Serous Macular Detachment as a Predictor of Resolution of Macular Edema with Intravitreal Triamcinolone Injection (original) (raw)
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Intravitreal triamcinolone for refractory diabetic macular edema
OPHTHALMOLOGY, 2002
To evaluate the effect of intravitreal triamcinolone acetonide (IVT) on clinical, angiographic, and optical coherence tomographic parameters in refractory diabetic macular edema (DME). Methods: In a double-masked placebo-controlled randomized clinical trial, 88 eyes of 61 patients with DME refractory to previous laser therapy or not suitable for such treatment were included in the study. Eligible eyes were randomly assigned into two groups. The treatment group (45 eyes) received 4 mg IVT and the placebo group (43 eyes) received subconjunctival injection of placebo. Complete ophthalmologic examination, fluorescein angiography, and optical coherence tomography (OCT) were performed before intervention and repeated after 2 and 4 months. Quantitative measurement of variables on angiograms including hard exudates (HE), size of foveal avascular zone, and leakage severity was performed using Photoshop software. Results: Two months after intervention, visual acuity (VA) improved in the treatment group (-0.13 LogMAR, P=0.01) but slightly deteriorated in the placebo group (0.02 LogMAR, P=0.63). The difference of the above changes (0.15 LogMAR) was statistically significant at 2 months (P=0.02) but reduced to 0.11 LogMAR (P=0.08) after 4 months. Mean (standard deviation) of central macular thickness (CMT) by OCT before and 2 and 4 months after injection was 393 (151), 293 (109), and 362 (119) microns in the treatment group and 393 (166), 404 (134), and 405 (160) microns in the placebo group, respectively. The second month difference was statistically significant (P=0.01). Reduction of the amount of HE (51%, P=0.004) and petaloid pattern (P=0.012) was significant in the treatment group as compared with the placebo group. There was no significant IVT-related side effects except for transient ocular hypertension in 32.6% of patients after 2 months. Conclusion: The greatest therapeutic effect of IVT on DME according to CMT and VA occurs at 2 months and decreases up to the fourth month. However, concerning cyctoid macular edema and hard exudates, the effect is maintained up to 4 months.
The response pattern of intravitreal triamcinolone injection for non-AMD macular edema
Journal of the Medical Association of Thailand Chotmaihet Thangphaet, 2009
Thirty-eight eyes from 36 patients who had undergone an IVTA injection for macular edema from etiologies other than age-related macular degeneration (non-AMD macular edema) were included in the present study. Visual improvement and retinal thickness were the main outcomes. Potential complications, including increased intraocular pressure (IOP), intraocular bleeding, and postoperative endophthalmitis were also recorded. Results: The mean pre-operative logarithm of Minimum Angle of Resolution (logMAR) visual acuity (VA) was 1.0 with an average macular thickness of 463.2 + 141.4 microns and mean IOP of 12.9 + 2.7 mmHg. The macular thickness rapidly decreased in the first week after an injection with a trough at two months (p < 0.001) and began to rise thereafter. The overall VA started to improve significantly at one month and lasted for two months. The IOP significantly increased from the mean baseline during the first two months in 31.6%, which could be controlled only by the medication. No other serious complications were observed. Conclusion: IVTA has the potential to improve both functional and anatomical outcomes in non-AMD macular edema. The decrease in macular thickness occurs from one week after an injection but the visual function improves more slowly and has a short-time effect.
Asian Journal of Pharmaceutical and Clinical Research Journal, 2022
Objective: The objective of the study was to study the therapeutic effects and adverse events of single dose of intravitreal triamcinolone acetonide (TA) in macular edema (ME). Methods: This prospective observational study was conducted for a period of 18 months in a tertiary care hospital. A total of 100 patients who received intravitreal injection of TA 4 mg were followed up within 1 month of injection and thereafter monthly for 3 months. Therapeutic effect was noted by improvement in visual acuity and reduction in macular thickness. Safety was assessed based on adverse events reported during the study period. The quantitative variables were analyzed by paired t-test and the qualitative variables by Wilcoxon signed-rank test and Chi-square test. Results: The mean age was 58.66±11.21 years with majority of patients (46%) in 46-60 age group. Diabetic retinopathy was the most common etiology. Fifteen patients experienced improvement in vision within 1 month, 51, 84, and 91 patients had better visual acuity after 1, 2, and 3 months, respectively, which were statistically significant (p=0.001). The mean macular thickness of 497.79±115.08 at baseline reduced to 448.62±112.48 within 1 month which further reduced to 383.72±105.79, 327.33±86.49, and 263.83±68.68 at the end of the 1 st , 2 nd , and 3 rd months, respectively (p=0.001). The adverse events of rise in intraocular pressure, cataract, redness, pain, floaters, and subconjunctival hemorrhage were not found to be statistically significant (p>0.05). Conclusion: Intravitreal TA injection may be an effective and safe treatment option for ME due to various etiologies.
