Intravitreal Triamcinolone Acetonide Group Research Articles

A prospective randomized clinical trial comparing nepafenac, intravitreal triamcinolone and no adjuvant therapy for epiretinal membrane.

To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA). Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation. Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively). Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.

Prospective study of intravitreal triamcinolone acetonide versus bevacizumab with or without laser for macular edema secondary to retinal vein occlusion

Objective: To assess difference in visual outcome, macular thickness and need for laser treatment in patients receiving intravitreal triamcinolone acetonide or bevacizumab for macular oedema secondary to retinal vein occlusion. Design: Open labeled prospective randomised controlled trial, evaluating 38 retinal vein occlusion patients. 19 patients each were assigned, to Intravitreal Triamcinolone Acetonide (IVTA) and Bevacizumab (IVB) group. Methodology: Baseline ocular parameters like best corrected visual acuity (BCVA), intraocular pressure (IOP) by Applanation tonometry, fundus examination using indirect ophthalmoscope, slit lamp biomicroscopy, Ocular Coherence Tomography of the macula and Fundus Flourescein Angiography performed. Under aseptic conditions, Injection of 4 mg (0.1 ml) Triamcinolone Acetonide (Kenacort) or 1.25 mg (0.05 ml) Bevacizumab (Avastin) was injected into the vitreous. Patients were given re-injections or laser treatment according to requirement. BCVA and IOP at 15 days, 1, 3 and 6 months post injection was recorded. OCT and FFA were repeated at 3 and 6 month. Outcome: At 6 months, patients with BRVO receiving IVTA, there was significant improvement in visual acuity (p = 0.014), as well as decrease in macular edema (p ≈ 0.000), whereas patients of BRVO in the IVB group did not show significant improvement in visual acuity (p= 0.375). Visual acuity of CRVO patients in the IVTA (p = 0.178) and IVB (p = 0.109) group did not show any significant improvement. Though there was significant decrease in macular edema in both IVTA (p ≈ 0.000) and IVB (p =0.042) groups. No significant increase in IOP was noted in either IVTA (p= 0.089) or IVB (p = o.637).Results and Conclusion: The results show a favourable influence of IVTA on BCVA at 6 months.Positive effect in decreasing central macular thickness (CMT) was observed in patients receiving IVTA and IVB.FFA guided laser photocoagulation helps in stabilizing the visual acuity and prevents vision threatening complications. Changes in OCT can be used to monitor patient response to treatments for CRVO related macular oedema. Summary: IVTA injection when combined with FFA guided laser in BRVO eyes showed most favourable outcome in terms of both visual improvement and CMT during follow up period of 6 months.

Long-term Results of Ranibizumab, Dexamethasone Implant, and Triamcinolone in Macular Edema due to Branch Retinal Vein Occlusion.

Objectives:The present study aims to compare the long-term efficacy and safety results of intravitreal ranibizumab (RAN), dexamethasone intravitreal implant (DEX) and intravitreal triamcinolone acetonide (IVTA) injections in macular edema due to branch retinal vein occlusion (BRVO).Methods:In this retrospective study, one eye each of 43 patients who were treated with intravitreal injections for macular edema secondary to BRVO was recruited into one of the study groups: RAN group (n=17), DEX group (n=16) and IVTA group (n=10). All patients were followed-up for 12 months. Best-corrected visual acuity (BCVA), central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and intraocular pressure (IOP) at month 1, 3, 6, and 12 were compared with baseline.Results:The BCVA increased significantly in the RAN and DEX groups at all visits (all p<0.05). BCVA increase in the IVTA group was significant only at month 1 and 6. CMT decreased significantly in all groups at the end of one year of follow-up (p=0.007; p=0.001; p=0.044, respectively). SFCT significantly decreased in all groups at month 1 (all p<0.05). IOP significantly increased in none, 18.8%, 30% of the patients in the RAN, DEX and IVTA groups, respectively. Cataract surgery was performed in none of the patients, 6.3%, and 30% of the patients in the RAN, DEX, and IVTA groups, respectively.Conclusion:BCVA increase was more prominent in both of the RAN and DEX groups than in the IVTA group. DEX may decrease the injection burden; however, ranibizumab may be a safer choice.

