Efficacy of Intravitreal Injection of Filtered Modified Low-Dose Triamcinolone Acetonide and Ranibizumab on Pseudophakic Cystoid Macular Edema.

Yidan He,Bo Ma,Ling Bai,Yanfen Wang,Farheen Tariq,Shu Zhang

doi:10.3389/fmed.2022.777549

Abstract

PurposeTo compare the visual and morphological effects between intravitreal injection of filtered modified 2 mg triamcinolone acetonide (TA) and 0. 5 mg ranibizumab in patients with pseudophakic cystoid macular edema (PCME).MethodsA retrospective, interventional study was conducted from January 2015 to February 2020 involving patients with PCME after uneventful cataract surgery. A total of 25 patients (25 eyes) with PCME received an intravitreal injection of 0.22 μm filtered modified 2 mg TA, while 15 patients (15 eyes) received 0.5 mg ranibizumab injection. Central macular thickness (CMT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), times of repeated injections, and other side effects were observed at 2 weeks, 1 month, 3 months, and 6 months after injection; then, the data were compared with preinjection information in each group and between the two groups.ResultsBoth the TA and ranibizumab intravitreal injection can achieve improved BCVA and reduced CMT in patients with PCME (P < 0.05), with a trend toward greater improvement in the TA group, but the difference was only significant at 3 months (P < 0.05). IOP was in the normal range without any significant difference (P > 0.05). Thirty-three percent of patients in the ranibizumab group required repeated intravitreal injection compared to 4% in the TA group. Further stratified analysis showed that the better therapeutic effect of the TA group at 3 months after injection only existed in patients with diabetes mellitus (DM), while not in patients without DM. There was no repeat injection in the TA group and 12.5% in the ranibizumab group for patients without DM, while 16.7% in the TA group and 57.1% in the ranibizumab group required repeated injection for patients with DM, which had a significant difference (P < 0.05).ConclusionIntravitreal injection of filtered modified 2 mg TA is safe, effective, and an inexpensive alternative to antivascular endothelial growth factor (anti-VEGF) agents for patients with PCME, especially for patients concurrently with DM. A large number of clinical randomized controlled studies along with long-term follow-up observations are needed.

Highlights

Pseudophakic cystoid macular edema (PCME), known as Irvine–Gass syndrome (IGS), remains to be a remarkable cause of compromised vision recovery after cataract surgery
This study aims to compare the effectiveness and safety of intravitreal injection of filtered modified 2 mg Triamcinolone acetonide (TA) and 0.5 mg ranibizumab in PCME, by the index of best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), times of repeated injections, and complications
In the TA group, macular edema recurred in 1 patient with diabetes mellitus (DM) at 3 months after injection and decreased BCVA was significantly improved with repeated IVTA

Summary

Introduction

Pseudophakic cystoid macular edema (PCME), known as Irvine–Gass syndrome (IGS), remains to be a remarkable cause of compromised vision recovery after cataract surgery. Due to the lack of large-scale randomized controlled trials for its treatment, there is still no guideline or generally accepted expert opinion for PCME treatment [2]. Large randomized controlled clinical trials have shown that intravitreous injections of anti-vascular endothelial growth factor (anti-VEGF) agents such as bevacizumab (BVB) [3], ranibizumab [4, 5], and aflibercept [6, 7] were efficient for diabetic macular edema (DME) with improved visual results than laser photocoagulation, which was the previous standard treatment for DME. Many studies have confirmed that intravitreal injection of TA (IVTA) for PCME is economical and effective, but its side effects of intraocular pressure (IOP) rise cannot be avoided [8, 9]. Most studies have used 4 mg/1 ml of IVTA for the treatment of PCME [10–12]. Forty to fifty percent of rates rise in IOP have been reported after 4 mg of IVTA [13]

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