Efficacy Of Intravitreal Triamcinolone Acetonide Research Articles

Study of efficacy of intravitreal triamcinolone acetonide (IVTA) for the treatment of refractory diabetic macular edema (DME) in type 2 diabetes mellitus patients

Study of efficacy of intravitreal triamcinolone acetonide (IVTA) for the treatment of refractory diabetic macular edema (DME) in type 2 diabetes mellitus patients - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.097, Indian Journal of Clinical and Experimental Ophtha

Efficacy of intravitreal triamcinolone acetonide with thermal combination therapy versus intravitreal triamcinolone acetonide monotherapy on diffuse diabetic macular edema

Purpose The aim of this study was to compare the efficacy of intravitreal triamcinolone acetonide (IVTA) monotherapy with IVTA plus macular grid laser photocoagulation combination therapy on the treatment of diffuse diabetic macular edema.Patients and methods Fifty eyes of 38 patients exhibiting diffuse diabetic macular edema were evaluated in this prospective comparative study. The patients were divided into two groups: IVTA monotherapy group and combination therapy group (IVTA plus grid laser). The main outcome measures of the study were best-corrected visual acuity (VA) scored in logMAR and the central macular thickness (CMT) as estimated at 3 and 6 months after treatment. The study further assessed the potential complications associated with IVTA injection.Results The baseline logMAR VA and CMT were 0.46±0.22 and 445.2±123.91 µm for the IVTA monotherapy group and 0.57±0.27 and 456.91 ±134.32 µm for the combination therapy group, respectively. The post-treatment logMAR VA at 3 and 6 months were 0.24±0.12 and 0.28±0.09 for the IVTA monotherapy group and 0.22±0.13 and 0.18±0.16 for the combination therapy group, respectively. The CMT values at 3 and 6 months were 305.5±115.30 and 310.8±86.8 µm for the IVTA monotherapy group and 280.9±43.9 and 254.2±45.95 for the combination therapy group. Improvement in VA and CMT after treatment was statistically significant in both groups. Approximately 10% of patients developed cataract after 5 months of intravitreal injection. The mean pretreatment intraocular pressure and the mean post-treatment intraocular pressure were 15.49±2.47 and 14.56±2.26 and 14.92±2.80 and 13.55±2.02 mmHg in both the IVTA monotherapy and combination therapy groups, respectively.Conclusion Macular grid laser photocoagulation after IVTA effectively maintains the VA and macular thickness of the patients included in this study during the first 6 months of treatment.

Short-term efficacy of intravitreal triamcinolone acetonide for macular edema secondary to retinal vein occlusion that is refractory to intravitreal bevacizumab.

Aims:To evaluate the 1-month efficacy of intravitreal triamcinolone acetonide (TA) in treating macular edema secondary to retinal vein occlusion (RVO) that was refractory to intravitreal bevacizumab.Materials and Methods:This retrospective, observational study included 23 eyes from 23 patients with macular edema secondary to RVO. Macular edema that did not respond to two or more consecutive intravitreal bevacizumab injections was treated with intravitreal TA. Central foveal thickness (CFT) and best-corrected visual acuity (BCVA) were compared before and one month after TA injection.Results:Fifteen eyes were diagnosed with central RVO, and eight eyes were diagnosed with branch RVO. All patients were previously treated with 2.4 ± 0.6 intravitreal bevacizumab injections. The TA injection was performed, on average, 5.8 ± 1.4 weeks after the last bevacizumab injection. The CFT before TA injection was 516.6 ± 112.4 μm and significantly decreased to 402.3 ± 159.7 μm after TA therapy (P < 0.001). The logarithm of the minimal angle of resolution BCVA was 0.72 ± 0.34 before TA therapy and was not significantly improved by the treatment (0.67 ± 0.35, P = 0.119), despite a decrease in CFT. However, seven eyes (30.4%) had a BCVA gain of one or more lines.Conclusions:Intravitreal TA therapy was beneficial in some patients with macular edema secondary to RVO that was refractory to intravitreal bevacizumab therapy. This study suggests that intravitreal TA should be considered as a treatment option for refractory macular edema.