Is the effect of intravitreal triamcinolone acetonide on diabetic macular edema dose-dependent
To determine whether the effect of intravitreal triamcinolone acetonide in diffuse diabetic macular edema is dose-dependent regarding the velocity and duration of macular edema reduction, visual acuity improvement, and induction of predictable complications. Methods: This clinical prospective study included 32 consecutive patients (32 eyes) with diffuse diabetic macular edema. All patients had visual acuity, fluorescein angiogram, and optical coherence tomography performed at the initial visit (baseline). Single triamcinolone acetonide injection was applied intravitreally in different high doses using sterile technique followed by timolol-maleate 0.5%/ acetazolamide fixed combination eyedrops twice a day for 6 consecutive months. Macular edema, intraocular pressure, and best-corrected distance visual acuity were reviewed after 5 days and 1, 3, and 6 months. results: Intraocular pressure did not change significantly during 6 months and was maintained within normal levels in all patients using prescribed antiglaucoma therapy. Best-corrected distance visual acuity and macular edema were better than preoperatively even 6 months after treatment while the highest improvement was recorded 1 month after treatment. There was a slight correlation of macular edema reduction and triamcinolone dose, especially in central 1-mm diameter zone 6 months post triamcinolone acetonide intravitreal injection, but it was not statistically significant. conclusions: Triamcinolone intravitreal injection is a relatively safe, inexpensive, and effective method used for diabetic macular edema reduction but its effect is not proven to be dose-dependent, at least in 10-32 mg dose range. Macular edema reduction rate correlated significantly with preoperative edema.
Ophthalmology, 2004
To evaluate prospectively the efficacy and safety of 1 intravitreal injection of 4 mg of triamcinolone acetonide for refractory diffuse diabetic macular edema. Interventional case series. Fifteen patients with bilateral diabetic macular edema unresponsive to laser photocoagulation. In all patients, one eye received the injection, and the other served as a control. Intravitreal injection of 4 mg of triamcinolone acetonide under subconjunctival anesthesia. The main outcome measure was central macular thickness (CMT) at 1, 3, and 6 months, measured by optical coherence tomography. Secondary outcomes were Early Treatment Diabetic Retinopathy Study (ETDRS) scores, intraocular pressure, and cataract progression. In this preliminary report, we give the results for 12 patients who had a follow-up of at least 3 months. Seven of them were followed up for 6 months. Before injection, CMT was 509.6+/-143.5 microm (mean +/- standard deviation [SD]) in injected eyes, versus 474.4+/-82.6 microm in ...
American Journal of Ophthalmology, 2005
HAKAN OZDEMIR, MD, MURAT KARACORLU, MD, MSC, AND SERRA ARF KARACORLU, MD • PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on serous macular detachment in eyes with diabetic macular edema. • DESIGN: Interventional case series. • METHODS: The study population comprised twenty eyes of 20 patients with diabetic macular edema (12 men, eight women), aged 48 to 76 years. The eligibility criteria for this study included clinically detectable macular edema in which the presence of serous macular detachment was documented by optical coherence tomography. After intravitreal injection of 0.1 ml (4 mg) triamcinolone acetonide, visual and anatomic responses were observed. • RESULTS: In all eyes, after an injection of triamcinolone acetonide, macular edema and serous macular detachment regressed. At 3 and 6 months, macular edema and serous macular detachment had recurred in eight (40%) and nine eyes (45%), respectively. Patients with recurrence were re-treated. No eyes lost vision at 1 month, and all eyes showed improvement. At 3 months, no eyes had lost vision from baseline, and 17 eyes (85%) showed improvement. At 6 months, again no eyes had lost vision from baseline, and 16 eyes (80%) maintained improved visual acuity. • CONCLUSION: Intravitreal triamcinolone acetonide is an effective treatment for serous macular detachment in patients with diabetic macular edema. (Am J Ophthalmol 2005;140:251-255.
