Combined Intravitreal Triamcinolone Research Articles

Combined Treatment with Bevacizumab and Triamcinolone Acetonide for Macular Edema Due to Retinal Vein Occlusion

SUMMARYThe purpose of this study was to determine the efficacy of combined intravitreal bevacizumab and triamcinolone in the treatment of macular edema due to retinal vein occlusion. A prospective randomized trial was conducted in the Department of Ophthalmology, Osijek University Hospital Centre in Osijek including 51 patients divided into three groups depending on the drug received. The first group received 1.25 mg intravitreal bevacizumab, the second group received 1 mg intravitreal triamcinolone, and the third group received a combination of 1.25 mg bevacizumab and 1 mg intravitreal triamcinolone on the same day. Changes in the central macular thickness, intraocular pressure and visual acuity were monitored during the follow up period. The retinal perfusion status was evaluated by fluorescein angiography. The group that received combined treatment had better outcome in terms of reduction of macular thickness. There was no statistically significant intraocular pressure elevation among the three treatment groups or within each group of patients. A positive trend regarding visual improvement was observed in the group receiving combined treatment in spite of the lowest initial visual acuity, highest value of macular thickness and longest mean duration of symptoms. In conclusion, combined treatment with bevacizumab and triamcinolone for the treatment of retinal vein occlusion is more potent, safe, efficient and cost-effective. It can also be recommended because fewer injections are needed in patients undergoing treatment for macular edema.

Combined Intravitreal Triamcenolone Acetonide and Bevacizumab for Refractory Diabetic Macular Edema.

To evaluate the effectiveness of combined Intravitreal triamcinolone acetonide (IVTA) and Intravitreal Bevacizumab (IVB) for treatment of refractory diabetic macular edema. Quasi-experimental study. Armed Forces Institute of Ophthalmology (AFIO), Rawalpindi, from January to December 2017. Pseudophakic diabetic patients with macular edema refractory to prior treatment were included. Patients having best corrected visual acuity (BCVA) better than 20/40 (6/12) or worse than 20/200(6/60) or the central subfield thickness (CSFT) less than 300 um on spectral domain optical coherence tomography (OCT) were excluded. Effectiveness of treatment was compared in terms of change in BCVA and CSFT on OCT. Intravitreal injection of 2 mg IVTA and 1.25 mg of IVB was given. IVB was repeated on monthly basis in next two months. Follow-up was done after one week of first injection and then monthly for next three months. Fifty eyes of 42 patients were studied. Mean age of the patients was 62.4 years +7.13. Male to female ratio was 2:1. Mean pre op LogMAR visual acuity was 0.708 +0.12 and CSFT was 439.10 +54.64 um. Mean postoperative LogMAR visual acuity was 0.586 +0.13 um and mean post op CSFT was 382.80 +56.12. There is statistically significant difference in improvement of LogMAR BCVA and decrease in CSFT after treatment. (p<0.001, paired t-test). Eyes with refractory macular edema showed improvement of visual acuity and reduction of CSFT at three months when treated with combined IVTA and IVB.

Intravitreal bevacizumab with prompt laser compared with steroid with prompt laser and prompt laser alone for treatment of diffuse diabetic macular edema

Aim The aim of this study was to compare the efficacy of combined intravitreal bevacizumab injection plus prompt laser versus combined intravitreal triamcinolone injection plus prompt laser and laser alone in the management of diffuse diabetic macular edema on both central macular thickness (CMT) and visual acuity. Patients and methods Sixty patients with diabetes mellitus (type 2) with diffuse macular edema (35 males and 25 females) were recruited for this prospective, randomized, interventional study. Complete history taking, full ophthalmological examination, and CMT measurement using optical coherence tomography were done for all patients. They were subdivided randomly into three groups: laser photocoagulation group (laser group), combined laser and intravitreal bevacizumab group (IVB+laser group), and laser and intravitreal triamcinolone acetonide group (IVTA+laser group), and they were followed up every 2 months for 1 year for evaluation of their response to these treatment modalities as well as for detection of any adverse effects. Results After 12-month follow-up, IVB+laser group showed a higher significant decrease in CMT than that occurred with the other two groups (P Conclusion Combined IVB+laser photocoagulation provided the highest and the longest efficacy in improving visual acuity and reducing CMT in treating diabetic macular edema, compared with laser group or combined IVTA+laser.