Periocular Triamcinolone vs. Intravitreal Triamcinolone vs. Intravitreal Dexamethasone Implant for the Treatment of Uveitic Macular Edema: The PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) Trial

To evaluate the comparative effectiveness of 3 regional corticosteroid injections for uveitic macular edema (ME): periocular triamcinolone acetonide (PTA), intravitreal triamcinolone acetonide (ITA), and the intravitreal dexamethasone implant (IDI). Multicenter, randomized clinical trial. Patients with uveitic ME. Patients were randomized 1:1:1 to receive 1 of the 3 therapies. Patients with bilateral ME were assigned the same treatment for both eyes. The primary outcome was the proportion of baseline (PropBL) central subfield thickness (CST) at 8 weeks (CST at 8 weeks/CST at baseline) assessed with OCT by masked readers. Secondary outcomes included ≥20% improvement and resolution of ME, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) events over 24 weeks. All treatment groups demonstrated improved CST during follow-up. At 8 weeks, each group had clinically meaningful reductions in CST relative to baseline (PropBL: 0.77, 0.61, and 0.54, respectively, which translates to reductions of 23%, 39%, and 46% for PTA, ITA, and IDI, respectively). Intravitreal triamcinolone acetonide (PropBL ITA/PropBL PTA, hazard ratio [HR], 0.79; 99.87% confidence interval [CI], 0.65-0.96) and IDI (PropBL IDI/PropBL PTA, HR, 0.69; 99.87% CI, 0.56-0.86) had larger reductions in CST than PTA (P < 0.0001). Intravitreal dexamethasone implant was noninferior to ITA at 8 weeks (PropBL IDI/PropBL ITA, HR, 0.88; 99.87% CI, 0.71-1.08). Both ITA and IDI treatments also were superior to PTA treatment in improving and resolving uveitic ME. All treatment groups demonstrated BCVA improvement throughout follow-up. Both ITA and IDI groups had improvements in BCVA that was 5 letters greater than in the PTA group at 8 weeks (P < 0.004). The risk of having IOP ≥24 mmHg was higher in the intravitreal treatment groups compared with the periocular group (HR, 1.83; 95% CI, 0.91-3.65 and HR, 2.52; 95% CI, 1.29-4.91 for ITA and IDI, respectively); however, there was no significant difference between the 2 intravitreal treatment groups. Intravitreal triamcinolone acetonide and the IDI were superior to PTA for treating uveitic ME with modest increases in the risk of IOP elevation. This risk did not differ significantly between intravitreal treatments.

Comparison of the Efficacy of Sub-Tenon versus Intravitreal Triamcinolone Acetonide Injection during Cataract Surgery for Diabetic Macular Edema

Purpose: We compared the efficacy of sub-Tenon triamcinolone acetonide (STTA) to intravitreal triamcinolone aceto­nide (IVTA) injections during cataract surgery (CS) for patients with diabetic macular edema (DME). Methods: The medical records of 33 eyes (26 patients) with DME which had undergone CS with STTA were compared to those of 34 eyes (27 patients) with DME which had undergone CS with IVTA. Central foveal thickness and best-corrected visual acuity (BCVA) were measured at the baseline and 1, 3, and 6 months after the surgery. Results: The BCVAs after STTA and IVTA were significantly improved at 3 and 6 months. Thirteen eyes in the IVTA group and 21 eyes in the STTA group required other therapies (p < 0.05). One case developed intraocular pressure elevation after IVTA and underwent selective la ser trabeculoplasty. Conclusions: Ophthalmologists should consider the merits and demerits of IVTA and STTA for DME treatment after CS.

Efficacy and Safety of Intravitreal Conbercept, Ranibizumab, and Triamcinolone on 23-Gauge Vitrectomy for Patients with Proliferative Diabetic Retinopathy.

Introduction To compare the effect and safety of intravitreal conbercept (IVC), intravitreal ranibizumab (IVR), or intravitreal triamcinolone acetonide (IVTA) injection on 23-gauge (23-G) pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Methods Fifty patients (60 eyes) of varying degrees of PDR were randomly grouped into 3 groups (1 : 1 : 1) (n = 20 in each group). The 23-G PPV was performed with intravitreal conbercept or ranibizumab injection 3–7 days before surgery or intravitreal TA injection during surgery. The experiment was randomized controlled, with a noninferiority limit of five letters. Main outcome measures included BCVA, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, and silicone oil tamponade. Results At 6 months after surgery, there were no significant differences of BCVA improvements, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, silicone oil tamponade, vitreous clear-up time, and the incidence of intraoperative bleeding between the IVC and IVR groups (all P values ≥ 0.05), but they were significantly different from the IVTA group (all P values < 0.05). IOP increases did not show significant differences between the IVC and IVR groups, but both were significantly different with the IVTA group. More patients had higher postoperative IOP in the IVTA group. Conclusions The intravitreal injection of conbercept, ranibizumab, or TA for PDR had a significant different effect on outcomes of 23-G PPV surgery. Conbercept and ranibizumab can reduce difficulty of the operation, improve the success rate of PPV surgery, and decrease the incidence of postoperative complications.

