Prospective evaluation of intravitreal triamcinolone acetonide injection in macular edema associated with retinal vascular disorders

H K Tewari, P Sony, R Chawla, S P Garg, P Venkatesh
European Journal of Ophthalmology 2005, 15 (5): 619-26

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography (OCT) in macular edema associated with various retinal vascular disorders.

METHODS: This prospective nonrandomized clinical interventional study included 81 eyes (76 patients) comprised of Group I, 57 eyes (51 patients) with diabetic macular edema; Group II, 10 eyes (10 patients) with branch retinal vein occlusion; and Group III, 13 eyes (13 patients) with central retinal vein occlusion. All eyes received an intravitreal injection of 4 mg triamcinolone acetonide (with the solvent) in the operation theater under sterile conditions.

RESULTS: Mean preinjection central macular thickness was 531.84+/-132 microm in Group I, 458.4+/-149 microm in Group II, and 750.81+/-148 microm in Group III. All groups showed a statistically significant decrease in mean central macular thickness at 1 month (300.7+/-119 microm in Group I, 218.2+/-99 microm in Group II, and 210.5 +/-56 microm in Group III) and 3 months (253.19+/-109 microm in Group I, 187+/-47 microm in Group II, and 182+/-50 microm in Group III) after injection (p < 0.05). Mean follow-up was 22+/-2.4 weeks. Mean visual acuity increased in all three groups (preoperative visual acuity in Group I, 1.2+/-0.4 logMAR units; Group II, 1.24+/-0.5 logMAR units; Group III, 1.1+/-0.4 logMAR units; 1 month postinjection in Group I, 0.88+/-0.3 logMAR units; Group II, 0.67+/-0.3 logMAR units; Group III, 0.86+/-0.4 logMAR units; 3 months postinjection in Group I, 0.84+/-0.4 logMAR units; Group II, 0.59+/-0.3 logMAR units; Group III, 0.82+/-0.5 logMAR units) (p < 0.05). Forty-one eyes completed 6 months and 20 eyes completed 9 months follow-up. Twelve of 20 (41%) eyes in Group I, 2/6 (33%) eyes in Group II, 3/6 (50%) eyes in Group III, and 8/15 (53%) eyes in Group I, 1/3 (33%) eyes in Group II, and 2/2 (100%) eyes in Group III developed recurrence of macular edema with worsening of visual acuity at 6 and 9 months, respectively. Thirty-three (40.7%) eyes developed IOP elevation (at least one reading > 24 mmHg). One eye developed infective endophthalmitis.

CONCLUSIONS: Intravitreal injection of triamcinolone acetonide may be considered as an effective treatment for reducing macular thickening due to diffuse diabetic macular edema, venous occlusion associated macular edema, and may result in increase in visual acuity at least in the short term. Further follow-up and analysis is required to demonstrate its long-term efficacy.

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