Comparison of Intravitreal Triamcinolone Acetonide with Intravitreal Bevacizumab for Treatment of Diabetic Macular Edema: A Meta-analysis

Purpose: To compare the effects of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) injections for the treatment of diabetic macular edema (DME).Methods: A literature search was conducted using PUBMED, the Cochrane Central Register of Controlled Trials, Web of Science and the Chinese Biomedical Database. Pooled mean differences (MDs) for changes in visual acuity (VA) and central macular thickness (CMT) were calculated between groups receiving a single TA (4 mg) and bevacizumab (1.25 or 1.5 mg) from baseline to 4, 8, 12 and 24 weeks after treatment, respectively. Changes in intraocular pressure (IOP) were calculated between the two groups from baseline to 4, 8 and 12 weeks after treatment.Results: Eight trials (n = 434 eyes) comparing the efficacy of IVTA with IVB were included in the meta-analysis. Patients in the IVTA group demonstrated significant post-treatment improvement in VA compared with those in the IVB group at 4 (MD = −0.08; 95% confidence interval [CI]: −0.12 to −0.03; p = 0.0008), 8 (MD = −0.15; 95% CI: −0.20 to −0.11; p < 0.00001), 12 (MD = −0.11; 95% CI: −0.15 to −0.06; p < 0.0001) and 24 (MD = −0.05; 95% CI: −0.10 to −0.01; p = 0.02) weeks. After receiving IVTA, MDs in CMT decreased significantly at 4 weeks (MD = −40.05 μm; 95% CI: −75.29 to −4.81; p = 0.03). No significant differences in CMT were seen between the two groups at 8, 12 and 24 weeks post-treatment. Fluctuations of IOP were within normal range for both groups throughout the entire observation period.Conclusions: Results of this meta-analysis suggest that IVTA is more effective for improving VA in DME. However, the CMT reduction with IVTA was unsustainable. Additional well-designed studies are needed to further investigate optimal interventions.

Therapeutic Effect of Intravitreal Injection of Triamcinolone in the Treatment of Endothelial Graft Rejection

To investigate the efficacy of intravitreal triamcinolone acetonide (IVTA) injection in the treatment of endothelial graft rejection and the expression of T-helper type 1 (Th-1) chemokines in the aqueous humor. Eleven patients (11 eyes) with acute endothelial graft rejection underwent IVTA (4 mg/0.1 mL) injection in addition to conventional treatment, including systemic and topical steroids and cyclosporine A (group A); 13 patients (13 eyes) received conventional treatment only (group B). Clinical characteristics were analyzed. In group A, Th-1 chemokines (CXCL-9, -10, and -11) in aqueous humor were measured by enzyme-linked immunosorbent assay and CXCR3(+) cells were counted by flow cytometry before treatment and at the period of improvement. There were no significant differences in visual acuity, intraocular pressure, and recurrence rate between the 2 groups. The mean time to improvement was 9.1 ± 3.9 days in group A and 15.4 ± 5.5 days in group B (P = 0.04). The concentrations of CXCL-9, -10, and -11 were 562.7 ± 109.4, 30293.1 ± 12537.1, and 228.3 ± 80.8 pg/mL before treatment and 6.7 ± 6.8 (P < 0.01), 207.5 ± 209.8 (P < 0.01), and 18.9 ± 19.5 (P < 0.01) pg/mL after treatment, respectively. The CXCL-10 level correlated with the time to improvement of graft rejection (P = 0.02). Flow cytometry demonstrated a significantly decreased number of CXCR3(+) and CXCR3(+)CD4(+) cells in the aqueous humor after treatment. IVTA injection was effective in reducing the time to improvement of endothelial graft rejection. Increased expression of CXCL-9, -10, and -11, and their receptors in the aqueous humor of patients with endothelial graft rejection decreased after treatment.

Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

BackgroundThe influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO).MethodsTwenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (−) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded.ResultsIn both the SRD (−) group and the SRD (+) group, the mean macular thickness within the central 4° field and the 10° and 20° fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P <0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P <0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4° field and the 10° and 20° fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P <0.05). The trend profiles of macular thickness within the 10° and 20° fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4° field and the 10° and 20° fields of the occluded region.ConclusionsThese results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.

Comparison of intravitreal triamcinolone treatment and intravitreal triamcinolone with grid laser treatment in patients with diffuse diabetic macular edema.

