Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

Juliane Riese, Vlassis Loukopoulos, Cornelia Meier, Melanie Timmermann, Heinrich Gerding
Graefe's Archive for Clinical and Experimental Ophthalmology 2008, 246 (12): 1671-6

BACKGROUND: To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO).

METHODS: Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later.

RESULTS: Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54-0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37-0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32-0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33-0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2-2.4). Median central foveal thickness (OCT-CFT) was 423 microm (KI: 378-456, n = 24) at baseline and decreased to 270 microm (KI: 249-311, n = 24) at 1 month (p < 0.0001), 265 microm (KI: 254-344, n = 24) at 3 months (p < 0.0001), and 266 microm (KI: 259-365, n = 18) at 6 months (p = 0.001).

CONCLUSIONS: Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.

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