Intravitreal Triamcinolone Injection Research Articles

A study comparing ranibizumab monotherapy versus ranibizumab plus dexamethasone combination therapy for treatment of diffuse diabetic macular edema

Purpose The aim of the study was to evaluate the hypothesis that combination therapy of intravitreal ranibizumab and dexamethasone would be more effective than ranibizumab monotherapy in patients with diffuse diabetic macular edema (DME). Patients and methods The study included 24 eyes of 24 patients with center-involved DME. The study included eyes with central foveal thickness greater than 300 μm on cross-hair protocol, diffuse macular thickening of greater than two disc-areas on slit-lamp biomicroscopy. Eligible study participants in this prospective, nonrandomized, comparative, interventional case series were divided into two groups. The first group was chosen to receive 0.5 mg/0.05 ml ranibizumab, whereas the other group was chosen to receive 0.4 mg/0.1 ml intravitreal dexamethasone (IVD) and 0.5 mg/0.05 ml ranibizumab. Exclusion criteria included: (a) eyes with previous treatments (such as focal laser therapy, vitrectomy, and intravitreal injection of triamcinolone or antivascular endothelial growth factor injections) beyond a 6-month period; (b) evidence of proliferative diabetic retinopathy on fundus fluorescein angiography or clinical examination; (c) any evidence of macular ischemia on fundus fluorescein angiography; (d) presence of a taut posterior hyaloid, vitreomacular traction or epiretinal membrane on optical coherence tomography (OCT); and (e) presence of subfoveal hard exudates. All patients were followed up for 6 weeks postinjection; changes of retinal thickness, visual acuity, and intraocular pressure were evaluated. Results Twelve eyes of 12 patients were treated with ranibizumab (group 1), and 12 eyes of another 12 patients were treated with IVD + ranibizumab (group 2). In group 1, the postinjection central macular thickness showed a statistically significant improvement from a baseline of 500.1 ± 40.1 to 456.7 ± 28.4 μm (reduction of 43.4 μm, P P Conclusion A single injection of intravitreal ranibizumab (IVR) demonstrated similar efficacy compared with IVD + ranibizumab in terms of OCT macular thickness reduction in selected cases of diffuse DME after 6-week follow-up.

Short-term effect of a single intravitreal injection of bevacizumab (Avastin) alone, triamcinolone alone, or in combination, followed by macular grid laser photocoagulation on diffuse diabetic macular edema

Purpose This study aimed to perform a short-term evaluation of best-corrected visual acuity (BCVA) and assess improvement central foveal thickness (CFT) in patients with diffuse diabetic macular edema (DME) after an intravitreal injection of triamcinolone alone, bevacizumab (Avastin) alone, or a combination of both, followed by modified grid macular laser photocoagulation. Study design This was a randomized prospective interventional study. Materials and methods This was a randomized prospective interventional study that included 90 eyes of 78 patients with diffuse DME, divided into three groups of interventions: group A received a single intravitreal triamcinolone injection, group B received a single bevacizumab (Avastin) injection, and group C received a single injection of both, followed by a modified grid macular laser photocoagulation 2 weeks after the injection. Patients were observed for a 6-month period and their BCVA, intraocular pressure (IOP), and CFT were recorded. Results In group A, the mean preoperative BCVA was 0.17 ± 0.15 and 0.345 ± 0.211 decimal at 6 months, in group B, the mean preoperative BCVA was 0.245 ± 0.162 and 0.462 ± 0.171 decimal at 6 months, and in group C, the mean preoperative BCVA was 0.238 ± 0.152 and 0.617 ± 0.200 decimal at 6 months, with a statistically significant improvement in all groups throughout the follow-up period ( P In group A, the mean preoperative CFT was 458.17 ± 79.4 μm and at 6 months the mean CFT was 358.53 ± 74.92 μm. In group B, the mean preoperative CFT was 398.40 ± 41.17 μm and at 6 months, the mean CFT was 335.10 ± 46.99 μm. In group C, the mean preoperative CFT was 388.00 ± 43.61 μm, and at 6 months, the mean CFT was 304.37 ± 54.44 μm. Statistical analysis of the difference in CFT between 3 and 6 months showed that there was no statistical difference between groups A and B ( P = 0.6), but there was a statistically significant difference when comparing groups A and C ( P = 0.006) and also when comparing groups B and C ( P = 0.003). Conclusion Combined Avastin and triamcinolone intravitreal injection, followed by modified grid macular photocoagulation led to more stable improvement in the treatment of eyes with diffuse DME.