The Efficacy and Safety of Current Treatments in Diabetic Macular Edema: A Systematic Review and Network Meta-Analysis.

PurposeTo compare the efficacy and safety of current treatments in diabetic macular edema (DME).MethodsPubMed, Embase and CENTRAL were systematically reviewed for randomized controlled trials of current treatments in DME through August 2015. Data on the mean change of best-corrected visual acuity (BCVA) and central macular thickness (CMT) were extracted, and adverse events (AEs) were collected.ResultsA total of 21 trials were included in our network meta-analysis. Intravitreal ranibizumab improved BCVA most significantly (OR: +7.01 95%CI (2.56 to 11.39)) in 6 months and intravitreal aflibercept (+8.19 (5.07 to 11.96)) in 12 months. Intravitreal triamcinolone combined with LASER decreased CMT most significantly (-111.34 (-254.61 to 37.93)) in 6 months and intravitreal aflibercept (-110.83 (-190.25 to -35.27)) in 12 months. Compared with the relatively high rate of ocular AEs in the groups with administration of steroids, systematic AEs occurred more frequently in the groups with vascular endothelial growth factor inhibitors involved.ConclusionsOur analysis confirms that intravitreal aflibercept is most favorable with both BCVA improvement and CMT decrease than other current therapies in the management of DME within 12 months. Vascular endothelial growth factor inhibitors for DME should be used with caution due to systematic AEs. Combined intravitreal triamcinolone with LASER has a stronger efficacy in decreasing CMT than the other interventions in the early stage after injection. More high-quality randomized controlled trials will be necessary.

Repeated Intravitreal Bevacizumab Injections versus Single Combined Intravitreal Bevacizumab and Posterior Subtenon Triamcinolone Injections for Treatment of Diabetic Macular Edema

Aim: To compare efficacy of combined intravitreal bevacizumab and subtenon triamcinolone versus three intravitreal injections of bevacizumab at one month interval for reducing foveal thickness. Methods: Sixty eyes of 30 diabetic patients with bilateral diabetic macular edema were randomly enrolled in two groups, group A eyes treated with three intravitreal injections of Bevacizumab of 1 month apart, and group B eyes treated with a single intravitreal injection of Bevacizumab comb ined with a subtenon triamcinolone in the same operative session. Pre and postoperative clinical data were measured and followed up over 6 months. Results: Difference between pre - treatment and post - treatment clinical data for each parameter in the same gro up was highly statistically significant. However, on comparing results of post treatment BCVA, IOP and CMT in both groups, there was no statistically significant difference. Conclusion: Combination of subtenon triamcinolone and intravitreal bevacizumab i s a safe and effective choice to treat DME. Original Research Article

Use of intravitreal triamcinolone for the treatment of optic nerve edema in a patient with acute retinal necrosis: case report.

To report the use of combined intravitreal triamcinolone and foscarnet therapy in a patient with active acute retinal necrosis. Retrospective case report. A 40-year-old white woman with a history of ulcerative proctitis, intolerant to oral steroids, developed an aggressive case of acute retinal necrosis complicated by severe optic nerve edema resulting in 20/200 vision. Intravitreal foscarnet provided an initial improvement of the vitritis and retinitis; however, optic nerve edema and 20/200 vision persisted. After 2 weeks, intravitreal triamcinolone was combined with the foscarnet dose. Four days later, the optic nerve edema had resolved, the vision returned to 20/40, and the herpetic infection remained controlled. Eight months later, the patient had not experienced a retinal detachment, and acuity was 20/20. Oral steroids are an accepted adjunct to antiviral therapy in acute retinal necrosis; however, combined intravitreal steroid and antiviral therapy has not been previously reported. After combined intravitreal therapy was attempted, the patient experienced a rapid resolution of symptoms without exacerbating her retinitis. In select patients, combined intravitreal triamcinolone and foscarnet may be effective in treating acute retinal necrosis and its inflammatory sequelae.