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.

Twenty-Four Months Follow-Up of Intravitreal Bevacizumab Injection Versus Intravitreal Triamcinolone Acetonide Injection for the Management of Persistent Non-Infectious Uveitic Cystoid Macular Edema

ABSTRACTPurpose: To report the efficacy of intravitreal bevacizumab (IVB) injection versus intravitreal triamcinolone acetonide (IVT) for persistent non-infectious uveitic cystoid macular edema (CME).Methods: Interventional retrospective comparative case series evaluated 37 consecutive patients (44 eyes) with completely controlled uveitis and recalcitrant CME. Patients received repeated injections of 1.25 mg of IVB or 4 mg of IVT.Results: Best-corrected visual acuity (BCVA) at baseline and 24 months was logMAR 1 and 0.8 respectively, in the IVB group (p = 0.002) and; logMAR of 1.1 and 0.6, in the IVT group (p = 0.001). Central macular thickness at baseline and 24 months was 399.2 µm and 333.7 µm (p < 0.0009), respectively, for the IVB group and; 464.4 µm and 316.5 µm in the IVT group (p = 0.044). Postoperatively, IOP increased in the IVT group.Conclusions: Repeated injections with IVT improve BCVA as effectively as repeated injections with IVB in the long-term management of persistent uveitic CME.

Comparison of treatment response to intravitreal injection of triamcinolone, bevacizumab and combined form in patients with central retinal vein occlusion: A randomized clinical trial.

BackgroundCentral retinal vein occlusion (CRVO), is the second-most common disorder after diabetic retinopathy that threatens the vision related to retinal vessels. One of the main reasons of vision loss is CRVO in acute and chronic forms.ObjectiveThe aim of this study was to investigate the response to intravitreal injection of triamcinolone, bevacizumab, and a combined form in patients with CRVO.MethodsThis study was a double-blinded randomized clinical trial conducted on patients with CRVO who were referred to the ophthalmology clinic of Urmia Imam Khomeini Hospital from May 2015 to May 2016. In total, ninety patients were divided into three groups using random numbers table. The first group received intravitreal triamcinolone acetonide (IVT) for treatment of macular edema due to CRVO, the second group received intravitreal bevacizumab (IVB) and the third group received a combination of IVT and IVB. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded and analyzed using optical coherence tomography system.ResultsIn this study a total of 90 eyes were studied, 41 case (45.55%) were male and 49 cases (54.44%) were female. The mean age of patients was 68.41±8.32 years. The mean score of final visual acuity was 0.293±0.11 in the IVT group, 0.25±0.10 in the IVB group and 0.48±0.15 in the IVB+IVT group. The differences between groups considering final visual acuity was significant (p<0.001). The mean thickness of final macular was 383.33±97.70 micrometer in IVT group, 386.33±136.79 micrometers in IVB group and 307.33±110.79 micrometers in IVT+IVB group which were significant (p=0.014).ConclusionUsing a combination of bevacizumab and triamcinolone in the treatment of central retinal vein occlusion compared with using each of them separately, had a better result and can be used as a solution in this disease.Trial registrationThe trial was registered at the Thai Registry of Clinical Trials (http://www.clinicaltrials.in.th) with the TCTR ID: TCTR20170612005.FundingThe authors received no financial support for the research, authorship, and/or publication of this article.