Comparison of Injection of Intravitreal Drugs with Standard Care in Macular Edema Secondary to Branch Retinal Vein Occlusion

PurposeTo compare the long-term efficacy and safety of intravitreal triamcinolon with or without rescue laser therapy (intravitreal triamcinolone injection [IVTA] group), bevacizumab with or without rescue laser treatment (intravitreal bevacizumab injection [IVB] group), or a combination of both with or without rescue laser therapy (IVTA + IVB group), with standard care for patients with macular edema secondary to branch retinal vein occlusion (BRVO).MethodsWe reviewed the medical records of 151 patients treated with intravitreal injection with or without rescue laser for treatment of macular edema caused by BRVO, and who were followed up at 1, 3, 6, 12, and 24 months. During the observation period, rescue grid laser or repeated intravitreal injection with initial drug was performed if recurrence of macular edema was confirmed. Visual acuity, change in visual acuity, and intraocular pressure were compared in each phase.ResultsTotals of 16%, 5.6%, and 0% of participants in the three groups showed significant visual loss of more than three lines of the Snellen chart at last follow-up. The IVTA group was the least effective treatment modality, with statistical significance. The development rates of elevated intraocular pressure were similar among the groups.ConclusionsAlthough IVTA yielded effects similar to those of standard grid photocoagulation based on the Standard Care vs Corticosteroid for Retinal Vein Occlusion study, IVB or IVTA + IVB with or without rescue laser treatment resulted in improvement in visual acuity at 24 months after the start of treatment and was associated with few serious adverse side effects. Thus, these approaches could be useful for treating macular edema arising secondary to BRVO.

Intravitreal versus subtenon injection of triamcinolone acetonide for diabetic macular edema

ObjectiveThe aim of this study was to compare the results of intravitreal injection with subtenon injection of triamcinolone in diabetic macular edema (DME).BackgroundTriamcinolone injection for DME.Patents and methodsThe study is a prospective randomized clinical trial including 80 eyes of patients with DME. Patients were divided into two groups: group I and group II. Group I (73.1% men and 26.9% women; mean age 55.7 ± 7.2 years) included 40 eyes that received 4 mg of intravitreal triamcinolone acetonide injection. Group II (65.5% men and 34.5% women; mean age 55.8 ± 7.9 years) comprised 40 eyes that received 40 mg of subtenon triamcinolone acetonide injection. The patients were followed up after 1 week and 1, 3, and 6 months later to assess best-corrected visual acuity, intraocular pressure, and macular thickness. Fluorescein angiography and optical coherence tomography were used to evaluate the improvement.ResultsThere was a statistically significant difference between the studied groups at 1 week and 1 month (P < 0.05) and no significant difference at 3 and 6 months (P > 0.05) as regards their post-treatment outcome for visual acuity, and there was no statistically significant difference between the studied groups at 1 and 6 months (P > 0.05) as regards their post-treatment outcome for macular thickness.ConclusionBoth intravitreal and subtenon triamcinolone injections cause a significant increase in visual acuity; the effect is early and more pronounced in the intravitreal group but subtenon injection is safer.

Scleral fixation of intraocular lenses using scleral tunnel

PurposeThe aim of the study was to study the outcome of scleral fixation of intraocular lenses (IOL) using scleral tunnel in cases of inadequate capsular support using the two-point technique.The postoperative outcomes include IOL stability, centeration, and stitch exposure.Patients and methodsThis was a prospective randomized controlled study that included 25 eyes of 20 patients. Surgery was performed only when the IOL was posteriorly dislocated or sublaxated or in patients who were left aphakic for a secondary implantation procedure.A modification of the technique using scleral tunnel was carried out, which made the procedure faster, with good centeration and sutures coverage.ResultsThe mean follow-up after surgery was 9 months (5-13).IOL centeration: we classified centeration into three groups: group A included 21 patients (84%), group B included three patients (12%), and group C included one patient (4%). Stitch exposure was observed in three patients (12%). No cases of postoperative dislocation of the fixated IOL were observed.We did not include VA in the results because of different indications of the surgery that will affect the VA in every patient leading to incorrect results.One case of postoperative macular edema was treated with single intravitreal injection of triamcinolone, whereas one case of vitreous hemorrhage resolved spontaneously.No cases of retinal detachment were observed.ConclusionScleral fixation of IOL using scleral tunnel is a fast technique with adequate IOL centeration and suture coverage with minimal postoperative complications.