Efficacy of combined intravitreal bevacizumab and triamcinolone for branch retinal vein occlusion

Purpose:To evaluate the efficacy of combined treatment with intravitreal bevacizumab (IVB) and triamcinolone acetate (IVT) for patients with macular edema secondary to branch retinal vein occlusion (BRVO).Materials and Methods:Retrospective analysis of 20 eyes injected with 1.25 mg IVB and 2 mg IVT for clinically identified BRVO within 8 weeks of onset. All patients lacked concomitant ocular pathology and completed 6 months’ follow-up. Clinical examination including LogMAR visual acuity (VA) and central macular thickness (CMT) by spectralis optical coherence tomography (OCT) was performed preoperatively and at 1, 3 and 6 months post-operatively.Results:Mean patient age was 61.3 years with a mean BRVO diagnosis time of 3 weeks at presentation. VA improved from logMAR 1.08 preoperatively to Mean logMAR VA of 0.55 ± 0.17 at 1 month (P < 0.001), 0.56 ± 0.21 at 3 months (P < 0.001), and 0.38 ± 0.1 at 6 months (P < 0.001) Mean CMT improved from 482 ± 107 μm preoperatively to 319 ± 53 μm at 1 month (P < 0.001), 344 ± 89 μm at 3 months (P < 0.001), and 241 ± 29 μm at 6 months (P < 0.001). Mean IOP preoperatively was 16.5 mmHg, 21 mmHg at 1 month, and 15 mmHg at 6 months. Six out of 20 patients (30%) were re-injected with IVB and IVT at 3 months.Conclusions:Early combined treatment with IVB and IVT is effective in improving anatomic and functional outcomes in patients with macular edema secondary to BRVO.

Vascularized retinal pigment epithelial detachment in age-related macular degeneration: treatment and RPE tear incidence

To review vascularized-pigment epithelial detachment (V-PED) treatment visual outcome, and to assess acute retinal pigment epithelium (RPE) tear incidence. One hundred and thirty-two eyes of 125 consecutive patients with age-related macular degeneration and V-PED were included. Ninety-four eyes (71.2%) were associated with choroidal new vessels (CNV), 38 (28.8%) with retinal angiomatous proliferation (RAP). Patients, treated over a 10-year period with the time-current therapy, received: verteporfin photodynamic therapy (PDT) (group 1, 38 eyes), combined intravitreal triamcinolone acetonide (IVTA) and PDT (group 2, 44 eyes) or intravitreal anti-VEGF injection (bevacizumab or ranibizumab) (group 3, 50 eyes). Mean follow-up was 20.5 months. At month 12, all eyes treated with PDT or with IVTA and PDT showed a mean significant severe visual decrease. Eyes with CNV lost -0.67 and -0.37 logMAR (p < 0.01 and p < 0.01 respectively), and eyes with RAP -0.55 and -0.31 logMAR (p < 0.01 and p = 0.01 respectively). RPE tear occurred in 14 eyes (36.8%) and in six eyes (13.6%) in groups 1 and 2 respectively. Eyes treated with anti-VEGF therapy showed slight mean visual acuity decrease at month 12. Those with CNV had a mean baseline best-corrected visual acuity (BCVA) of 0.36 ± 0.24 logMAR, final of 0.44 ± 0.30 logMAR (-0.08 logMAR, n.s.). In eyes with RAP, mean baseline BCVA was 0.58 ± 0.39 logMAR, final was 0.78 ± 0.47 logMAR (-0.20 logMAR, n.s.). RPE tear occurred in 14 eyes (36.8%). Patients with either V-PED with CNV or a better baseline BCVA showed greater risk of acute RPE tear (p = 0.01 and p = 0.003 respectively). Effective treatment for vascularized PED is still lacking. Until now, only stabilization of the disease has been achieved using anti-VEGF therapy, but the risk of RPE tear can further hamper our expectations. Baseline characteristics are helpful for prognosis, but patients must be informed of the uncertain response. New therapeutic strategies are needed.

