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.     

Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders. METHODS: This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions. RESULTS: Mean preinjection central macular thickness was 531.84+/-132 microm in Group I, 458.4+/-149 microm in Group II, and 750.81+/-148 microm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7+/-119 microm in Group I, 218.2+/-99 microm in Group II, and 210.5 +/-56 microm in Group III) and 3 months (253.19+/-109 microm in Group I, 187+/-47 microm in Group II, and 182+/-50 microm in Group III) after injection (p < 0.05). Mean follow-up was 22+/-2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2+/-0.4 logMAR units; Group II, 1.24+/-0.5 logMAR units; Group III, 1.1+/-0.4 logMAR units; 1 month postinjection in Group I, 0.88+/-0.3 logMAR units; Group II, 0.67+/-0.3 logMAR units; Group III, 0.86+/-0.4 logMAR units; 3 months postinjection in Group I, 0.84+/-0.4 logMAR units; Group II, 0.59+/-0.3 logMAR units; Group III, 0.82+/-0.5 logMAR units) (p < 0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.     

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.     

Intravitreal triamcinolone acetonide injection as primary treatment for diabetic macular edema

PURPOSE: To evaluate the effectiveness of intravitreal triamcinolone injection on the course of diabetic macular edema. METHODS: Forty-eight eyes of 48 diabetic patients were treated with 8 mg of intravitreal triamcinolone injection as the primary therapy for diabetic macular edema. The main outcome measures included best-corrected visual acuity, fundus fluorescein angio- graphy, macular edema map values of Heidelberg Retinal Tomograph II (HRT II), and intraocular pressures before and after intravitreal injection. RESULTS: The visual acuity increased in 41 of 48 eyes (85.4%) during a mean follow-up time of 7.5 months. The mean baseline best-corrected logMAR (logarithm of minimal angle of resolution) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.17+/-0.20. After treatment, it was 0.85+/-0.29 at 1 month, 0.73+/-0.30 at 3 months, and 0.74+/-0.31 at 6 months, and the differences were significant when compared with baseline values (for each, p<0.001). The mean edema map values significantly decreased by 36% at the 6-month examinations when compared with preinjection values (p<0.001). Average intraocular pressure rose 24.3%, 29.1%, and 11.8% from baseline at the 1-, 3-, and 6-month follow-up intervals. Intraocular pressure elevation exceeding 21 mmHg was observed in 8 of 48 eyes (16.6%), but was controlled with topical antiglaucomatous medications in all eyes. CONCLUSIONS: Intravitreal triamcinolone application provides significant improvement in visual acuity of diabetic patients and clinical course of macular edema, and may therefore be a promising approach in the primary treatment of 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.     

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.     

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.     

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.     

Intravitreal injection of crystalline triamcinolone acetonide in the treatment of diffuse diabetic macular oedema

BACKGROUND: To evaluate the clinical outcome of an intravitreal injection of crystalline triamcinolone acetonide as treatment of clinically significant diffuse diabetic macular oedema. PATIENTS AND METHODS: The study included 8 patients (10 eyes) who received an intravitreal injection of 25 mg crystalline triamcinolone acetonide as treatment of clinically significant diffuse diabetic macular oedema follow-up time was 3.48 +/- 3.25 months (mean +/- SD). The study group was compared with a control group of 16 patients with diffuse diabetic macular oedema who underwent grid laser coagulation of the macular region. RESULTS: In the study group, visual acuity increased significantly (p = 0.03) from 0.11 +/- 0.09 at baseline of the study to a maximum of 0.19 +/- 0.13 during the follow-up period. Six (85.7 %) of the seven eyes with a follow-up period of more than 4 weeks gained in visual acuity. Towards the end of the follow-up period, the triamcinolone acetonide crystals completely resolved and visual acuity decreased to 0.15 +/- 0.11, which was higher, but not significantly (p = 0.14) higher than the baseline value. Visual acuity was significantly (p < 0.05) higher in the study group than in the control group for the examinations obtained up to 12 weeks after the injection. CONCLUSIONS: Intravitreal injection of 25 mg crystalline triamcinolone acetonide may be beneficial for temporarily increasing visual acuity in patients with clinically significant diffuse diabetic macular oedema.     