Intravitreal bevacizumab (Avastin) versus triamcinolone (Volon A) for treatment of diabetic macular edema: one-year results

The objective was to compare retinal morphology and function following intravitreal injections of bevacizumab (Avastin) or triamcinolone (Volon A) in patients with early diabetic macular edema (DME). The study was planned as a randomized, prospective, interventional clinical trial. A total of 30 diabetic patients with treatment-naïve, clinically significant macular edema were included in this study and randomized to two equal groups. One group initially received three injections of 2.5 mg bevacizumab in monthly intervals. The second group received a single injection of 8 mg triamcinolone, followed by two sham interventions. Functional and anatomic results were evaluated monthly using ETDRS vision charts and spectral-domain optical coherence tomography. According to the study protocol, retreatment after 3 months was dependent on functional and anatomic outcome in a PRN regimen. Baseline best corrected visual acuity (BCVA) was 0.30 logMAR and central retinal subfield thickness (CSRT) was 505 μm in the bevacizumab group and 0.32 logMAR and 490 μm CSRT in the triamcinolone group. After 3 months, BCVA improved to 0.23 logMAR (bevacizumab) and 358 μm CRST and 0.26 logMAR (triamcinolone) and 308 μm CSRT. After 12 months, BCVA further recovered in the bevacizumab group (0.18 logMAR) but slightly decreased in the triamcinolone group (0.36 logMAR). Intravitreal bevacizumab and triamcinolone are both equally effective in reducing CSRT in early DME. After 6 months, rehabilitation of vision was comparable in both treatment arms, whereas at the final follow-up at month 12, BCVA was superior in the bevacizumab than in the triamcinolone sample. This may be related to cataract development following steroid treatment, as well as to substance-specific mechanisms within the angiogenic versus the inflammatory cascade.

Evolução da esclerite nodular com biomicroscopia ultrassônica: relato de caso

To establish evolutionary pattern of a case of nodular scleritis with high frequency ultrasound during treatment. Twenty-seven year old female, initial manifestation of intermediate uveitis, bilateral macular edema after clinical treatment with topical and oral steroids. After four months, we observed the formation of a scleral nodule in the right eye when patient underwent high frequency ultrasound (Paradigm, 50 MHz transducer, immersion technique). The lesion in right eye was characterized at high frequency ultrasound as a nodular lesion located at the anterior inferior temporal wall associated with localized reduction of scleral thickness. After intravitreal injection of triamcinolone for treatment of macular edema, clinical regression of the scleral nodule was observed in right eye, maintaining reduced scleral thickness. High frequency ultrasound assisted in the diagnosis of nodular scleritis during the phases of treatment and in the identify its characteristic sequel feature, the scleral thinning.

Subtenon injection of natural leukocyte interferon α-2a in diabetic macular edema: a case report

BackgroundTo report the effect of subtenon injections of natural leukocyte interferon α-2a (IFNα) on best corrected visual acuity (BCVA) and central macular thickness (CMT) in a patient with diabetic macular edema (DME).Case presentationA 66-year-old man affected by DME, with glycated hemoglobin (HbA1c) at 6.9%, refractory to laser grid treatment and intravitreal injections of triamcinolone, was selected to receive a cycle of three subtenon injections/week of IFNα (1×106 IU/ml). BCVA and CMT, using spectral domain ocular coherence tomography (SD-OCT), were evaluated preoperatively and at 1 week, 1 month, 4 months, and 1 year postoperatively. BCVA and CMT were significantly improved at 1 week after the three injections (20/200 vs. 20/40 and 498 μm vs. 237 μm, respectively). BCVA remained stable during the 1-year follow-up. CMT was slightly increased, but was still lower than the baseline value (215 μm, 255 μm, and 299 μm during the follow-up visits). No adverse events were recorded, with the exception of mild subconjunctival hemorrhage at the injection site.ConclusionsIFNα, with its immunomodulatory, anti-proliferative and anti-angiogenic actions, was effective in improving BCVA and reducing CMT in refractory DME. Further randomized controlled studies are required to assess the effect of IFNα alone or in combination with other therapies for DME treatment.