INTRAVITREAL BEVACIZUMAB VERSUS COMBINED INTRAVITREAL BEVACIZUMAB AND TRIAMCINOLONE FOR NEOVASCULAR AGE-RELATED MACULAR DEGENERATION

To determine whether combined intravitreal bevacizumab (IVB) and triamcinolone (IVT) is more effective than IVB alone in neovascular age-related macular degeneration. This was a prospective, randomized clinical trial performed at two centers. Eligible eyes were assigned randomly to one of the two study arms. In the IVB group, 3 consecutive injections of 1.25 mg of bevacizumab were given 6 weeks apart, while in the IVB/IVT group, the first of the triple IVB injections was combined with 2 mg of IVB. A fourth IVB was injected in eyes demonstrating active choroidal neovascularization at Week 24. Sixty and 55 eyes were in the IVB and IVB/IVT groups, respectively. Best-corrected visual acuity improved, and central macular thickness was reduced significantly in both groups at all time points. Visual improvement was more pronounced in the IVB/IVT group compared with the IVB group 6 weeks (8.5 ± 14.4 vs. 3.8 ± 8.9 letters, P = 0.04) and 12 weeks (11.8 ± 16.6 vs. 6.2 ± 10.8 letters, P = 0.03) after initiation of therapy. However, there was no significant difference in visual improvement at Week 24 (11.3 ± 17.2 letters in the IVB/IVT group vs. 8.7 ± 15.6 letters in the IVB group, P = 0.40). The IVB/IVT group showed significantly less need for a fourth injection at Week 24 (34.5% vs. 53.3% in the IVB/IVT and IVB groups, respectively, P = 0.04). Mandated therapy with IVB improved best-corrected visual acuity and decreased central macular thickness in neovascular age-related macular degeneration. The addition of low-dose IVT temporarily increased the therapeutic efficacy in the early postinjection period and resulted in fewer requirements for repeat IVB injections at 6 months; however, final levels of visual improvement were comparable in the 2 study groups.

INITIAL MACULAR THICKNESS AND RESPONSE TO TREATMENT IN DIABETIC MACULAR EDEMA

To assess the effect of initial central macular thickness (CMT) on the response to treatment in diabetic macular edema. The data of 150 eyes of 129 patients with clinically significant diabetic macular edema and no previous treatment who had been randomly assigned in the original trial to 1 of the 3 groups, 1) intravitreal bevacizumab (IVB) group (50 eyes); 2) combined intravitreal bevacizumab and triamcinolone (IVB/IVT) group (50 eyes); and 3) macular laser photocoagulation group (50 eyes), were reevaluated. This time the data of the cases were reanalyzed based on their initial CMT. Accordingly, the original treatment groups were categorized into 3 subgroups: 1) <250 μm, 2) 250 μm to 349 μm, and 3) ≥350 μm. Visual acuity and CMT changes in response to different treatments were compared. Main outcome measures were changes in visual acuity and CMT at Weeks 6, 12, 24, and 36. At 6 weeks in all subgroups, mean visual acuity improvement in the IVB group was significantly greater than the other groups (P = 0.002, P = 0.003, P < 0.001, for subgroups of <250, 250-349, and ≥350 μm, respectively). At 12, 24, and 36 weeks in the subgroup >350 μm and at 24 weeks in the subgroup 250 μm to 349 μm, the difference of mean visual acuity changes among the groups reached to a significant level (P = 0.010, P = 0.028, P < 0.001, and P < 0.001, respectively) in favor of the IVB group. The difference in mean CMT changes at 6 weeks and 12 weeks was significant among the groups in the subgroup ≥350 μm (P < 0.001 and P < 0.001) in favor of the IVB group and in the subgroup 250 μm to 349 μm at 24 weeks in favor of combined IVB/IVT group (P < 0.001). In the primary treatment of diabetic macular edema, initial CMT may be an important factor in decision making. Regardless of initial CMT, IVB caused a better visual outcome only at 6 weeks. With longer follow-up, however, IVB was superior to IVB/IVT and macular laser photocoagulation only in the eyes with initial CMT of ≥350 μm. Concerning CMT reduction, this superiority of IVB in the eyes with initial CMT of ≥350 μm was not observed beyond 12 weeks.