Intravitreal bevacizumab (Avastin) therapy for persistent diffuse diabetic macular edema

PURPOSE: To evaluate the efficacy of bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) for the treatment of diabetic macular edema. METHODS: This prospective, consecutive, noncomparative case series included 51 consecutive patients (26 females and 25 males; mean age, 64 years) with diffuse diabetic macular edema. Inclusion criteria were determined independently of the size of edema, retinal thickness, visual acuity, age, metabolic control, type of diabetes, or previous treatments beyond a 6-month period. At each visit, patients underwent complete eye examination, including determination of best-corrected visual acuity, slit-lamp examination, intraocular pressure measurement, stereoscopic biomicroscopy of the macula, retinal thickness measurement by optical coherence tomography, fluorescein angiography, and fundus photography. After written informed consent was obtained, all patients were treated with a 0.05-mL injection containing 1.25 mg of bevacizumab. RESULTS: All patients completed 6 weeks of follow-up; 23 (45%) completed 12 weeks of follow-up. Sixteen patients (70%) had received at least two intravitreal injections. All patients had undergone previous treatments, such as focal laser therapy (35%), full-scatter panretinal laser therapy (37%), vitrectomy (12%), and intravitreal injection of triamcinolone (33%). The mean diameter of the foveal avascular zone was 503 micro m, with 49% with values of >500 micro m. At baseline, mean visual acuity +/- SD was 25.88 +/- 14.43 ETDRS letters (0.86 +/- 0.38 logMAR of Snellen letters). Mean central retinal thickness by optical coherence tomography +/- SD was 501 +/- 163 micro m (range, 252-1,031 micro m). Mean visual acuity +/- SD increased to 0.75 +/- 0.37 logMAR of Snellen letters at 6 weeks after injection (P = 0.001), with some regression to 0.84 +/- 0.41 logMAR of Snellen letters after 12 weeks. Changes in ETDRS letters were not significant throughout follow-up. Mean retinal thickness +/- SD decreased to 425 +/- 180 micro m at 2 weeks (P = 0.002), 416 +/- 180 micro m at 6 weeks (P = 0.001), and 377 +/- 117 micro m at 12 weeks (P = 0.001). Changes of retinal thickness and visual acuity correlated weakly (r = -0.480 and P = 0.03 at 6 weeks; r = -0.462 and P = 0.07 at 12 weeks). The increase of visual acuity after 6 weeks as measured by ETDRS charts could be predicted best by baseline visual acuity. No other factors investigated, such as age, thickness by optical coherence tomography, or previous treatments, were predictive for the increase in visual acuity. CONCLUSION: Even in cases of diffuse diabetic macular edema not responding to previous treatments such as photocoagulation, intravitreal injection of triamcinolone, or vitrectomy, improvement of visual acuity and decrease of retinal thickness could be observed after intravitreal injection of bevacizumab. Although our follow-up period was too short to provide specific treatment recommendations, the short-term results encourage further prospective studies with different treatment groups and longer follow-up.     

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 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.     

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.     

Intravitreal triamcinolone acetonide for pseudophakic cystoid macular edema

PURPOSE: To report the clinical outcome of patients undergoing intravitreal injection of triamcinolone acetonide as treatment of long-standing cystoid macular edema after phacoemulsification. DESIGN: Prospective clinical interventional cases series studies. METHODS: The study included five patients suffering from cystoid macular edema after cataract surgery. They received an intravitreal injection of 25-mg crystalline triamcinolone acetonide transconjunctivally with topical anesthesia. RESULTS: In the follow-up period of 6.6 +/- 4.1 months, visual acuity increased from 0.26 +/- 0.13 to a mean maximal visual acuity of 0.60 +/- 0.19. For all patients, visual acuity improved during the follow-up by at least 0.20. Two (40%) patients developed intraocular pressure values higher than 21 mm Hg, which could be controlled by topical antiglaucomatous treatment. CONCLUSIONS: Intravitreal triamcinolone acetonide may be a therapeutic option for long-standing cystoid macular edema after cataract surgery.     

