Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Background: To compare the outcome of bevacizumab or triamcinolone acetate (TA) treatment in patients with macular edema (ME) after branch retinal vein occlusion (BRVO). Methods: In a retrospective assessment, 10 bevacizumab-treated patients and 10 TA-treated with ME after BRVO were pair-matched according to initial best-corrected visual acuity (BCVA) and central macular thickness (CMT) as measured by Stratus optical coherence tomography (OCT). BCVA and CMT were the main endpoints. Results: The initial BCVA was 0.2 ± 0.13 in bevacizumab-treated patients and 0.2 ± 0.16 in TA-treated patients, with a CMT of 497 ± 102 µm and 517 ± 88 µm, respectively. Following bevacizumab, the mean final BCVA increased by 2.8 ± 4 lines, and by 0.6 ± 3.5 lines in patients receiving TA. The mean final CMT was 238 ± 118 µm and 195 ± 243 µm in the respective treatment groups. Conclusions: Both treatments decreased the CMT, but only bevacizumab induced an improvement in BCVA from baseline, which was significant 8 weeks after treatment, but no longer significant after 13 months.

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Comparison of Bevacizumab and Triamcinolone for Treatment of Macular Edema Secondary to Branch Retinal Vein Occlusion in a Pair-Matched Analysis

Guthoff

Meigen²,

Hennemann³

et al. 2010

“…The combination of IVTA with grid laser photocoagulation has been proposed, obtaining positive outcomes [77,78,79]. On the other hand, the combined treatment with IVTA and intravitreal bevacizumab has been tested [80,81].…”

Section: Treatmentmentioning

confidence: 99%

Retinal Vein Occlusion: Current Treatment

Lattanzio¹,

Gimeno

Parodi³

et al. 2010

Retinal vein occlusion (RVO) is a pathology noted for more than 150 years. Although a lot has been written on the matter, it is still a frequent condition with multifactorial etiopathogenesis with many unclear aspects. The RVO pathogenesis has varied systemic and local implications that make it difficult to elaborate treatment guidelines. The management of the patient with RVO is very complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. Laser therapy remains the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Multicenter studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are the future weapons to stop disease progression and get a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow a better patient management.

“…Recently, there have been two reports [252,253] from different departments showing an encouraging effect of IVTA combined with laser photocoagulation in eyes with macular edema after BRVO. In the report by Riese et al [252], at 6 months after treatment, a gain of 1 or more logarithmic lines was achieved in 16/24 eyes (67%) and a gain of 3 lines or more was achieved in 8/24 eyes (33%), and the median central foveal thickness decreased from 423 µm at baseline to 266 µm (p = 0.001).…”

Section: Clinical Studies: Ta As Drug Treatment For Macular Edemamentioning

confidence: 99%

Intravitreal Triamcinolone

Tao

Jonas

2010

Background: To provide an update on the intravitreal use of triamcinolone acetonide. Methods: Review of literature regarding triamcinolone-related research. Results: After the introduction of bevacizumab and ranibizumab into clinical practice, intravitreal triamcinolone has lost its leading position as the drug most often injected intravitreally. Due to its properties as a long-acting steroid, triamcinolone has still been used for various conditions such as diffuse diabetic macular edema, retinal vein occlusions, pseudophakic cystoid macular edema, chronic prephthisical ocular hypotony and uveitis, and in combination with bevacizumab or ranibizumab. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataract and postoperative infectious or noninfectious endophthalmitis. Conclusions: Due to its widespread biological effects as a steroid and due to a relatively large therapeutic window, intravitreal triamcinolone has remained in clinical use for a variety of intraocular disorders, and it may be a promising candidate for intravitreal medical combination therapies.