Intravitreal Triamcinolone Injection as an Adjuvant to Standard Laser Therapy in Management of Proliferative Diabetic Retinopathy

Purpose: To evaluate efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA) injection plus panretinal photocoagulation (PRP) in comparison with PRP in proliferative diabetic retinopathy (PDR). Methods: 38 eyes of nineteen patients with PDR were enrolled. One eye of each patient was randomly selected to undergo IVTA injection one week prior to PRP session (IVTA eye), and contralateral eye treated with PRP alone (control eye). Patients were followed at 1, 4 and 6 months after treatment. Main outcome measures included change in logarithm of the minimum angle of resolution best-corrected visual acuity (logMAR BCVA), central macular thickness (CMT) and complications. Results: Mean baseline logMAR BCVA was 0.41±0.36 (IVTA eyes) and 0.36±0.30 (control eyes). At 6 months, Mean change of visual acuity to logMAR BCVA was - 0.054±0.114 (IVTA eyes) and 0.053±0.145 (control eyes) (p=0.02). Mean baseline CMT was 274.5±61.7 µm (IVTA eyes) and 246.7±74.7 µm (control eyes). Injected eyes showed significant reduction in mean CMT at all visits. However, there was no significant difference for CMT between IVTA and control eyes at all visits. Significant reduction of CMT in IVTA eyes was observed at 1 month from 319.2±79.1 to 260.5±78.5 (p=0.024). At 6 months, CMT reduction was still significant in IVTA eyes as compared with baseline values (p=0.048). In control eyes, CMT was not significantly reduced at 1 and 6 months of treatment. Conclusions: IVTA injection is a relatively safe method which might have prophylactic role against visual acuity exacerbation and macular edema secondary to PRP in PDR eyes.

Color Doppler Imaging of Ocular Blood Flow after Combined Photodynamic Therapy with Intravitreal Triamcinolone in Age-Related Macular Degeneration

Purpose: To investigate the effect of combined intravitreal triamcinolone and ocular photodynamic therapy on retinal and choroidal hemodynamics in age-related macular degeneration.Methods: Intravitreal triamcinolone (4 mg, 0.1 cc) and photodynamic therapy with verteporfin were applied to 48 eyes of 33 subjects (25 male and 8 female; mean age: 68.9 years) with subfoveal choroidal neovascular membrane secondary to age-related macular degeneration. Patients were assessed for ocular hemodynamic parameters with color Doppler imaging 24 hr before and 1 week, 1 month, and 3 months after a single-dose administration of combined intravitreal triamcinolone and photodynamic therapy.Results: Throughout the study period, no significant difference in resistance index, peak systolic velocity, or end diastolic velocity existed in the ophthalmic artery (P = 0.58, P = 0.18, and P = 0.19, respectively), the posterior ciliary arteries (P = 0.73, P = 0.19, and P = 0.34, respectively), or the central retinal artery (P = 0.09, P = 0.32, and P = 0.47, respectively).Conclusion: Combined intravitreal triamcinolone and photodynamic therapy was not associated with any alteration in ocular blood flow or flow velocity over 3 months in eyes with age-related macular degeneration.

Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with retinal pigment epithelial detachment in age‐related macular degeneration

Abstract Purpose To discuss the effect and outcome of a combined intravitreal triamcinolone acetonide (IVTA) injection with intravitreal bevacizumab (IVB) in treating choroidal neovascularization (CNV) associated with retinal pigment epithelial detachment (PED) in age‐related macular degeneration (AMD). Methods Ten eyes (10 patients) with CNV associated with PED in AMD were treated by IVT (4 mg/ 0.1 ml) followed by a IVB (1.25 mg/0.05 ml) one week later. Indications for retreatment by combined injection was defined as persistent DEP with subretinal and/or intraretinal fluid on OCT. Patients with flattening of the DEP and activity leakage demonstrated by OCT underwent subsequent IVT. Results The mean duration of follow up was 12 months (6 to 16 months). BCVA at baseline averaged 20/63 (range 20/200 to 20/32) and 20/58 (range 20/125 to 20/32) at the end of follow‐up. FA showed no leakage from the lesion in 6 eyes at the end of follow‐up examination and three eyes showed a decrease in leakage from that seen at baseline. Average central foveal thickness was (CFT) 366.9 microns (range 253 to 388) at baseline and 212.1 microns (range 168 to 245) at the end. the PED had disappeared in six eyes, while in the remaining four they had decreased in size at the end. The subretinal fluid had disappeared in all patients at the end. The combined treatment was repeated in 6 eyes and the number of IVB after combined injection ranged from one to three. No RPE tear appeared during follow‐up. Conclusion combined IVB and IVT therapy seems to be an effective and safe therapeutical procedure to treat CNV associated with large PED in AMD.

Combined intravitreal bevacizumab and triamcinolone in exudative age‐related macular degeneration

We report on the combined application of intravitreal bevacizumab and triamcinolone acetonide for treatment of exudative age-related macular degeneration (AMD). The clinical interventional case-series study included 16 patients (16 eyes) with exudative AMD who had previously received 3.5±1.8 mono-injections of bevacizumab (1.5mg) without significant improvement in visual acuity (VA) or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5mg) and triamcinolone acetonide (about 20mg). Main outcome measures were VA and macular thickness as determined by optical coherence tomography. All patients were re-examined at 2-3months after the intervention. Visual acuity improved significantly (p=0.03) from 0.80±0.40 logMAR prior to the combined injection to 0.65±0.42 logMAR at 3 months after the injection. An improvement of ≥1Snellen line was found in eight subjects, an increase of ≥2lines in five subjects, and an improvement of ≥3lines in two subjects. One patient lost 1line and one patient lost 3lines. Central retinal thickness decreased significantly from 272±62μm to 220±47μm (p=0.03). At the 6-month follow-up examination, central retinal thickness had increased again to 319±142μm, which was not significantly (p=0.30) different from baseline measurements. The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative AMD if previous intravitreal bevacizumab mono-injections have failed to improve vision and reduce macular oedema.

Macular atrophy after combined intravitreal triamcinolone and photodynamic therapy to treat choroidal neovascularization.

To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) to treat choroidal neovascularization (CNV) associated with age related macular degeneration (AMD). The present study was retrospective about non-randomized interventional case series. Fifty-one consecutive eyes with subfoveal (all types) CNV associated with AMD were treated by PDT and intravitreal (19.4±2.1)mg per 0.1mL TA at the Alicante Institute of Ophthalmology. The appearance of macular choriocapillaris and retinal pigment epithelium (RPE) atrophy was considered at two years follow-up. Thirty consecutive eyes treated by PDT alone, matched for age, sex, and type and size of CNV were considered as control group. Twenty-one of 47 eyes in the study group (45%) and 7 of 30 eyes in the control group (23%) developed macular RPE and choriocapillaris atrophy in the treated area at month 24 (P=0.04, Chi-square test). The greatest diameter of the atrophic areas averaged (5044±1666)µm in the study group vs (4345±1550)µm in the control group. Mean final best corrected visual acuity (logarithm of minimal angle of resolution) was (0.87±0.33) in the cases with RPE atrophy vs (0.66±0.26) in the cases with no RPE atrophy in the study group (P=0.11, Mann-Whitney U test). The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.