To compare the efficacy of intravitreal triamcinolone acetonide (IVTA) and IVTA plus macular laser grid photocoagulation therapy in diffuse diabetic macular edema (DME). Sixteen patients affected by diffuse DME were retrospectively evaulated. Patients were divided into two groups: control group (IVTA injection) and laser group (IVTA plus grid laser). Main outcomes were best corrected visual aquity (BCVA) and central macular thickness (CMT) at the 3(rd) and 6(th) months of treatment. IVTA associated complications and reinjection necessity were assessed. Our study comprised 18 eyes of 16 patients. The baseline BCVA and CMT were 0.93±0.45 and 530±136μm for the control and 1.02±0.52 and 509±177μm for the laser group respectively. Posttreatment BCVA at the 3(rd) and 6(th) month were 0.73±0.4 and 0.75±0.45 for control and 0.98±0.44 and 1.04±0.4 for laser group respectively (p>0.05 for all). CMT values at the 3(rd) and 6(th) months were 260±174μm (p=0.008) and 362±163 μm (p=0.05) for control and 331±161μm (p=0.05) and 388±215 μm (p>0.05) for laser groups. 55% of control and 66% of laser groups needed reinjection with an avarage of 7±4 months after the first injection. 22% cataract progression and 33% intraocular pressure elevation were noted. Macular grid laser photocoagulation after IVTA does not have beneficial effects for diffuse DME.

Pharmacokinetics of triamcinolone acetonide for the treatment of macular edema

Introduction: The use of intravitreal triamcinolone acetonide (TA) for the treatment of various types of macular edema has been widespread, particularly for the last decade. Currently, there is a scant amount of evidence-based literature evaluating the pharmacokinetic profile of TA despite clinical data showing the efficacy of intravitreal TA for multiple forms of macular edema.Areas covered: This paper is an extensive review of human and experimental studies published on the pharmacokinetics of TA for the treatment of macular edema. The literature search was conducted via OVID, TRIP Database and EMBASE, up to April 2011.Expert opinion: The pharmacokinetic profile of TA is unpredictable and the agent has a time-limited therapeutic action due to its relatively short half-life. This has led to the need for repeated injections. Future research should investigate the pharmacokinetic profiles of TA when administered intravitreally, as well as through alternate routes in more robust studies.

Comparison Between Efficacy of Triamcinolone Acetonide and Bevacizumab in a Case with Type 2A Idiopathic Parafoveal Telangiectasia

Address for Correspondence/Yaz›flma Adresi: Dr. Sabri Raza, Ataturk Training and Research Hospital First Ophthalmology Clinic Bilkent Ankara, Turkey Gsm: +90 507 7 3 8 1 7 97 E-mail: sabri_raza@yahoo.com R e c e i v e d/Gelifl Tarihi: 04.02.2010 A c c e p t e d/Kabul Tarihi 26.10.2010 S u m m a r y P u r p o s e : To compare the efficacy of intravitreal triamcinolone acetonide and bevacizumab in the treatment of a case of type 2A idiopathic parafoveal telangiectasia (IPT). Material and Method: A 55-year-old man with complaint of decreased vision in both eyes was diagnosed as type 2A IPT after a complete ophthalmological examination, fundus fluorescein angiography (FA) and optical coherence tomography (OCT). We injected intravitreally 4 mg /0.1 cc of triamcinolone acetonide into the right eye and 24 hours later 1.25 mg /0.05 cc of bevacizumab into the left eye. The patient was evaluated on the first day, first week, first month, and the third month with FA and OCT. R e s u l t s : Before treatment, best-corrected visual acuity (BCVA) was 5/100 in the right eye and 5/10 in the left eye. At the first-week post-treatment visit, BCVA improved to 5/10 in the right eye and 10/10 in the left eye. On FA, edema in the temporal foveal area was detected in both eyes. This macular edema began to decrease at the first-week visit. Visual acuity was the same on the firstand third-month visits. The FA findings also remained the same. During this 3-month follow-up period, the patient did not need any other additional treatment. D i s c u s s i o n : Intravitreal injections of triamcinolone acetonide and bevacizumab are optional modalities in the treatment of type 2 IPT. The efficacy and permanence of influence-duration of action of triamcinolone acetonide and bevacizumab were similar in our case. (Turk J Ophthalmol 2011; 41: 6-9)