Pakistan Journal of Ophthalmology, 2010
The visual outcome in patients with refractory diabetic macular edema receiving intravitreal triamcinolone acetonide injection. Materials and Methods: This was an interventional, prospective hospital based study conducted at LRBT Eye Hospital Lahore from Jan 2007 to Aug 2007. Fifty eyes of 50 patients received lntravitreal injection of triamcinolone in a single dose of 4mg/0.1 ml. visual acuity was measured preoperatively and at postoperative visit of 1 week, 1 month and 3 months using Snellen's Visual Acuity chart. Results: Pre operatively there was 1 (2%) eye with VA > 6/18, 28 (56%) eyes with VA 6/24-6/60 and 21 (42%) eyes had VA <6/60. On third post operative month follow up visit day there were 6 (12%) eyes with VA > 6/18, 31 (62%) eyes with VA 6/24-6/60 and 13 (26%) eyes had VA <6/60. There is statistically significant difference between the preoperative and postoperative visual acuity, p=0.005. Conclusion: This study suggests that lntravitreal injection of triamcinolone acetonide in a dose of 4mg/0.1ml considerably improved vision in patients with diffuse diabetic macular edema refractory to previous macular grid photocoagulation at three months after the injection.
Journal francais d'ophtalmologie
Long-term follow-up of patients with diabetic macular edema (DME) treated with intravitreal antivascular endothelial growth factor (anti-VEGF) combined focal laser and identification of prognostic morphological characteristics. Methods. Prospective clinical trial (50 treatment-naive eyes) with DME randomized 1 : 1 receiving intravitreal ranibizumab (0.5 mg/0.05 ml) and prompt grid laser compared with ranibizumab and deferred laser. Morphological characteristics potentially relevant for prognosis were assessed at baseline, month 6, month 9, and years 1, 2, 3, 4, and 5 of follow-up. Results. Although functional results were slightly higher in the prompt group at week 12 (0.5; 20/40 Snellen (SD � 0.04, 0.3 logMAR) versus 0.4; 20/50 Snellen (SD � 0.04, logMAR: 0.4), p � 0.4) and month 9 (prompt group: 0.5; 20/40 Snellen (SD � 0.03, 0.3 logMAR) versus deferred group: 0.4; 20/50 Snellen (SD � 0.04, 0.4 logMAR), p � 0.4), these were statistically insignificant. ere was no significant benefit regarding functionality during long-term follow-up in the prompt group compared to the deferred group. BCVA in the eyes with clusters of hyperreflective foci in the central macular region was inferior compared with the eyes without these alterations at year 5 (0.39; 20/50 Snellen, (SD � 0.25, 0.4 logMAR) versus 0.63; 20/80 Snellen (SD � 0.22, 0.2 logMAR), p < 0.01). Conclusion. Grid laser and ranibizumab therapy are effective in DME management during the long-term follow-up. Intraretinal hyperreflective material in SD-OCT is negatively related to BCVA.
The Israel Medical Association journal : IMAJ, 2006
The major cause of visual impairment in diabetic patients is macular edema. The failure of laser photocoagulation in a large subgroup of patients with clinically significant diabetic macular edema has prompted interest in other treatment methods. To evaluate the long-term efficacy and safety of an intravitreal injection of triamcinolone acetonide for clinically significant diabetic macular edema. In a retrospective case series 31 diabetic patients with persistent, recurrent or diffuse clinically significant diabetic macular edema received a single 4 mg (0.1 ml) intravitreal triamcinolone acetonide injection and were followed for at least 6 months. The main outcome measures evaluated were classified as primary: visual acuity and central macular thickness, and secondary: intraocular pressure and cataract progression. Statistical analysis included Student's t-test, chi-square test and the MacNamar test. Best visual acuity results were observed 2.6 +/- 2.4 months post-injection. At ...