Intravitreal injection of triamcinolone combined with bevacizumab for choroidal neovascularization associated with large retinal pigment epithelial detachment in age-related macular degeneration

To discuss the effect and outcome of a combined intravitreal triamcinolone acetonide (IVTA) injection with intravitreal bevacizumab (IVB) in treating choroidal neovascularization (CNV) associated with large retinal pigment epithelial detachment (PED) in age-related macular degeneration (AMD). Prospective, consecutive, observational case series. Seven eyes (five patients) with CNV associated with large PED in AMD were treated by IVTA (4 mg/ 0.1 ml), followed by a IVB (1.25 mg/0.05 ml) 1 week later. Patients were evaluated for best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) at baseline, at 1 week and every 6 weeks. Fluorescein angiography (FA) and indocyanine green angiography (ICG) were performed at baseline and every 3 months afterwards. Indications for retreatment by combined injection were defined as persistent PED with subretinal and/or intraretinal fluid on OCT. Patients with flattening of the PED and activity leakage demonstrated by OCT underwent subsequent IVB. The mean duration of follow-up was 11 months (range 9-14 months). BCVA at baseline averaged 20/125, and 20/80 at the end of follow-up. FA showed no leakage from the lesion in four eyes at the end of follow-up, and three eyes showed a decrease in leakage. Average central foveal thickness was (CFT) 325.7 microns at baseline and 209.2 microns at the end. The average size of the PED was 2.34 disk diameters (range 1.33-3.25) at baseline, and the PED disappeared in four eyes, while it decreased in size at the end in the remaining three. The subretinal fluid disappeared in all patients at the end. The combined treatment (IVTA with IVB 1 week later) was repeated in four eyes, and the number of IVB after combined injection ranged from one to three. No RPE tear appeared during follow-up. Two eyes developed glaucoma controlled by topical medication. There were no other ocular or systemic complications Combined IVB and IVTA therapy seems to be an effective and safe procedure to treat CNV associated with large PED in AMD.

INTRAVITREAL TRIAMCINOLONE AS AN ADJUNCT TO STANDARD LASER THERAPY IN COEXISTING HIGH-RISK PROLIFERATIVE DIABETIC RETINOPATHY AND CLINICALLY SIGNIFICANT MACULAR EDEMA

To evaluate the efficacy and safety of combined intravitreal triamcinolone acetonide (IVTA) injection plus panretinal photocoagulation (PRP) and macular photocoagulation (MPC) in comparison with PRP and MPC in eyes with coexisting high-risk proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). Twenty-three patients diagnosed with both high-risk PDR and CSME were enrolled in our prospective, randomized clinical trial study. One eye of each patient was selected to undergo IVTA injection one week before initial PRP and MPC (IVTA eye), and the other eye was treated with PRP and MPC (control eye) based on block randomization. Panretinal photocoagulation was performed in 3 sessions at 1 week intervals. Baseline characteristics included best-corrected visual acuity (BCVA) using Snellen charts, intraocular pressure and patients were observed at 1, 4, and 6 months of treatment. Main outcome measures included change in central macular thickness (CMT) as measured by optical coherence tomography (OCT), logarithm of the minimum angle of resolution BCVA (logMAR), and complications occurring within the follow-up period. Of 23 enrolled patients, 5 patients did not complete follow-up visits due to dense vitreous hemorrhage, tractional retinal detachment and loss of future follow-up. Mean baseline logMAR BCVA was 0.46 +/- 0.29 and 0.56 +/- 0.27 in IVTA eyes and controls. Final mean logMAR BCVA was 0.39 +/- 0.29 (IVTA eyes) and 0.55 +/- 0.33 (control eyes), which was not significantly different (P = 0.08). Mean baseline CMT was 319.2 +/- 79.1 microm (IVTA eyes) and 345.9 +/- 100.6 microm (control eyes). Significant reduction of CMT in IVTA eyes was observed at 1 month (P = 0.024), which had not remained stable after 6 months showing no significant difference as compared with baseline CMT (P = 0.06). In control eyes, CMT was not significantly reduced at 1 and 6 months of treatment. The standardized change in macular thickening (SCMT) was 29.4 +/- 52.2 (IVTA group) versus 5.66 +/- 31.5 (control group) (P = 0.12) at 1 month. At 6 months, SCMT was 16.8 +/- 55.8 (IVTA group) versus 5.03 +/- 47.4 (control group) (P = 0.51). Combined IVTA plus PRP and MPC in coexisting high-risk PDR and CSME eyes do not have a significant beneficial effect on BCVA improvement and CMT reduction compared with standard treatment.

