantly in Group 3 ( p = 0.003). Combination PDT with anti-VEGF agents appeared to be efficacious in eyes with myopic CNV. However, a larger study with a longer follow-up is required to validate these results.     

Comparison of intravitreal bevacizumab with intravitreal triamcinolone acetonide for treatment of cystoid macular edema secondary to retinal vein occlusion: a Meta-analysis

AIM: To compare the effects of intravitreal injection of bevacizumab (IVB) with intravitreal triamcinolone acetonide (IVTA) on the treatment of cystoid macular edema (CME) secondary to retinal vein occlusion (RVO). METHODS: A literature search was conducted using PubMed, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. The comparison was divided into two groups, group 1 conducted comparison in branch RVO (BRVO) or central RVO (CRVO), group 2 conducted comparison in ischemic-RVO or nonischemic-RVO. Pooled mean differences (MDs) for changes in visual acuity (VA), central macular thickness (CMT) and intraocular pressure (IOP) were calculated in groups at 4, 12 and 24wk after treatment respectively. RESULTS: Eight studies comparing the efficacy of IVB with IVTA were included in the Meta-analysis. In group 1, in BRVO, significant difference was shown on the comparison of CMT at 24wk (MD, -45.66; 95% CI, -76.03 to -15.28; P=0.003), IVB was effective on BRVO for at least 24wk; no significant differences were found in the comparison of VA at each time points (P>0.05 respectively). In CRVO, no significant differences were found in the comparison of VA or CMT between IVB and IVTA at each time points (P>0.05, respectively). In group 2, in ischemic-RVO, significant differences were shown in the comparison of VA (MD, -0.28; 95% CI, -0.42 to -0.14; P<0.0001) and CMT (MD, -86.50; 95% CI, -151.18 to -22.43; P=0.008) at 24wk; In nonischemic-RVO, no significant differences were demonstrated in the comparison of VA or CMT between IVB and IVTA at each time points (P>0.05, respectively). The occurrence of high IOP was much lower in IVB group. CONCLUSION: This Meta-analysis suggested that IVB was effective in decreasing CMT in BRVO for at least 24wk, IVB is more effective on improving VA and reducing CMT in ischemic-RVO. IVB is more promising on RVO than IVTA.