Intravitreal versus posterior subtenon injection of triamcinolone acetonide in treatment of diabetic macular edema

Purpose: The aim of the study was to compare the efficacy and safety of intravitreal triamcinolone acetonide (IVTA) versus posterior subtenon injection of triamcinolone acetonide (PSBTA) for diabetic macular edema (DME). Materials and Methods: The study design was a prospective, interventional, randomized controlled study. Participants: The study participants were 26 patients (Thirty eyes) with DME and central subfield thickness (CST) >250 μm. Intervention: Eyes were randomly assigned to two equal groups; Group A received a single 4 mg IVTA and Group B received a 40 mg PSBTA. Four patients had bilateral DME; they received IVTA in one eye and PSBTA in another eye. Main Outcome Measures: Changes in visual acuity (VA) and CST obtained using optical coherence tomography were measured during a 3-month follow-up. Potential treatment complications were monitored including change in intraocular pressure (IOP). Results: The mean preoperative CST was 393.7 ± 93.0 μm and 351.5 ± 56.4 μm in Group A and B, respectively. Both groups showed comparable significant improvement in CST and VA at 1 and 3 months postinjection compared to preoperative values. The mean CST in Group A was 282.2 ± 65.0 μm compared to 284.0 ± 59.0 μm in Group B at 1 month (P = 0.910) and 276.3 μm ± 71.1 compared to 260.2 μm ± 63.3 at 3 months (P = 0.519). The mean VA in LogMAR in both groups at 3 months was 0.47 ± 0.23 and 0.32 ± 0.29, respectively (P = 0.142), compared to preoperative VA of 0.80 ± 0.19 and 0.68 ± 0.23, respectively. The preoperative IOP was 13.80 ± 2.07 in the IVTA group and 13.07 ± 1.83 in the PSBTA group. IOP showed significantly higher elevation in the IVTA group at 1 and 3 months (19.4 mmHg ± 1.35 and 19.0 mmHg ± 1.36) compared to the PSBTA (16.5 mmHg ± 1.40 and 16.2 mmHg ± 1.50) (P = 0.000). No eyes had IOPs >21 mmHg. Conclusions: Posterior subtenon injection of TA is a safe and valid alternative to the intravitreal injection for the treatment of DME having a comparable effect on VA and CST, yet a lower risk of IOP elevation.

Incidence of anterior segment neovascularization during intravitreal treatment for macular edema secondary to central retinal vein occlusion.

To analyze the effects of injections of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) on the incidence rates of anterior segment neovascularization (ASN) and neovascular glaucoma (NVG) in patients with macular edema secondary to central retinal vein occlusion (CRVO). In this prospective, randomized, double-masked, sham-controlled study, 35 patients with macular edema following CRVO were randomized to intravitreal bevacizumab, intravitreal triamcinolone acetonide, or sham injections during the first 6 months of the study. The primary outcome was the incidence rate of ASN at month 6. The secondary outcomes were the mean changes from baseline in best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography over time to month 12. ASN developed in 8 (22.86%) eyes, including 5 (62.50%) eyes in the sham group and 3 (37.50%) eyes in the IVTA group, during 12 months of fol low-up (p=0.009). BCVA differed significantly (p<0.05) among the groups only at month 1. CFT did not differ significantly (p<0.05) among the groups over 12 months. NVG required surgery and developed in one eye despite laser treatment. Early treatment with intravitreal antivascular endothelial growth factor therapy decreases the rates of ASN and NVG after CRVO.

Factors correlated with the resolution of macular oedema after one dose injection of intravitreal triamcinolone acetonide treatment in branch retinal vein occlusion.

ObjectiveTo investigate the predictive baseline factors for a successful outcome following one dose of intravitreal triamcinolone acetonide (IVTA) in patients with macular oedema (ME) caused by branch retinal vein occlusion (BRVO).MethodsThis retrospective study enrolled patients with ME (macular retinal thickness [MRT] ≥ 300 µm) due to BRVO who still had ME 3 months after grid laser photocoagulation. Patients were divided according to treatment into an IVTA group and a laser-only group. The resolution of ME was documented at months 3 and 6.ResultsA total of 154 eyes with ME were investigated: IVTA group (90 eyes) and laser-only group (64 eyes). Predictive factors for successful IVTA treatment were younger age, shorter duration of ME, initial onset ME, accompanied by serous retinal detachment, few concomitant systemic diseases and nonischaemic BRVO. A broken foveal capillary ring was related to a poor treatment outcome. Eyes with cystoid spaces in the outer plexiform layer were more likely to have a good treatment response.ConclusionIVTA is effective for resolving ME due to BRVO after grid laser photocoagulation treatment.

