A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion: the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6 (original) (raw)
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Archives of Ophthalmology, 2009
The SCORE Study Research Group* Objective: To compare the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone with observation for eyes with vision loss associated with macular edema secondary to perfused central retinal vein occlusion (CRVO). Methods: Multicenter, randomized, clinical trial of 271 participants. Main Outcome Measure: Gain in visual acuity letter score of 15 or more from baseline to month 12. Results: Seven percent, 27%, and 26% of participants achieved the primary outcome in the observation, 1-mg, and 4-mg groups, respectively. The odds of achieving the primary outcome were 5.0 times greater in the 1-mg group than the observation group (odds ratio [OR],5.0; 95% confidence interval [CI], 1.8-14.1; P=.001) and 5.0 times greater in 4-mg group than the observation group (OR,5.0; 95% CI, 1.8-14.4; P=.001); there was no difference identified between the 1-mg and 4-mg groups (OR, 1.0; 95% CI, 0.5-2.1; P=.97). The rates of elevated intraocular pressure and cataract were similar for the observation and 1-mg groups, but higher in the 4-mg group. Conclusions: Intravitreal triamcinolone is superior to observation for treating vision loss associated with macular edema secondary to CRVO in patients who have characteristics similar to those in the SCORE-CRVO trial. The 1-mg dose has a safety profile superior to that of the 4-mg dose. Application to Clinical Practice: Intravitreal triamcinolone in a 1-mg dose, following the retreatment criteria applied in the SCORE Study, should be considered for up to 1 year, and possibly 2 years, for patients with characteristics similar to those in the SCORE-CRVO trial.
Retina-the Journal of Retinal and Vitreous Diseases, 2005
To assess the efficacy of intravitreal triamcinolone treatment for macular edema from central retinal vein occlusion (CRVO) and hemiretinal vein occlusion (HRVO). Methods: This study was a retrospective medical records review of 24 eyes of 24 patients (mean age, 71 years) that were injected with 4 mg of intravitreal triamcinolone acetonide for treatment of macular edema due to CRVO (n ϭ 21) and HRVO (n ϭ 3). Of the 24 eyes, 14 were injected once, 6 were injected twice, 3 were injected 3 times, and 1 received 4 injections. Mean follow-up time was 10 months (range, 3-24 months). The average time between onset of symptoms and first injection was 5.4 months (range, 2-48 months). Available documents on pre-and postinjection optical coherence tomography central foveal thickness in 23 of 39 total injections were evaluated. Results: All injections resulted in reduction in central foveal thickness as determined by optical coherence tomography. The mean central foveal thickness decreased to 55% of preinjection values ([n ϭ 23] 635 vs. 352 m, respectively; P Ͻ 0.001). The average gain in visual acuity was 1.3 Snellen lines (range, Ϫ3-7) over the course of the study period. Ten eyes gained Ն2 lines of visual acuity, 3 eyes improved 1 line, 7 eyes remained the same, and 4 eyes worsened. There was no correlation between improvement in foveal thickness and corresponding visual gain (P ϭ 0.24). None of the eyes of diabetic patients (n ϭ 6) or patients with ischemic CRVO (n ϭ 2) improved in visual acuity. The difference in mean baseline (20/167) and mean final visual acuity (20/91) was statistically significant (P ϭ 0.015). The mean best postinjection visual acuity (20/67) was also significantly higher than the mean final visual acuity (P ϭ 0.019). When diabetic and ischemic CRVO patients were excluded, the difference between mean baseline visual acuity and mean final visual acuity was found to be highly significant ([n ϭ 16] 20/133 vs. 20/67, respectively; P Ͻ 0.001), while mean final and best postinjection visual acuities (20/50) did not differ (P ϭ 0.085). Eight of 16 phakic eyes showed progression of cataract, 2 of which underwent cataract extraction. Nine of 18 patients without a history of glaucoma developed ocular hypertension and required glaucoma medication during postinjection follow-up. Trabeculectomy was performed on two eyes with glaucoma. Two other eyes developed epiretinal membranes, one of which underwent vitrectomy. Conclusions: Intravitreal triamcinolone may be effective in treating macular edema from CRVO and HRVO. Subjects with concurrent diabetes or ischemic central retinal vein were less likely to have visual improvement.