Intravitreal triamcinolone treatment for macular edema associated with central retinal vein occlusion and hemiretinal vein occlusion

PURPOSE: To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). METHODS: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n = 21) and HRVO (n = 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre- and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. RESULTS: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n = 23] 635 vs. 352 mum, respectively; P < 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, -3-7) over the course of the study period. Ten eyes gained > or =2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P = 0.24). None of the eyes of diabetic patients (n = 6) or patients with ischemic CRVO (n = 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P = 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P = 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n = 16] 20/133 vs. 20/67, respectively; P < 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P = 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. CONCLUSIONS: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.     

Intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema

PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.     

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.     

两种剂量曲安奈德玻璃体腔注射治疗糖尿病性黄斑水肿的疗效及安全性对比

目的观察2 mg和4 mg曲安奈德（ TA）玻璃体腔内注射治疗糖尿病性黄斑水肿的疗效及并发症的差异性。方法54例（58只眼）糖尿病性弥漫性黄斑水肿病例随机分成2组,A组29例（31只眼）玻璃体腔注射2 mg TA,B组25例（27只眼）玻璃体腔内注射4 mg TA,术后随访6个月,观察术后视力、眼压、晶状体、视网膜厚度改变及眼内炎发生情况。结果术后3个月,A组视力0．12±0．21,B组视力0．16±0．25,两组比较差异无统计学意义。术后6个月,A组视力0．14±0．16,B组视力0．15±0．23,两组比较差异无统计学意义。术后3个月视网膜厚度A组（241．32＋50．13）μm,B组（238．62±56．75）μm,两组比较差异无统计学意义。术后6个月A组（286．17＋51．31）μm,B组（245．56±61．75）μm,两组比较差异无统计学意义。 A组术后3个月6只眼眼压大于21 mmHg, B组8只眼眼压大于21 mmHg,差异无统计学意义。术后6个月A组2只眼眼压超过21 mmHg,B组5只眼眼压超过21 mmHg,两组比较差异无统计学意义。术后3个月A组晶状体混浊加重2只眼,B组8只眼,差异有统计学意义。术后6个月A组晶状体混浊加重4只眼。 B组11只眼,差异有统计学意义。两组患者术后均未见眼内炎发生。结论2 mg及4 mg曲安奈德玻璃体腔内注射治疗糖尿病性黄斑水肿,两者在提高患者视力、减轻视网膜水肿疗效无差异性,但4 mg较2 mg的剂量更容易引起白内障加重。     

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.     

Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema

PURPOSE: To report the clinical outcome of a diabetic patient with macular edema treated with an intravitreal injection of crystalline cortisone. METHODS: Interventional case report. A 73-year-old patient with diabetes mellitus presented with clinically significant diffuse macular edema caused by nonproliferative diabetic retinopathy. Despite grid laser coagulation in the macular region, cystoid macular edema progressed, and within 6 months before the cortisone injection, visual acuity declined from 0.25 to 0.16 and, finally, to 0.10. The patient received a single intravitreal injection of triamcinolone acetonide with topical anesthesia. RESULTS: After the intravitreal injection of triamcinolone acetonide, visual acuity improved from 0.10 to 0.40 during the follow-up period spanning 5 months. Intraocular pressure increased to values up to 30 mm Hg before antiglaucomatous treatment. CONCLUSION: Intravitreal injection of triamcinolone acetonide may be useful for treatment of diabetic macular edema resistant to conventional therapy.