Adjunctive Intravitreal Triamcinolone Acetonide Injection at the End of a Sutureless Phacovitrectomy for Diabetic Vitreous Hemorrhage

Purpose: This study aims to evaluate the visual outcome, clinical outcome and complications of intravitreal triamcinolone acetonide (IVT) injections at the end of a sutureless 23 G phacovitrectomy in diabetic patients with vitreous hemorrhage. Methods: This is a prospective comparative case study comprising 22 eyes that underwent a 23 G sutureless phacovitrectomy for diabetic vitreous hemorrhage (VH) with or without tractional retinal detachment (TRD). An IVT (4 mg/0.1 ml) injection was performed on 11 eyes at the end of the vitrectomy, and no injection was administered in 11 eyes. The main outcome measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP), and incidence of postoperative VH and reoperation in patients with at least three months of follow-up. Results: Early postoperative VH within one month occurred in (9.1%) of the IVT group and in (27.27%) of the control group. The rate of early postoperative VH was significantly reduced in the IVT group compared to the control group (p=0.006). Late postoperative VH after one month occurred in (18.18%) of the IVT group and in (27.27%) of the control group. No difference was noticed between the two groups (p=0.341). No difference in BCVA was noticed between the two groups at three ms (p>0.05). In the IVT group, The IOP on postoperative day 1 was higher than preoperative IOP (p=0.003). No significant difference in the rate of reoperation was noted between the two groups (p=0.285). Conclusions: Adjunctive IVT injections in diabetic phacovitrectomy reduced early postoperative VH; however, it did not affect the final visual outcome.

Comparison of intravitreal bevacizumab and triamcinolone acetonide theraphies for diffuse diabetic macular edema.

To compare therapeutic effects of intravitreal triamcinolone acetonide (IVTA) versus intravitreal bevacizumab (IVB) injections for bilateral diffuse diabetic macular edema (DDME). Forty eyes of 20 patients with bilateral DDME participated in this study. For each patient, 4 mg/0.1 mL IVTA was injected to one eye and 2.5 mg/0.1 mL IVB was injected to the other eye. The effects of injection for diabetic macular edema (DME) were evaluated using best-corrected visual acuity (BCVA), central macular thickness (CMT) by optical coherence tomography (OCT) and intraocular pressure (IOP) by applanation tonometer. Patients underwent eye examinations, including BCVA, CMT, and IOP at pre-injection, 1, 4, 8, 12 and 24wk after injection. During the follow-up, second injections were performed to eyes which have CMT greater than 400 µm at 12wk for salvage therapy. BCVA (logarithm of the minimum angle of resolution) at pre-injection, 1, 4, 8, 12 and 24wk after injection was 0.71±0.19, 0.62±0.23, 0.63±0.12, 0.63±0.13, 0.63±0.14 and 0.61±0.24 in the IVTA group and 0.68±0.25, 0.61±0.22, 0.60±0.24, 0.62±0.25, 0.65±0.26 and 0.59±0.25 in the IVB group, respectively. CMT (µm) at pre-injection, 1, 4, 8, 12 and 24wk after injection was 544±125, 383±96, 335±87, 323±87, 333±92, 335±61 in the IVTA group and 514±100, 431±86, 428±107, 442±106, 478±112, 430±88 in the IVB group respectively. Reduction ratios of mean CMT were 29% at 1wk, 38% at 4wk, 40% at 8wk, 38% at 12wk, and 38% at 24wk in the IVTA group. Second IVTA injections were performed to the 6 eyes (30%) at 12wk. Reduction ratios of mean CMT were 16% at 1wk, 17% at 4wk, 14% at 8wk, 7% at 12wk, and 16% at 24wk in the IVB group. Second IVB injections were performed to the 15 eyes (75%) at 12wk. This study showed earlier and more frequent macular edema recurrences in the eyes treated with bevacizumab compared with the ones treated with triamcinolone acetonide. Triamcinolone acetonide was found to provide more efficient and long-standing effect in terms of reducing CMT compared with the bevacizumab.

Protective effects of N-acetylcysteine on triamcinolone acetonide-induced lens damage in rats

Objective: To examine the relationship of cataract forming effect of intravitreal triamcinolone acetonide (IVTA) injection with oxidative status and the effect of N-acetylcysteine (NAC) on these alterations.Materials and methods: Twenty-six Wistar-Albino rats were included in the study. Rats were assigned into four groups as follows: intravitreal saline injection group (controls); IVTA injection group; IVTA + intraperitoneal NAC injection group (IVTA + NAC); and intraperitoneal NAC injection group (NAC). Triamcinolone acetonide was intravitreally injected at a dose of 1 mg. NAC was intraperitoneally injected at a dose of 150 µg/g body weight. Animals were sacrificed and lens specimens were analyzed for levels of malondialdehyde (MDA) and protein carbonyl (PC) and activities of glutathione (GSH) and glutathione peroxidase (GSH-Px).Results: We found that the MDA and PC levels of lenses were increased in the IVTA group (p < 0.01). It was seen that GSH and GSH-Px in lenses were decreased in the IVTA group (p < 0.01). NAC administration significantly ameliorated these changes in the IVTA + NAC group (p < 0.05).Conclusion: These results indicate that the NAC produces a protective mechanism against IVTA-induced cataract and suggest a role of oxidative stress in pathogenesis.

