Intravitreal Triamcinolone for the Management of Macular Edema Dueto Nonischemic Central Retinal Vein Occlusion

Bashshur, Ziad F.; Ma’luf, Riad N.; Allam, Souha; Jurdi, Fadi A.; Haddad, Randa; Noureddin, Baha’ N.

doi:10.1001/archopht.122.8.1137

Cited by 83 publications

(43 citation statements)

References 24 publications

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“…Intravitreal triamcinolone treatment has exhibited encouraging results for patients with vascular occlusive diseases and macular oedema. (9)(10)(11)(12)(13)(14)15,16) Similar results were found in our study in eyes with macular oedema secondary to retinal venous occlusion, which showed improvement in mean BCVA from 20/300 at baseline to 20/125 at 15 months (p=0.03). At 15 months, 50% of eyes had improved VA when compared to baseline.…”

Section: Discussionsupporting

confidence: 89%

Indications and Outcomes of Intravitreal Triamcinolone Acetonide Injection in Macular Oedema

Anand¹,

Kumar²

2016

jemds

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To determine the indications, complications, and outcomes of intravitreal triamcinolone acetonide (IVitTA) injection in macular oedema. METHODSThis retrospective study included 105 eyes of 81 patients who received 4 mg IVitTA for treatment of macular oedema due to different aetiologies between May 2011-October 2012. Recorded were demographic data, best corrected visual acuity, intraocular pressure (IOP), degree of cataract if any, macular thickness (By optical coherence tomography) complications and improvement in visual acuity and macular oedema. RESULTSShort-term improvement in visual acuity and macular thickness were in 50% patients and long-term outcomes were less promising. Main complications were cataract (61%), increase in IOP (31%). CONCLUSIONIVitTA remains a promising therapy for patients with macular oedema of different aetiologies refractory to other modalities of treatment at least in short term. It seems relatively safe, but not without complications.

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Section: Discussionsupporting

confidence: 89%

Indications and Outcomes of Intravitreal Triamcinolone Acetonide Injection in Macular Oedema

Anand¹,

Kumar²

2016

jemds

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Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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

Tao

Hou

et al. 2009

Eye

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Purpose To compare the effect of intravitreal bevacizumab vs intravitreal triamcinolone for the treatment of non-ischaemic central retinal vein occlusion (CRVO). Methods The comparative nonrandomized retrospective clinical interventional study included 72 patients with non-ischaemic CRVO, divided into a bevacizumab group of 30 patients (1.25 mg bevacizumab) and a triamcinolone group of 42 patients (4.0 mg triamcinolone). All patients were consecutively included. At baseline, both study groups did not vary significantly in visual acuity, macular thickness, and duration of symptoms (191 ± 300 days vs 222 ± 256 days). The minimal follow-up was 3 months (mean: 7.8 ± 4.3 months; range: 3-12 months). During follow-up, 1.3 ± 0.4 reinjections of the triamcinolone group (range: 1-2 injections) and 2.7±1.8 re-injections of bevacizumab (range:1-6 injections) were administered. Results In both study groups, the mean visual acuity increased significantly (Po0.001) from baseline during follow-up. The differences in gain in visual acuity were not statistically significant (P40.40) between both study groups at any time during follow-up. The mean macular thickness decreased significantly (Po0.001) in both study groups, with the reduction being significantly (P ¼ 0.006) more pronounced in the triamcinolone group. Intraocular pressure increased significantly (Po0.001) in the triamcinolone group. ConclusionsIn long-standing non-ischaemic CRVO, intravitreal bevacizumab and intravitreal triamcinolone are both associated with a comparable gain in visual acuity. The reduction in macular oedema was more marked in the triamcinolone group. In view of the potential complications of intravitreal triamcinolone in terms of intraocular pressure rise and cataractogenesis, bevacizumab may be preferred compared with triamcinolone for intravitreal use in non-ischaemic CRVO. Retinal vein occlusions belong to the most common retinal disorders affecting the macula and reducing central visual acuity. [1][2][3] In a recent populationbased study, retinal vein occlusions were detected in about 0.7% of eyes of adult Chinese aged 40 þ years. Branch retinal vein occlusions were about 12 times more common than central retinal vein occlusions (CRVOs), and the non-ischaemic type was about 9 times more common than the ischaemic type. From a pathogenic point of view, a decreased tissue perfusion and an increased hydrostatic pressure within the involved segments as a consequence of the vascular obstruction may lead to intraretinal haemorrhages, exudation of fluid, varying levels of tissue ischaemia, and eventually to intraocular neovascularization, if retinal ischaemia is pronounced. 4 Although the Central Vein Occlusion Study Group has shown the beneficial of panretinal

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“…Intravitreal triamcinolone acetonide injection (IVTA) is being increasingly used to treat patients with macular oedema resulting from a variety of conditions such as diabetes, 1,2 retinal vein occlusion, 3,4 pseudophakia, 5 various types of uveitis, 6 radiation retinopathy, 7 and idiopathic cystoid macular oedema (CME). 8 It has also been tried in patients with choroidal neovascular membranes associated with age-related macular degeneration, 9 presumed ocular histoplasmosis syndrome, or choroiditis.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

Shulman

Ferencz

Gilady

et al. 2006

Eye

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Purpose In some patients with macular oedema, intravitreal triamcinolone acetonide injection (IVTA) fails to improve visual acuity, although oedema shows clinical and angiographic improvement. Side effects can include increased intraocular pressure, cataract development, and (rarely) endophthalmitis. Our purpose was to identify prognostic factors for visual acuity improvement after IVTA. Methods Data on patients treated by IVTA for macular oedema were retrospectively reviewed. Three months postinjection, visual acuity was rated as 'improved' (two or more Snellen lines gained) or 'nonimproved' (unchanged or worsened). Comparative demographic data and pre-and post-IVTA clinical and fluorescein angiographic findings were analysed with SPSS software. Results Of 57 eyes (57 patients), 27 (47%) improved after IVTA. Initial visual acuity ('good', 'moderate', or 'poor') and aetiology of macular oedema (diabetic, venous occlusion, or pseudophakic) did not differ between the two groups. Improvement occurred in significantly more eyes with clinical or angiographic evidence of cystoid macular oedema (CME) than in those with diffuse retinal thickening (P ¼ 0.04) or diffuse leakage on fluorescein angiography (P ¼ 0.02), respectively, and in significantly more pseudophakic than phakic eyes (P ¼ 0.046). Conclusions Pseudophakia and clinical or angiographic CME, but not aetiology or initial visual acuity, were prognostic of visual acuity improvement after IVTA for macular oedema.

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Intravitreal Triamcinolone for the Management of Macular Edema Dueto Nonischemic Central Retinal Vein Occlusion

Cited by 83 publications

References 24 publications

Indications and Outcomes of Intravitreal Triamcinolone Acetonide Injection in Macular Oedema

Indications and Outcomes of Intravitreal Triamcinolone Acetonide Injection in Macular Oedema

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

Prognostic factors for visual acuity improvement after intravitreal triamcinolone injection

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