Evaluation of Contrast Sensitivity after Single Intravitreal Triamcinolone Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose. To evaluate visual acuity (VA), contrast sensitivity (CS), and central retinal thickness (CRT) after intravitreal triamcinolone acetonide (IVT) injection for macular edema secondary to branch retinal vein occlusion (BRVO). Methods. In this prospective study, a total of 21 eyes of 21 patients were included. VA, CS, and CRT were assessed at baseline and at 1, 3, and 6 months after a single IVT injection. Results. Mean age was 64.57 ± 8.34 years. The mean baseline VA (LogMAR) increased from 1.11 ± 0.63 to 0.55 ± 0.39 (P < 0.001), 0.60 ± 0.40 (P < 0.001), and 0.78 ± 0.39 (P = 0.07) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 1 meter improved from 0.66 ± 0.49 to 1.11 ± 0.32 (P < 0.001), 0.99 ± 0.38 (P < 0.001), and 0.72 ± 0.37 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 3 meters improved from 0.34 ± 0.41 to 0.74 ± 0.41 (P < 0.001), 0.64 ± 0.44 (P = 0.036), and 0.46 ± 0.49 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CRT decreased from 511 ± 146 μm to 242 ± 119 μm, 277 ± 131 μm, and 402 ± 166 μm at 1, 3, and 6 months after IVT (P < 0.001 for each). Conclusion. Single IVT injection improved VA and CS and reduced CRT at 1 and 3 months of treatment. VA and CS returned to baseline levels at 6 months.

MACULAR LASER GRID ALONE VERSUS COMBINED WITH INTRAVITREAL TRIAMCINOLONE PLUS BEVACIZUMAB FOR DIABETIC MACULAR EDEMA

Diabetic retinopathy is the leading cause of blindness among individuals of working age in advanced societies, most of the vi sion loss resulting from diabetic macula r edema (DME) . Macular laser photocoagulation or i ntravitreal tiamcinolone or anti - vascular endothelial growth factor injection are modalities of therapy for diabetic macular edema. T his study aim was to present the clinical outcomes of 60 eyes of 41 patie nts with diffuse DME who treated with macular laser grid (MLG) alone or combined with intravitreal triamcinolone (IVTA) and intravitreal bevacizumab (IVB) injection. Thirty eyes (group1) treated with MLG and 30 eyes (group 2) treated with MLG + IVB + IVTA. The values of BCVA, central macular thickness ( CMT ) , intraocular pressure ( IOP ) and complications were compared between two groups. At baseline, BCVA was 0.35 ± 0,18 LogMAR (logarithm of the minimum angle of resolution ) in the group 1 and 0.36 ± 0.36 ± 0. 14 logMAR in the group 2. At 6 and 20 months after initial treatment in both groups had no significant improvement in BCVA, whereas had a significan t improvement in CMT (p < 0.001) compared with baseline. An increase in IOP was present in 13 % and cataract was developed in 6.7 % in the group 2. At 6 th and 20 th month , MLG and MLG + IVTA + IVB provided improvement of BCVA and CMT in the both groups . There was no significant difference in BCVA and CMT betwee n two groups. Increased IOP and devel opment of catar act was recorded i n the group 2 secondary to IVTA . MLG may be preffer ed for treatment of DME because of side events of IVTA + IVB.

Resolution of diabetic papillopathy with a single intravitreal injection of bevacizumab combined with triamcinolone acetonide