Photodynamic Therapy and Intravitreal Triamcinolone for Neovascular Age-Related Macular Degeneration: A Randomized Clinical Trial

To evaluate the efficacy of intravitreal triamcinolone acetonide (ITA) as an adjunct to photodynamic therapy with verteprofin (VPDT) in the treatment of predominantly classic, subfoveal choroidal neovascularization (CNV) owing to age-related macular degeneration (AMD). A multicenter, 2-year, double-blind, randomized, sham-controlled trial conducted at 11 sites in Canada. One hundred individuals over the age of 50 were randomized 1:1 to either to VPDT alone or combined VPDT and ITA. Participants all received full-fluence VPDT and were randomly assigned to either (1) a same-day injection of 4 mg ITA or (2) a sham intraocular injection. The primary end point was the change in numbers of letters read between baseline and 1 year. Combination therapy with VPDT and ITA when compared with VPDT therapy alone resulted in no significant difference in final visual acuity at 1 year. Eyes treated with combination therapy lost an average of 17 letters compared with 20 letters for the VPDT group. Subjects receiving ITA required significantly fewer retreatments over the course of the study (1.28 vs 1.94, respectively; P = 0.003). Although elevated intraocular pressures were noted in a larger proportion of subjects receiving ITA, all of these individuals were managed successfully with topical ocular antihypertensive agents. There was no visual benefit to the addition of intravitreal triamcinolone to VPDT. Combination therapy, however, can reduce the number of VPDT treatments required by subjects who have predominantly classic CNV owing to AMD. This reduced treatment quantity needs to be weighed against potential side effects. (ClinicalTrials.gov number, NCT00148551).

Intravitreal Triamcinolone Acetonide Preceding Photodynamic Therapy for Exudative Age-Related Macular Degeneration

To evaluate the efficacy of intravitreal triamcinolone acetonide 1 week before photodynamic therapy (PDT) with verteporfin in the treatment of exudative age-related macular degeneration (AMD). Retrospective chart review of 70 eyes of 66 consecutive patients who were treated with intravitreal triamcinolone acetonide followed by standard PDT 1 week later. Group 1 consisted of 42 eyes that received one or more previous treatments with PDT alone and responded poorly. Group 2 consisted of 28 eyes that had never received PDT. No statistically significant change in mean visual acuity was seen during the follow-up period for either group. At 12 months, 90% of group 1 eyes and 80% of group 2 eyes lost less than 2 lines of Snellen visual acuity. A mean of 1.24 additional PDT sessions were required in group 1 eyes and 1.04 additional sessions in group 2 eyes during the follow-up period. In eyes with exudative AMD, intravitreal triamcinolone acetonide preceding PDT with verteporfin results in stabilization of visual acuity and a decreased need for re-treatments with PDT. This regimen may be superior to PDT monotherapy.

Intravitreal triamcinolone acetonide vs bevacizumab for treatment of macular oedema due to central retinal vein occlusion

To compare the efficacy of intravitreal triamcinolone acetonide vs intravitreal bevacizumab in eyes with macular oedema caused by central retinal vein occlusion (CRVO). Retrospective consecutive case series. Retrospective review of the medical records of 35 consecutive patients (35 eyes) with macular oedema associated with CRVO. Twenty-two patients were treated with intravitreal injection of 4 mg/0.1 ml triamcinolone acetonide. The other 13 patients accepted intravitreal bevacizumab 1.25 mg in 0.05 ml. Initial visual acuity, intraocular pressure (IOP), and macular thickness were recorded. Final visual acuity, IOP, macular thickness, and adverse events were recorded during the treatment period. The mean follow-up was 282.73+/-70.62 days in the group administered with triamcinolone acetonide and 253.92+/-36.10 days in the study group who accepted bevacizumab, respectively. Visual acuity measurements improved significantly and showed significant macular oedema resolution in optical coherence tomography examination in both the two groups. However, the therapeutic effects had no significant difference between these two groups with regard to visual results (F=1.723, P=0.240) and macular thickness decrease (F=1.814, P=0.832). Thirteen eyes developed recurrent macular oedema and received repeat injections of triamcinolone acetonide or bevacizumab. Intravitreal injection of triamcinolone acetonide or bevacizumab can both lead to a significant improvement in visual acuity and a resolution of macular oedema in patients with CRVO. However, the significant effect was not permanent. Besides, the efficacy of intravitreal triamcinolone acetonide showed no significant differences compared with intravitreal bevacizumab but seemed to cause more adverse events than bevacizumab.

