Intravitreal triamcinolone acetonide in patients with macular oedema due to central retinal vein occlusion

Abstract

ABSTRACT.Purpose: To evaluate treatment of macular oedema due to central retinal vein occlusion (CRVO) with intravitreal triamcinolone acetonide. Methods: In a prospective case series, 13 patients with macular oedema due to non-ischaemic CRVO received an intravitreal injection of 4 mg triamcinolone acetonide. Examination included assessment of best corrected visual acuity (BCVA) for distance and reading, measurement of intraocular pressure (IOP), fluorescein angiography and high resolution imaging by optical coherence tomography, preoperatively and 1 week, 1 month, 3, 6 and 9 months postoperatively. Results: Preoperative mean BCVA was 0.9 -0.4 for distance vision and 1.0 -0.3 for reading acuity, respectively. A significant improvement in distance VA (0.5 -0.3, p < 0.001) and reading acuity (0.7 -0.3, p = 0.03) was observed until 3 months and 6 months, respectively. Mean macular thickness was significantly reduced until 9 months postoperatively. Conclusion: Intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with macular oedema due to CRVO. However, the significant effect was not permanent and persisted for a maximum of 6 months.

Comparison of Bevacizumab and Triamcinolone for Treatment of Macular Edema Secondary to Central Retinal Vein Occlusion – A Matched-Pairs Analysis

“…Significant impact on BCVA was found 3 months [15, 20, 21] and 6 months [15] after bevacizumab injection. Similarly, for TA treatment a significant increase in BCVA was shown 3 months [8, 22] and 6 months [8] after the first injection. In contrast, failure of significant effect on BCVA of bevacizumab therapy 3 months after injection was reported [23] equally as for TA treatment 2 and 6 months later [24], in line with our results.…”

“…Therefore, we come to the conclusion that other factors play a more important role for the prognosis of BCVA, as for the TA reinjection rate of our cohort, which is similar to others, but in contrast we found no effect on BCVA (table 3, [6, 8]). There is agreement that the effect of TA lasts for 6 months [6, 22, 26], which is favorable for TA compared to bevacizumab because of the lower rate of necessary reinjections. …”

“…In a prospective trial, no effect of TA on mean BCVA was shown after 9 months, again despite a significant decrease in ME [22]. Similar to bevacizumab no proven functional benefit of TA has been shown yet for a 12-month follow-up period [10].…”

Intravitreal Triamcinolone

“…After the first reports on the use of IVTA for the treatment of CRVO by Greenberg et al [99] and Jonas et al [104], the number of reports on the use of IVTA as therapy of CRVO have increased exponentially [93,94,95,96,97,98,99,100,101,102,103,104,105,106,107,108,109,110,111]. 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].…”

Intravitreal Dexamethasone Implant (Ozurdex) for Macular Edema Secondary to Retinal Vein Occlusion

“…They have potent anti-inflammatory effects, can reduce vascular permeability, inhibit fibrin deposition and leukocyte movement, suppress homing and migration of inflammatory cells, stabilize endothelial cell tight junctions, and inhibit synthesis of VEGF, prostaglandins, and other cytokines [18]. Intravitreal injections of the lipophilic corticosteroid triamcinolone acetonide have been shown to produce benefits in eyes with RVO, but several adverse events have been noted (with elevated intraocular pressure [IOP] and cataract being the most common) [8,10,15,[21][22][23][24][25][26][27][28][29]. Other corticosteroids, however, have their own unique properties and may have different clinical profiles in intravitreal use [30].…”