Dear Editor, As we know, diabetic papillopathy (DP) is an uncommon condition in diabetic patients, and traditionally considered to be a self-limiting disease [1]. In recent case reports, treatment with a single injection of intravitreal triamcinolone acetate or intravitreal inhibitor of vascular endothelial growth factor was effective in reducing disc swelling and shortening the course [2–6]. However, self-healing cases and treated cases are rare in optic atrophy, which results in best-corrected visual acuity (BCVA) not reaching 1.0 (leading BCVA only reached 0.8). We reported a case of diabetic papillopathy that demonstrated a rapid and complete visual recovery when intravitreal bevacizumab was administered with an intravitreal triamcinolone injection. A 37-year-old Chinese male with a 9-year history of poorly controlled Type 2 diabetes mellitus presented with a 1-month history of decreased vision without pain in his right eye. Six months earlier, the patient had undergone grid pattern retinal photocoagulation, and received oral prednisone in doses decreasing from 30 mg per day for 3 weeks for clinically significant optic swelling in his left eye. His BCVA was 0.2 in the right eye (OD) and 0.4 in the left eye (OS). The intraocular pressure (IOP) was 17 mmHg in both eyes (OU). There was no afferent pupillary defect. An anterior segment examination was unremarkable. A posterior segment examination showed mild non-proliferative diabetic retinopathy without macular edema and a pale optic disc OS. An OD fundus examination was significant for a swollen optic disc (Fig. 1a). Optical coherent tomography (OCT) revealed a significant increase in retinal nerve fiber layer (RNFL) thickness without macular edema (Fig. 1b). Glycosylated hemoglobin was 11.2 %. Arterial blood pressure was 118/70 mmHg. An MRI scan of the brain was normal. A diagnosis of DP was made in the right eye. After receiving consent from the patient for a trial of triamcinolone and off-label use of bevacizumab, the patient received an intravitreal injection of bevacizumab (1.25 mg/0.05 ml) and triamcinolone (4 mg/0.1 ml). One week post-injection, the patient’s visual acuity OD had improved to 0.8, and the disc swelling disappeared. Six weeks post-injection, his visual acuity had improved to 1.0, and a fundus examination revealed no disc swelling (Fig. 1c and d). One year after the injection, the right eye visual acuity remained at 1.0 with normal IOP. In the case of the 37-year-old Chinese male, we used a combination of anti-VEGF and anti-inflammatory therapies to treat the DP. Compared with reports of single anti-VEGF [4–6] or anti-inflammatory [2, 3] treatment cases, this patient experienced a more rapid visual improvement 1 week after the intravitreal injection, and his BCVA improved from 0.2 J. Feng : J.<F. Qu :Y.<R. Jiang (*) Department of Ophthalmology, People’s Hospital, Peking University, 11 Xizhimen South Street, Xicheng District, 100044 Beijing, China e-mail: drjyr@vip.sina.com

Therapeutic dilemma in serpiginous choroiditis

A 43-year-old woman had blurred vision in the left eye for 4 years. Her best-corrected visual acuity was 20/20 in the right eye and 20/200 in the left eye. The fundus showed grayish-yellow, jigsaw-puzzle-shaped lesions at the level of the retinal pigment epithelium and choriocapillaries emanating from the optic nerve head in both eyes. Fluorescein angiography showed late leakage in active lesions and hypofluorescence in hyperpigmented areas. Oral prednisolone and cyclosporine were given first. However, after posterior subtenon triamcinolone injections in both eyes and one intravitreal triamcinolone injection in the left eye, macular edema worsened. Steroid-induced central serous chorioretinopathy was suspected, so we tapered prednisolone rapidly and changed to azathioprine. Subsequent optical coherence tomography demonstrated retinal pigment epithelial detachment in the right eye subsided gradually. Fundus autofluorescence imaging showed progressively quiescent lesions. Unfortunately, acute myocardial infarction, atrial fibrillation, and ischemic stroke developed after 6 weeks azathioprine. In the acute phase of serpiginous choroiditis, corticosteroids are most commonly used. However, steroid therapy may be complicated with steroid-induced central serous chorioretinopathy. When we shift to other systemic immunosuppressive regimens, such as azathioprine, the possibility of acute myocardial infarction should be kept in mind.

INTRAVITREAL DICLOFENAC VERSUS INTRAVITREAL TRIAMCINOLONE FOR THE TREATMENT OF UVEITIC CYSTOID MACULAR EDEMA.