Intravitreal triamcinolone and bevacizumab therapy for combined papillophlebitis and central retinal artery occlusion.

To report a case of an idiopathic, unilateral combined central retinal artery and vein occlusion in a young, healthy patient successfully treated with combined intravitreal triamcinolone and bevacizumab injection. Interventional case report. A 38-year-old man presented with a 2-hour history of acute painless loss of vision in his right eye. Ophthalmic examination revealed count fingers visual acuity, an afferent pupillary defect, a discreet cherry red spot, optic disk edema, and scattered intraretinal hemorrhages in the right fundus. Fluorescein angiography confirmed the central retinal artery occlusion diagnosis. A standard treatment for central retinal artery occlusion and a combined intravitreal triamcinolone and bevacizumab injection were performed. An exhaustive laboratory workup failed to reveal any evidence of systemic vascular, inflammatory, or hypercoagulable disorders. Transesophageal echocardiography, carotid Doppler, and magnetic resonance imaging of the orbits and brain were all unremarkable. In the month after initiation of the treatment, the patient's visual acuity gradually improved to 20/30 and remained stable during a 12-month follow up. Although the visual prognosis of a combined central retinal artery and vein occlusion is generally poor, our patient experienced an excellent visual recovery more than 1 month after prompt standard of care and a combined intravitreal triamcinolone and bevacizumab injection. Further investigation is necessary to support the efficacy and safety of this approach.

Combined intravitreal bevacizumab and triamcinolone for exudative age‐related macular degeneration

Abstract Purpose To report on the combined application of intravitreal bevacizumab with triamcinolone acetonide for treatment of exudative age‐related macular degeneration. Methods The clinical interventional case‐series study included 16 patients (16 eyes) with exudative age‐related macular degeneration who had previously received 3.5±1.8 mono‐injections of bevacizumab (1.5 mg) without significant improvement in visual acuity or reduction in macular exudation. All patients underwent a combined intravitreal injection of bevacizumab (1.5 mg) and triamcinolone acetonide (about 20 mg). Main outcome measures were visual acuity and macular thickness as determined by optical coherence tomography. All patients were re‐examined at 2 to 3 months after the intervention. Results Visual acuity improved significantly (P=0.03) from 0.80±0.40 logMAR prior to the combined injection to 0.65±0.42 log MAR at 3 months after the injection. An improvement by at least one Snellen line was found for 8 subjects, an increase by at least 2 lines for 5 subjects, and an improvement of 3 or more lines for 2 subjects. One patient lost one line, and one patient lost 3 lines. The central retinal thickness decreased significantly from 272±62 to 220±47 micrometer (P=0.03). At the 6 months follow‐up examination, the central retinal thickness increased again to 319± 142 micrometer, which was not significantly (P=0.30) different from the baseline measurements. measurements. Conclusion The combined intravitreal application of bevacizumab and triamcinolone may temporarily be helpful in the treatment of exudative age‐related macular degeneration if previous intravitreal bevacizumab mono‐injections failed to improve vision and reduce macular edema

Combined Intravitreal Bevacizumab and Triamcinolone Acetonide Injection for Idiopathic Neuroretinitis

Purpose: To present a case with idiopathic neuroretinitis that was treated with combined intravitreal bevacizumab and triamcinolone. Design: Case report. Methods: Interventional case report. Results: A 31-year-old man presented with a visual acuity of 3/10 and afferent pupillary defect in the right eye. Ophthalmologic examination disclosed papillitis and macular edema. Neurology consultation with cranial computerized tomography scan revealed no abnormality. The patient was injected with bevacizumab and triamcinolone intravitreally. One week later, the vision increased to 10/10, macular edema disappeared. One month later, optic disc edema disappeared. Conclusions: Intravitreal injection of bevacizumab and triamcinolone effectively treated idiopathic neuroretinitis.