Comparison of Clinical Efficacy of Intravitreal Ranibizumab with and without Triamcinolone Acetonide in Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose: To compare visual outcomes and spectral-domain optical coherence tomography results following treatment with intravitreal ranibizumab (IVR) or IVR combined with intravitreal triamcinolone acetonide (IVTA) for macular edema (ME) secondary to central retinal vein occlusion (CRVO).Methods: This prospective, case-controlled study examined 57 eyes (57 patients) with ME secondary to CRVO, which were treated with IVR (0.5 mg, n = 30 eyes) or IVR (0.5 mg) and IVTA (1 mg, n = 27 eyes) as the initial therapy. Further intravitreal treatment was administered as necessary.Results: All 57 patients completed at least 6 months of follow-up. At baseline, mean ( ± standard error) best-corrected visual acuity (BCVA) was 45.8 ± 23.2 letters in the IVR group and 47.3 ± 19.3 letters in the IVR + IVTA group (p = 0.790). Significant improvement in BCVA over baseline was observed in both groups at all six study visits (IVR group: p = 0.0003, 0.0001, 0.0018, 0.0145, 0.0107, 0.005; IVR + IVTA group: p = 0.0001, 0.0001, 0.0004, 0.0068, 0.0007, 0.0002), with no significant BCVA differences between groups. Significant reduction in mean central subfield thickness, compared with baseline, was also observed in both groups at all six study visits (IVR group, p = 0.0001; IVR + IVTA group, p = 0.0001), with no significant difference between groups in the magnitude of macular thickness reduction. The mean number of injections was significantly higher (p = 0.0001) in the IVR group (4.23 ± 0.56) than in the IVR + IVTA group (3.42 ± 0.41).Conclusions: Treating ME secondary to CRVO with IVR or IVR + IVTA had similar effects on central macular thickness and BCVA in patients with ME secondary to CRVO over a 6-month follow-up period. The mean number of intravitreal injections was higher in the IVR group than in the IVR + IVTA group.

The comparison of intravitreal triamcinolone and bevacizumab in patients with macular edema secondary to branch retinal vein occlusion

PurposeThis study was conducted to compare the efficacy and safety of intravitreal triamcinolone acetonide (IVTA) and intravitreal bevacizumab (IVB) in the treatment of macular edema related to branch retinal vein occlusion (BRVO), using the new optical coherence tomography parameters.Material and methodsThe medical records of 62 patients (IVTA n=26; IVB n=36) with macular edema secondary to BRVO and at least 12 months follow-up between 2007 and 2011 were evaluated by within-group and inter-group comparisons.ResultsBoth groups were similar in terms of demographic characteristics (P>0.05). Best corrected visual acuity (BCVA) improvement and central subfoveal thickness (CST) reduction were significantly higher in the IVTA group at only the third month (P<0.05). In nonischemic BRVO, while BCVA improvement was significantly higher in the IVTA group at the third and sixth months (P<0.05), no significant difference was found in CST reduction at all visits (P>0.05). In ischemic BRVO, no significant difference was found in BCVA improvement at all visits, but CST reduction was significantly higher in the IVTA group at the first and third months. Logarithmic optical coherence tomography change (LogOCTc) and relative change in retinal thickness (RCRT) showed the same levels of significance in the comparisons. Relative change in retinal thickening (RCRTing) was more valuable compared to the other parameters in the subgroup analyses.ConclusionThere was no difference between groups at the 12th month. IVTA was more efficient than IVB in regard to BCVA improvement in nonischemic BRVO in the early follow-up. IVTA made significant retinal thinning compared to IVB in ischemic BRVO in the early period. RCRTing and LogOCTc are important parameters used to monitor the response to treatment in BRVO. Because of the similar levels of significance, RCRT and LogOCTc can be used interchangeably.