PURPOSE:: To compare the effect of intravitreal diclofenac (IVD) versus intravitreal triamcinolone (IVT) on refractory uveitic cystoid macular edema. METHODS:: In this pilot, randomized, clinical trial, 15 eyes were randomly assigned to IVD group, patients (8 eyes) who received a single intravitreal injection of diclofenac (500 μg/0.1 mL), and IVT group (7 eyes) patients who received a single intravitreal injection of triamcinolone (2 mg). Change in best-corrected visual acuity in logarithm of the minimum angle of resolution at Week 36 was the primary outcome measure. Secondary outcomes included changes in best-corrected visual acuity (BCVA) at 12 weeks and 24 weeks, central macular thickness, macular leakage, and potential injection-related complications. RESULTS:: In the IVD group, BCVA was more than the baseline values in 4 eyes at 36 weeks; however, within-group analysis disclosed no statistically significant changes in the mean BCVA in this group. Nonetheless, in the IVT group, mean BCVA improved significantly at 12, 24, but not at 36 weeks compared with the baseline values. It was 0.86 ± 0.37 at baseline and 0.63 ± 0.48, 0.62 ± 0.42, and 0.43 ± 0.49 logarithm of the minimum angle of resolution at 12, 24, and 36 weeks, respectively. Mean central macular thickness diminished also significantly only in the IVT group. Nevertheless, comparing the mean BCVA and central macular thickness changes, macular leakage, and the occurrence of any injection-related complications, no significant difference was observed between the groups at any of the follow-up visits. CONCLUSION:: This pilot study demonstrated the superiority of IVT over IVD in the treatment of refractory uveitic cystoid macular edema regarding both functional and anatomical outcomes. Further studies are warranted to confirm potential benefit of IVD observed in this study.

A Pilot Study of Intravitreal Diclofenac versus Intravitreal Triamcinolone for Uveitic Cystoid Macular Edema

Purpose: To compare the effect of intravitreal diclofenac (IVD) versus intravitreal triamcinolone (IVT) on refractory uveitic cystoid macular edema (CME).Methods: In this pilot randomized clinical trial, 15 eyes were randomly assigned to an IVD group, patients (8 eyes) who received a single intravitreal injection of diclofenac (500 μg/0.1 mL), and an IVT group (7 eyes), cases who received a single intravitreal injection of triamcinolone (2 mg). Change in best-corrected VA in logMAR at week 36 was the primary outcome measure. Secondary outcomes included changes in best-corrected visual acuity (BCVA) at 12 and 24 weeks, central macular thickness (CMT), macular leakage, and potential injection-related complications.Results: In the IVD group, BCVA was more than the baseline values in 4 eyes at 36 weeks; however, within-group analysis disclosed no statistically significant changes in the mean BCVA in this group. Nonetheless, in the IVT group, mean BCVA improved significantly at 12, 24, and 36 weeks compared to the baseline values. It was 0.86 ± 0.37 at baseline and 0.63 ± 0.48, 0.62 ± 0.42, and 0.43 ± 0.49 logMAR at 12, 24, and 36 weeks, respectively. Mean CMT reduction diminished also significantly only in the IVT group. Nevertheless, comparing the mean BCVA and CMT changes, macular leakage, and the occurrence of any injection-related complications, no significant difference was observed between the groups at any of the follow-up visits.Conclusion: This pilot study demonstrated the superiority of IVT over IVD in the treatment of refractory uveitic CME regarding both functional and anatomical outcomes. Further studies are warranted to confirm potential benefit of IVD observed in this study.

ASSOCIATION OF OCT ANGLE RECESS WIDTH WITH IOP RESPONSE AFTER INTRAVITREAL TRIAMCINOLONE INJECTION

A circumferential pretrabecular anatomical structure, the angle recess (AR), can be imaged with anterior segment ocular coherence tomography. AR's utility to predict ocular hypertension after intravitreal triamcinolone injection was assessed. All intravitreal triamcinolone injection recipients from 2002 to 2005 with high-resolution anterior segment ocular coherence tomography images had AR width (between the anteriormost prominence of the iris root and posterior cornea) measured by masked physicians using the caliper function of Stratus ocular coherence tomography. Intraocular pressures (IOPs) from 1 month before to 6 months after the injection were compiled for IOP rise (Δ) and maximal IOP (max), categorized as "minimal" (IOPmax < 21 mmHg and/or IOPΔ ≤ 5 mmHg), "moderate" (IOPmax 21-29 mmHg and/or IOPΔ 6-14 mmHg), or "severe" (IOPmax ≥ 30 mmHg and/or IOPΔ ≥ 15 mmHg). Linear regression and analyses of variance were applied. Twenty-six eyes satisfied the entry criteria, with 11 (42%) eyes demonstrating minimal, 11 (42%) moderate, and 4 (15%) severe IOP responses. The corresponding (mean ± SEM) AR widths were: 326 ± 31.5 μm, 281 ± 22.0 μm, and 138 ± 20.3 μm, respectively. Highly significant AR width differences existed between moderate and severe responders and between minimal and severe responders (both P < 0.004); 5 of 6 patients with IOP ≥ 29 mmHg had AR < 200 μm. These findings indicate that a potentially clinically useful relationship exists between AR width and IOP elevation accompanying intravitreal triamcinolone injection. Anterior segment screening could become a beneficial extension of ocular coherence tomography for retinal practices.