EFFICACY OF INTRAVITREAL TRIAMCINOLONE ACETONIDE IN LONG STANDING DIABETIC MACULAR EDEMA

To investigate the efficacy of intravitreal triamcinolone acetonide in patients suffering from diffuse long standing diabetic macular edema, by the assessment of retinal thickness and retinal function by means of optical coherence tomography (OCT) and microperimetry-1. Twenty eyes received 8 mg in 0.2 mL preservative free intravitreal triamcinolone injection delivered through the pars plana. The best corrected visual acuity (BCVA), foveal thickness, and the average retinal sensitivity of the 45 stimuli were considered in our study. Patients were instructed to attend for OCT and microperimetry-1 follow-up at baseline, 1, 3, and 6. At the baseline, mean macular thickness was 692 micro +/- 70 micro; mean visual acuity was 0.13 +/- 0.09. Mean macular sensitivity determined with the microperimetry-1 was 6.85 dB +/- 2.1 dB. At the 1 month follow-up, mean OCT macular thickness decreased to 348.28 micro +/- 132.10 micro (P = 0.0001); mean BCVA improved to 0.23 +/- 0.15 (P = 0.019); mean retinal sensitivity improved to 8.71 dB +/- 2.79 dB (P = 0.03). At the 3 months follow-up, mean OCT macular thickness changed to 363.7 micro +/- 123.52 micro (P = 0.0002); mean BCVA was 0.23 +/- 0.15 (P = 0.0024); mean retinal sensitivity 8.54 dB +/- 2.78 dB (P = 0.048). Six months after the injection, mean OCT macular thickness was 460.61 micro +/- 104.9 micro (P > 0.05); mean BCVA was 0.15 (P > 0.05); mean retinal sensitivity 7.54 dB +/- 2.58 dB (P > 0.05). In our study, we found intravitreal effective in improving BCVA, macular thickness, and retinal sensitivities during the first 3 months. At 6 months, follow-up of the data were not dissimilar to those obtained at baseline. Further investigation is warranted to asses the correlation among daily life visual performance, retinal sensitivities, and macular thickness.

ISIS-DME

: To determine safety and efficacy of intravitreal triamcinolone acetonide (IVTA) for refractory clinically significant diabetic macular edema (DME). : Prospective, randomized, dose-escalation pilot study comparing single injection of 2 mg versus 4 mg doses of IVTA. : Inclusion criteria included clinically significant DME persisting >/=3 months after maximal laser treatment and visual acuity </=20/40. Best-corrected ETDRS vision, intraocular pressure, presence of DME, and fluorescein angiography (FA) were evaluated at 3 months and 6 months after injection. : Mean change in visual acuity at 3 months compared to baseline was 7.1 letters (P = 0.01) in the 2 mg group and 12.5 letters in the 4 mg group (P < 0.0001). However, there was not a significant difference in visual improvement between the 2 mg and 4 mg dose groups (P = 0.11). Vision improved >15 letters at 3 months in 23% (3/13) of 2 mg group and in 33% (5/15) of 4 mg group (P = 0.69), and 0% (0/11) and 21% (3/14) at 6 months, respectively (P = 0.23). Visual improvement was more likely in cystoid-type DME than diffuse DME. Intraocular pressure rise of >/=10 mmHg occurred in 19% (3/16) of 2 mg group and 41% (7/17) of 4 mg group. : Both doses of IVTA were well tolerated and had significant positive effects on refractory DME for short term. There were consistent trends throughout the study that suggest that a 4 mg IVTA may be more effective than a 2 mg dose. The benefit of IVTA was greater for cystoid-type DME.

