Intravitreal triamcinolone acetonide in patients with macular oedema due to branch retinal vein occlusion: a pilot study

Abstract

ABSTRACT.Purpose: To evaluate treatment of macular oedema due to branch retinal vein occlusion (BRVO) with intravitreal triamcinolone acetonide. Methods: In a prospective case series, nine patients with macular oedema due to BRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included best-corrected visual acuity (BCVA) for distance and reading, intraocular pressure (IOP) measurement, fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and at 1 week, 1 month, 3 and 6 months postoperatively. Results: Preoperative mean BCVAs were 1.3 ± 0.8 for distance vision, and 1.1 ± 0.3 for reading acuity, respectively. A significant improvement in reading acuity was observed until 1 month (0.7 ± 0.4, p = 0.02). No significant reduction in mean macular thickness was observed. Conclusions: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to BRVO. However, the significant effect was not permanent and persisted for only 1 month.

Intravitreal Triamcinolone

“…In a prospective nonrandomized comparative study on 11 eyes with CRVO receiving an intravitreal injection of TA, compared with 6 eyes of a control group without intravitreal injection of TA, the gain in visual acuity was significantly (p = 0.003) higher in the study group [103]. This confirms results of other reports on the beneficial effect of intravitreal TA on macular edema and visual acuity in patients with CRVO [81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99]. The results additionally suggest that the increase in visual acuity after IVTA injection may not last permanently in eyes with CRVO.…”

“…In an exponentially increasing number of case series studies and nonrandomized comparative studies, IVTA has been used for the treatment of BRVO [80,81,82,83,84,85,86,87,88,89,90,91,92,251]. Özkiris et al [86] evaluated the efficacy of IVTA injection on persistent macular edema in BRVO that failed to respond to previous laser photocoagulation.…”

“…Robert Machemer and colleagues in particular thought about intravitreal triamcinolone acetonide (IVTA) as a therapy of proliferative vitreoretinopathy [1,3,4,9,13,14,15,16]. As a consequence of Machemer’s suggestion, IVTA has been used for the treatment of other intraocular proliferative, edematous and neovascular diseases such as proliferative diabetic retinopathy [17,18], diffuse diabetic macular edema (DME) and diabetic retinopathy in general [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79], branch retinal vein occlusion (BRVO) [80,81,82,83,84,85,86,87,88,89,90,91,92], central retinal vein occlusion (CRVO) […”

Intravitreal triamcinolone acetonide vs bevacizumab for treatment of macular oedema secondary to branch retinal vein occlusion

“…Recently, various medical and surgical strategies have been tried by many physicians to treat macular oedema secondary to BRVO. Several studies have demonstrated the usefulness of intravitreal injection of triamcinolone acetonide [16][17][18] and of anti-vascular endothelial growth factor (anti-VEGF) agents, such as bevacizumab 19,20 and ranibizumab, 21 in dealing with macular oedema due to BRVO. These treatment modalities have been reported to be associated with short-term promising anatomical and functional improvement in some patients with macular oedema due to BRVO.…”

Reply to Ozkiris et al

“…However, there seems to be a wide variation in injection technique, and few appear to be evidence-based, as highlighted in a recently published survey. 2 The dosage for several studies looking at the use of IVTA in the treatment of macular oedema in branch retinal vein occlusions is 4 mg, [3][4][5] and in one study was 20-25 mg. 6 Ozkiris and co-workers used 8 mg to treat their patients, but the reasoning for this dose is not commented upon. The varying doses administered to patients in different studies can make it difficult to draw any definite conclusions about the appropriate therapeutic dose.…”