Intravitreal triamcinolone acetonide as treatment of macular edema in central retinal vein occlusion

Abstract

Intravitreal injection of triamcinolone acetonide may be a therapeutic option for long-standing cystoid macular edema due to central retinal vein occlusion.

Intravitreal bevacizumab vs triamcinolone acetonide for macular oedema due to central retinal vein occlusion

“…6,7,[9][10][11][12][13][14][15][16][17][18][19] A disturbed balance of angiogenic and inflammatory cytokines has been reported to be associated with retinal vein occlusion, 20 and experimental investigations and clinical studies have suggested a temporary antioedematous and antiangiogenic effect of intravitreal triamcinolone in eyes with CRVO. 6,7,[9][10][11][12][13][14][15][16][17][18][19] The two major side effects of the intravitreal triamcinolone were a steroid induced increase in intraocular pressure and development of cataract.…”

“…6,7,[9][10][11][12][13][14][15][16][17][18][19] A disturbed balance of angiogenic and inflammatory cytokines has been reported to be associated with retinal vein occlusion, 20 and experimental investigations and clinical studies have suggested a temporary antioedematous and antiangiogenic effect of intravitreal triamcinolone in eyes with CRVO. 6,7,[9][10][11][12][13][14][15][16][17][18][19] The two major side effects of the intravitreal triamcinolone were a steroid induced increase in intraocular pressure and development of cataract. [21][22][23][24][25] In contrast, studies on intravitreal bevacizumab by Rosenfeld et al and other researchers showed an improvement in visual acuity, reduction in macular thickness, and only minor complications in patients with CRVOs, [26][27][28][29][30][31][32][33][34] so that intravitreal triamcinolone was rapidly exchanged by intravitreal bevacizumab for the treatment of CRVO.…”

“…7 The preservatives were removed. We applied a dosage of 4 mg of triamcinolone or of 1.25 mg of bevacizumab.…”

“…5 In the past 8 years, a change in a paradigm has taken place, now to consider the vitreous cavity as drug reservoir for the treatment of retinal disorders, such as diabetic retinopathy and retinal vein occlusions. 6 The first drug, which was intravitreally injected was triamcinolone, [7][8][9][10][11][12][13][14] followed by ranibizumab and bevacizumab. [15][16][17][18][19][20][21][22] Both drugs differ in the spectrum of side effect and potentially in the magnitude and duration of their effect.…”

Cataract surgery after intravitreal injection of triamcinolone acetonide

“…Recently, intravitreal injections of triamcinolone acetonide have increasingly been used as a treatment for these diseases such as exudative age-related macular degeneration, [1][2][3][4][5][6][7][8] diffuse diabetic macular oedema, [6][7][8][9][10][11] central retinal vein occlusion, 12,13 persistent pseudophakic cystoid macular oedema, proliferative diabetic retinopathy, 14 proliferative vitreoretinopathy, 15 iris neovascularisation, 16 chronic prephthisical ocular hypotony, 17 chronic uveitis, [18][19][20][21] and neovascular glaucoma. 22 Complications and side-effects of the intravitreal injection of triamcinolone acetonide include secondary ocular hypertension developing in about 50% of the eyes injected and leading to high intraocular pressure up to 60 mmHg with the need for antiglaucomatous filtering surgery in about 1% of the eyes; 23 infectious endophthalmitis in less than 1% of the eyes, if the injection was performed under sterile criteria in the operation room; and, because of the cataractogenic effect of steroids, a cataract that has eventually to undergo surgery.…”