Single injection of triamcinolone versus three repeated injections of bevacizumab for treatment of diabetic macular edema

To compare the effect of a single intravitreal injection of triamcinolone acetonide versus three consecutive monthly intravitreal injections of bevacizumab for the treatment of diabetic macular edema (DME). Forty patients treated with a single intravitreal injection of 4mg triamcinolone acetonide (triamcinolone group) were compared with 40 patients treated with three consecutive monthly intravitreal injections of 1.25mg bevacizumab (bevacizumab group). The triamcinolone group showed a significant decrease in mean central retinal thickness (CRT) from 472.5μm±120.35 to 374.0μm±152.31 after 3 months (p < 0.001). The bevacizumab group also showed a significant reduction in CRT from 464.5μm±115.3 to 370.0μm±142.31 (p<0.001). The triamcinolone group displayed an increase in best-corrected visual acuity (BCVA) following a single intravitreal triamcinolone acetonide injection from a mean of +0.70±0.17 logMAR to a mean of +0.54±0.38 logMAR after 3months (p<0.05). The bevacizumab group also showed an increase in BCVA following three injections of bevacizumab from a mean of +0.73±0.28 logMAR to a mean of +0.57±0.33 logMAR (p<0.05). Statistical analysis showed no significant difference between both groups at 3months. Our study showed that a single intravitreal injection of triamcinolone is as effective as three consecutive monthly intravitreal injections of bevacizumab for treatment of DME with regard to BCVA and CRT measured by optical coherence tomography. Despite the recent popularity of bevacizumab, three injections are no more effective than a single injection of triamcinolone for the treatment of DME.

Traumatic chorioretinal folds treated with intra-vitreal triamcinolone injection

A 34-year-old male visited the hospital due to decreased visual acuity in the left eye following an injury from a car accident. In the left eye, best-corrected visual acuity (BCVA) was hand motion and intraocular pressure (IOP) was 8 mmHg. Choroidal vasodilation and chorioretinal folds were observed by spectral domain-optical coherence tomography (SD-OCT). Topical and systemic steroid treatments did not improve the chorioretinal folds. Twelve months after the injury, intra-vitreal triamcinolone (4 mg/0.1 ml) was injected. Six months after intra-vitreal triamcinolone injection, BCVA in the left eye had improved to 20/100. Fundus examination showed improvement in retinal vascular tortuosity and SD-OCT revealed improvements in choroidal vasodilation and chorioretinal folds. Intra-vitreal triamcinolone injection (IVTI) was effective against traumatic chorioretinal folds with no recurrence based on objective observation by fundus photography and SD-OCT.

Scleral abscess after intravitreal bevacizumab and triamcinolone injection

We report a case of 61-year-old male who presented with scleral abscess, an unusual complication following intravitreal bevacizumab and triamcinolone injection. Patient was presented with redness, pain, foreign body sensation, and swelling in left eye 1 week post-intravitreal injection for second opinion. We treated him with topical and oral antibiotics. In our case, the small, localized abscess was confined to the site of the intravitreal injection, required no surgical intervention, and resolved on oral and topical antibiotics. To the best of our knowledge, scleral abscess has not been reported in literature as complication post-intravitreal injection, hence we report this case.

Vogt-Koyanagi-Harada Disease in a Pregnant Patient Successfully Treated with Intravitreal Triamcinolone Injection

Vogt-Koyanagi-Harada Disease in a Pregnant Patient Successfully Treated with Intravitreal Triamcinolone Injection

Adjuvant treatment modalities to control macular edema in diabetic patients undergoing cataract surgery

Cataract surgical outcomes in diabetic patients has been subject to changes with the advances in the surgical techniques. Recent studies suggest that cataract surgery does not cause the progression of diabetic retinopathy and intravitreal bevacizumab and/or triamcinolone injections combined with cataract surgery may contribute in short term improvement of macular edema in diabetic patients. This article reviews the progression of diabetic retinopathy after cataract surgery with phacoemulsification and the use of adjuvant intravitreal treatments combined with phacoemusification in diabetic patients undergoing cataract surgery.