Short-term Safety and Efficacy of Intravitreal Triamcinolone Acetonide for Uveitic Macular Edema in Children

To evaluate the short-term safety and efficacy of intravitreal (IV) triamcinolone acetonide (TA) for treating pediatric cystoid macular edema (CME) secondary to noninfectious uveitis. A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (16 eyes) with uveitic CME treated with IVTA (2 or 4 mg) were reviewed. Data collected included details of uveitis, CME, visual acuity, intraocular pressure, and cataract development. The median follow-up time was 16 months (range, 9-36 months). Resolution of CME was achieved in all of the treated eyes. The median time taken for CME to resolve was 3 weeks (range, 1-24 weeks). The mean improvement of visual acuity after IVTA was 0.6 logarithm of the minimum angle of resolution. Following initial response to IVTA, CME relapsed in 5 eyes (31%) after a median time of 7 months (range, 3-13 months). The most common adverse effect was increased intraocular pressure, with an increase of more than 15 mm Hg in 5 eyes (31%). Steroid-induced cataract was observed in 6 of 11 phakic eyes (55%). We found that IVTA is efficacious in the treatment of uveitic CME in children and results in CME resolution and visual acuity improvement. As in adults, treatment in children may be associated with elevated intraocular pressure and cataract.

Intravitreal and posterior subtenon triamcinolone acetonide in idiopathic bilateral uveitic macular oedema

To study the efficacy of intravitreal triamcinolone acetonide (IVTA) versus posterior subtenon triamcinolone acetonide (PSTA) in bilateral macular oedema secondary to idiopathic intermediate uveitis. In a prospective, interventional case series, 10 patients (20 eyes) with bilateral uveitic macular oedema were included. Patients underwent fundus fluorescein angiography, record of visual acuity and intraocular pressure (IOP). Patients received IVTA 4 mg/0.1 mL in one eye and PSTA 20 mg/0.5 mL in the fellow eye at an interval of > or =4 weeks. The outcome measures were record of IOP, best corrected visual acuity and angiographic resolution of cystoid macular oedema at 3 and 6 months. The mean pre-intervention IOP at baseline between the IVTA and the PSTA group was comparable. At 1 week, the mean IOP recorded was greater in the eyes that received IVTA than those that received PSTA (P < 0.001). However, at 1- and 3-month follow up, the mean IOP between the two groups was similar. Best corrected visual acuity of > or =6/12 achieved at 3 and 6 months in the IVTA and PSTA group was comparable (77.8% vs. 44.4% [P = 0.14] and 88.9% vs. 77.8% [P = 0.53]). There was also no significant difference in angiographic resolution of cystoid macular oedema at 3 (P = 0.32) and 6 months (P = 0.53) between the two groups. Recurrence of macular oedema was seen in one and two eyes that received IVTA and PSTA, respectively, at 6 months. Triamcinolone acetonide injection, whether administered intravitreally or via posterior subtenon route, is an effective treatment option in achieving complete anatomic and functional improvement in cases treated for macular oedema secondary to idiopathic intermediate uveitis.

Intravitreal Triamcinolone Acetonide to control the diabetic macular edema

Abstract Purpose: To asses the efficacy of intravitreal Triamcinolone Acetonide (TA) in diffuse diabetic macular edema (DME) refractory to laser coagulation Methods: Descriptive, retrospective, non randomized study without control group done on 35 eyes of 27 patients with DME and negative dexamethasone test, treated with 4mg intravitreal TA between January‐2006 and March‐2007. Variation in Visual Acuity (VA)(Snellen Chart) was considered as main outcome, and angiographic (AFG) edema was consider as secondary outcome. The statistic analysis was performed by contingency tables, Chi‐square test and Fisher exact test Results: The median basal VA was 0.16, observing an improvement of two or more lines in 31.4% at first month post op and 34.3% at the end of follow up(7 months). Although the edema was resolved in 42.9% at the first month by AFG, it persisted in 77.1% by the end of the study. A mayor effect was observed in patients treated with insulin+oral hypoglucemiants+diet(p:0.021), cystic CSME(p:0.018), or previous grill laser(p:0.055).A statistically significant relation was observed between VA and the absent of edema in the AFG. Three eyes developed ocular hypertension during the first 24 hours and 4 eyes at first month, all them controlled by topical treatment. No endophthalmitis was observed Conclusions: Results were similar to bibliography. A strong relation was observed between VA and AFG during entire follow up. Systemic treatment with diet‐insulin‐oral hypoglucemiants seemed to induce a better respond to the intravitreal TA in the control of DME