Archives of Ophthalmology, 2004
To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edemaassociatedwithcentralretinalveinocclusion(CRVO). Methods: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. Each intravitreal injection was delivered through the pars plana using a 27-or 30-gauge needle. Main Outcome Measures: Change in Snellen visual acuity, clinical appearance of macular edema, measurement of foveal thickening with optical coherence tomography (OCT), and frequency of complications. Results: The median age of the 13 patients was 67 years (interquartile range, 57-77 years), and the median duration of symptoms before injection was 8 months (interquartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n = 5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n=8) demonstrated a nonsignificant visual acuity improvement. No patient had a de-From the
Introduction: Macular edema (ME) occurs in a wide variety of ocular situations like uveitis, trauma, vascular retinopathies, hereditary dystrophies, and intraocular surgery. It is one of the most important causes of visual disturbance in patients with retinal vein occlusions. Materials and Methods: A total of 43 eyes of 43 patients with ME due to retinal vein occlusion were randomized to receive either 1 mg or 4 mg dose of intravitreal injection of triamcinolone acetonide. Each patient had a complete comprehensive ophthalmic examination at baseline and at each subsequent visit. Fundus fluorescein angiography and optical coherence tomography were done at baseline and at 1, 3, and 6 months. Best-corrected visual acuity (BCVA), the status of the lens and intraocular pressure (IOP) were recorded at each follow-up visit. BCVA was measured in Snellen’s lines and converted into logarithm of minimum angle of resolution scale for statistical analysis. The data were statistically evaluated using the Wilcoxon signed rank test, Mann-Whitney test, and t-tests wherever applicable. A P < 0.05 was considered significant. Results: There was no statistically significant difference in the mean foveal thickness measurement at baseline (P = 0.159) or at the 3rd month (P =0.605) between both the groups. There was no statistically significant difference observed in mean BCVA between the two groups at 1 day, 1 month, 3 months, and 6 months. There was no statistically significant difference observed in IOP between the two groups at any follow-up visit. Conclusions: The results of our study suggest that 1 mg dose of IVTA is as effective as 4 mg dose of IVTA in improving the functional and anatomical outcome in ME associated with retinal vein occlusions.
Intravitreal triamcinolone for acute branch retinal vein occlusion: a randomized clinical trial
Journal of ophthalmic & vision research, 2011
To evaluate the therapeutic effect of intravitreal triamcinolone (IVT) injection for recent branch retinal vein occlusion (BRVO). In a randomized controlled clinical trial, 30 phakic eyes with recent (less than 10 weeks' duration) BRVO were assigned to two groups. The treatment group (16 eyes) received 4 mg IVT and the control group (14 eyes) received subconjunctival sham injections. Changes in visual acuity (VA) were the main outcome measure. VA and central macular thickness (CMT) changes were not significantly different between the study groups at any time point. Within group analysis showed significant VA improvement from baseline in the IVT group up to three months (P < 0.05); the amount of this change was -0.53 ± 0.46, -0.37 ± 0.50, -0.46 ± 0.50, and -0.29 ± 0.45 logMAR at 1, 2, 3, and 4 months, respectively. Corresponding VA improvements in the control group were -0.20 ± 0.37, -0.11 ± 0.46, -0.25 ± 0.58, and -0.05 ± 0.50 logMAR (all P values > 0.05). Significant redu...
2006
Purpose: To evaluate the effectiveness of intravitreal triamcinolone acetonide on visual acuity and macular thickness using optical coherence tomography in macular edema associated with nonischemic central retinal vein occlusion (CRVO). Design: A prospective interventional case series. Patients & Methods: Twenty eyes of 25 patients with nonischemic CRVO and macular edema with visual acuity of less than or equal to 0.4 logarithm of minimum angle of resolution (logMAR) received 4 mg intravitreal triamcinolone acetonide after baseline examination which included measurement of best corrected visual acuity (BCVA) and intraocular pressure, slit lamp examination, fluorescein angiography, and optical coherence tomography (OCT) of macula. The main outcome measures were visual acuity after 1, 3, 6, and 9 months and 1-mm central macular thickness change at 3 months after injection. Results: Mean duration of symptoms before injection was (83.72±57.60 days). Mean visual acuity significantly impr...
Indian Journal of Ophthalmology, 2013
To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on retinal sensitivity in cases of macular edema(ME) secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Total of 14 eyes of 14 cases of BRVO were included in this prospective study. In each eye, at baseline and 1, 3, and 6 months after IVTA injection, logMAR visual acuity, central 4° retinal sensitivity by MP-1 microperimetry, and optical coherence tomography foveal thickness were assessed. Results: Cases ages ranged from 60 to 79 years (mean 68 ± 8 years). At 1, 3, and 6 months, the logMAR visual acuity had increased from 0.71 ± 0.21 to 0.42 ± 0.21, 0.46 ± 0.30, and 0.46 ± 0.27; the mean foveal thickness had decreased from 540 ± 88 µm to 254 ± 51 µm, 288 ± 84 µm, and 280 ± 91 µm; and the mean retinal sensitivity had increased from 4.7 ± 2.5 dB to 7.9 ± 2.7 dB, 8.2 ± 3.6 dB, and 8.3 ± 4.6 dB, respectively. Conclusion: In eyes with ME secondary to BRVO, IVTA injections result in a significant increase in not only the visual acuity but also the central 4° retinal sensitivity in 6 months follow-up.