Comparison of the effects of intravitreal bevacizumab and triamcinolone acetonide in the treatment of macular edema secondary to central retinal vein occlusion

Aim:To compare the effects of intravitrealbevacizumab (IVB) and intravitreal triamcinolone acetonide (IVT) in the treatment of macular edema (ME) secondary to central retinal vein occlusion (CRVO).Materials and Methods:There were 20 patients treated with IVB (1.25 mg/0.05 mL) and 16 treated with IVT (4 mg/0.1 mL). The two groups were compared with regard to best-corrected visual acuity (BCVA), central macular thickness (CMT) on optical coherence tomography (OCT), slit-lamp biomicroscopy and fundus fluorescein angiography results, intraocular pressure (IOP), numbers of injections, and adverse events.Results:The mean follow-up times in the IVB and IVT groups were 17.45±8.1 months (range: 8–33 months) and 19.94±10.59 months (range: 6–40 months), respectively (P = 0.431). Visual acuity increased and CMT decreased significantly within both groups, but no differences were observed between the groups (P = 0.718). The percentages of patients with increased IOP and iatrogenic cataracts were significantly higher in the IVT group than in the IVB group.Conclusions:Treatment with IVB and IVT both resulted in significant improvement in visual acuity and a decrease in CMT in patients with ME secondary to non-ischemic CRVO, with no difference between the two treatments. The incidence of adverse events, however, was significantly greater in the IVT group than in the IVB group. IVB may be preferred over IVT for the treatment of ME in patients with non-ischemic CRVO.

Optical coherence tomography as a prognostic tool for visual improvement after management of diabetic macular edema

Objectives The aim of the study was to evaluate the role of optical coherence tomography (OCT) as a prognostic tool for visual improvement after management of diabetic macular edema (DME). Background OCT provides an easy quantitative assessment of the relationship between DME and visual acuity. Patients and methods Fifty eyes affected with DME were treated and followed up for 6 months. The main outcome measures were best corrected visual acuity (BCVA) and central macular thickness (CMT) in addition to photoreceptor integrity changes, which were measured using OCT at 1 month and 6 months after treatment. Result After treatment of DME, follow-up at 1 month revealed that the mean CMT was significantly higher among patients in the panretinal photocoagulation (PRP) + intravitreal triamcinolone acetonide (IVTA) + grid group compared with the patients in the grid + PRP group ( P = 0.001), focal + PRP group ( P = 0.01), and focal management group ( P = 0.008). The mean BCVA was significantly lower among patients in the grid + IVTA group compared with patients in the grid + PRP group ( P = 0.03), focal + PRP group ( P = 0.02), and focal treatment group ( P = 0.008). After 6 months of treatment, there was no significant difference between the mean values of CMT ( P = 0.46) or BCVA ( P = 0.07) with respect to different ways of management. With respect to the photoreceptor integrity at 1 month follow-up, the mean CMT was significantly lower in the intact ( P = 0.001) and disrupted ( P = 0.01) groups compared with that in the absent photoreceptor integrity group, whereas the mean BCVA was significantly higher in the intact group than in the absent ( P = 0.001) and disrupted ( P = 0.001) photoreceptor integrity groups. At 6 months, the mean CMT of the absent photoreceptor integrity group was significantly higher than that of the intact group ( P = 0.03), and the mean BCVA was significantly higher in the intact group than that in the disrupted photoreceptor integrity group ( P = 0.01). Conclusion CMT measured using OCT and the status of photoreceptor layer significantly provide an objective guideline for predicting the visual improvement in eyes with DME after treatment.

Meta-Analysis of the Effect of Intravitreal Bevacizumab Versus Intravitreal Triamcinolone Acetonide in Central Retinal Vein Occlusion

To further evaluate the effect of intravitreal bevacizumab (IVB) for the treatment of central retinal vein occlusion (CRVO) by meta-analysis. Pertinent publications were identified through PubMed, EMBASE, and the Cochrane Controlled Trials Register up to January 30, 2013. Changes in central macular thickness (CMT) and best-corrected visual acuity (BCVA) were extracted at 4, 12, and 24 weeks after treatment, and a meta-analysis was carried out to compare results between groups receiving IVB and intravitreal triamcinolone acetonide (IVTA). One randomized controlled trial and 4 comparative studies were identified and included. All of the funnel plots, the Egger's method and Begg method did not show publication bias. