Intravitreal triamcinolone injection for macular edema secondary to increased retinal vascular permeability.

Abstract

Macular edema is an important cause of visual loss in various retinal diseases, and may be refractory to conventional treatment. We investigated the efficacy of intravitreal injection of triamcinolone acetonide for the treatment of intractable macular edema. A prospective study was conducted in 17 patients (18 eyes) with a diagnosis of macular edema unresponsive to conventional treatment, resulting from inflammatory or retinal vascular diseases. The underlying diseases associated with the development of macular edema were: diabetic retinopathy (6 eyes), branch retinal vein occlusion (5 eyes), Irvine-Gass syndrome (3 eyes), and central retinal vein occlusion (4 eyes). Triamcinolone acetonide 4 mg was injected intravitreally. Ophthalmological examinations, fundus photography, fluorescein angiography, and optical coherence tomography were performed before treatment, 3 months and 6 months after treatment. During the follow-up period, recurrent macular edema was retreated with the same dosage and followed for another 6 months. Sixteen eyes received a single injection and 2 others (11%) underwent reinjection after the 3-month follow-up examination. Among the eyes that received a single injection, 10 (63%) showed visual acuity gain of 2 or more Snellen lines at the 6-month follow-up. The pretreatment central macular thickness averaged 581 microm [corrected] and reduced to 215 microm [corrected] at the 6-month follow-up. In the 2 eyes that received reinjection, macular edema also showed significant reduction 6 months after retreatment. Sterile endophthalmitis was noted in 3 eyes (17%). Two eyes (11%) developed significant cataract. Three eyes (17%) developed high intraocular pressure; 1 of them (5.5%) ultimately required filtering surgery. Intravitreal injection of triamcinolone temporarily reduced refractory macular edema. Potential complications should be monitored after treatment.