Intravitreal triamcinolone acetonide in the management of cystoid macular edema in Behçet’s disease

To determine the efficacy of intravitreal triamcinolone acetonide (ivTA) injection in the management of cystoid macular edema (CME) due to uveitis in patients with Behçet's disease. Ten eyes of seven patients with CME associated with Behçet's disease were included in the study. A quantity of 4 mg of triamcinolone acetonide was injected intravitreally in all of the eyes. The maculas of the patients were evaluated with optical coherence tomography (OCT) and fluorescein angiography (FA). The change in visual acuity, fluorescein leakage, macular thickness, and potential complications were assessed. The mean follow-up was 15.6 months (range 7-19 months). There was an increase of more than two Snellen lines in the visual acuity in seven of the ten eyes (70%) at the last examination. Macular edema regressed completely in eight of the ten eyes (80%) at the last visit on OCT and FA. The mean central macular thickness assessed by OCT was 406 mum before treatment and 186.9 mum at the last visit. The intraocular pressure (IOP) exceeded 21 mmHg in six eyes of five patients (60%) during the follow-up. At the last visit, the IOP was less than 21 mmHg in five eyes with medication. One eye underwent glaucoma filtration surgery. Four eyes of three patients had cataract progression. In four eyes of four patients (40%), a second ivTA injection was given due to relapsing CME. Intravitreal triamcinolone acetonide (ivTA) may be beneficial in the management of CME in patients with Behçet's disease. Repeated ivTA injections might be required if CME reoccurs.

Efficacy of Intravitreal Triamcinolone Acetonide for Eyes with Postvitrectomy Diabetic Vitreous Hemorrhage

PurposeTo evaluate the efficacy of intravitreal triamcinolone acetonide (IVT) for the management of postvitrectomy diabetic vitreous hemorrhage.MethodsThe authors conducted a retrospective study of patients with postvitrectomy diabetic vitreous hemorrhage who were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. Ocular history, adverse events, BCVA, intraocular pressure, external eye examination, slit-lamp biomicroscopy, fundus examination, B-scan ultrasonography, and fundus photography were assessed on day 1, weeks 1, 2, and 4 and months 2 and 3.ResultsThere were 19 eyes of 18 consecutive patients with mean follow-up after IVT injection of 28 weeks. Of the 19 eyes, 17 eyes (89%) experienced clearing of vitreous hemorrhage within 1 to 5 weeks (mean, 1.7 weeks) with visible triamcinolone precipitates along with blood clot in the inferior aspect of fundus. Of these 17 eyes, 12 eyes (63%) maintained vitreous hemorrhage-free condition at last follow-up with a mean visual acuity of 20/63 (range, 20/320 20/25), whereas 5 (29%) developed recurrent vitreous hemorrhage after clearing of vitreous hemorrhage. Vitreous hemorrhage was not cleared in 2 eyes, which required surgical procedures.ConclusionsIVT injection may be beneficial for clearing recurrent postvitrectomy Diabetic Vitreous Hemorrhage.

Triamcinolone Acetonide as an Adjuvant in the Surgical Treatment of Retinal Detachment With Proliferative Vitreoretinopathy

To report the efficacy of intravitreal triamcinolone acetonide as an adjuvant in the surgical management of cases with advanced proliferative vitreoretinopathy (PVR). Patients with complicated rhegmatogenous retinal detachment and PVR grade C2 or greater were recruited for this interventional, noncomparative, prospective study. All patients underwent three-port pars plana vitrectomy, membrane peeling, laser photocoagulation, and silicone oil injection to reattach the retina followed by 0.1 mL (4 mg) of triamcinolone acetonide injected through the pars plana into the silicone oil. All patients had supplemental laser therapy around retinal breaks and retinectomy edges at 1 to 2 weeks postoperatively. Patients included 15 males and 9 females, with an average age of 53.6 years (range: 15 to 84 years) and PVR grade C2 to PVR C9. The mean follow-up period was 11.0 months (range: 3 to 26 months). Twenty-one (87.5%) patients had attached retinas at the final followup visit. Visual acuity improved in all patients following surgery (P < .05). Triamcinolone acetonide may have potential as an adjuvant in the treatment of retinal detachment with PVR. Further research is required to evaluate the efficacy of this adjuvant treatment.