Intravitreal steroids versus observation for macular edema secondary to central retinal vein occlusion

Abstract

Background Central retinal vein occlusion (CRVO) is a common retinal vascular abnormality associated with conditions such as hypertension, diabetes, glaucoma, and a wide variety of hematologic disorders. Macular edema (ME) represents an important vision-threatening complication of CRVO. There is no proven treatment; laser photocoagulation is not effective in treating cystoid macular edema secondary to CRVO. Intravitreal steroids, such as triamcinolone acetonide, have been utilized to treat macular edema stemming from a variety of etiologies and may represent a treatment option for CRVO-ME. Objectives The objective of this review was to explore the effectiveness and safety of intravitreal steroids in the treatment of CRVO-ME. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2008), MEDLINE (January 1950 to November 2008) and EMBASE (January 1980 to November 2008). There were no language or date restrictions in the search for trials. The electronic databases were last searched on 5 November 2008. For all included primary studies, we used The Science Citation Index and manually reviewed reference lists to identify other possible relevant trials. We contacted researchers in the field, currently working on a randomized controlled trial (RCT) on this topic (The Standard Care versus Corticosteroid for Retinal Vein Occlusion - SCORE study), for information on additional current, past, or unpublished trials. Selection criteria We considered RCTs that compared intravitreal steroids of any dosage/duration to observation in the treatment of CRVO-ME for inclusion in this review. We focused on studies that included individuals of any age or gender with unilateral or bilateral disease, with a minimum of six months follow up. Secondarily we considered non-randomized studies with the same criteria for description of evidence, however we did not conduct a separate electronic search for finding all non-randomized studies. Data collection and analysis We found no RCTs that met the inclusion criteria after independent and duplicate review of the search results. Main results We found no relevant RCTs and therefore performed no meta-analysis. Evidence from non-randomized studies is reported in this review. Authors’ conclusions There is inadequate evidence for the use of intravitreal steroids for CRVO-ME due to a paucity of RCTs and well-designed observational studies on the topic; therefore, it is still an experimental procedure.

Retinal Vein Occlusion: Current Treatment

“…Even with different dosages (from 4 to 25 mg), the response appears short lived, so more than one injection is needed [67,68,69,70,71,72]. Besides, the efficacy is better after the first injection than after the next ones, perhaps because of a tachyphylactic effect [67,68,69,70].…”

“…Besides, the efficacy is better after the first injection than after the next ones, perhaps because of a tachyphylactic effect [67,68,69,70]. The risks of steroid administration must also be considered, such as raised IOP, infection, cataract progression or retinal detachment [67,68,69,70,71,72]. On the other hand, the macular edema reduction seems less effective for ischemic forms, not only in case report studies [69] but also in prospective, comparative studies [71].…”

Anti-vascular endothelial growth factor for macular edema secondary to central retinal vein occlusion

“…Two recent RCTs on corticosteroids for CRVO-ME have also demonstrated promise, but there are concerns about the incidence of complications (Gewaily 2009). Firstly, the Standard Care vs. Corticosteroid for Retinal Vein Occlusion trial (SCORE 2009) treated participants with non-ischemic CRVO-ME with either 1mg or 4mg intravitreal triamcinolone (IVTA) injections repeated every four months, or observation alone.…”

Intravitreal steroids versus observation for macular edema secondary to central retinal vein occlusion

“…At the time this review was originally prepared and published, there was no accepted treatment for CRVO-ME (Gewaily 2009). As of this update, the accepted treatments for CRVO are intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) inhibitors, such as ranibizumab, bevacizumab, and aflibercept (Braithwaite 2014); however, intravitreal steroids may still be used where anti-VEGF agents are not readily available.…”

“…Macular edema remains the primary cause of decreased vision. At the time of the original publication of this review (Gewaily 2009), there was no standard of care. The use of intravitreal steroids has been proposed over the last few years and multiple studies of this intervention are underway or have been completed.…”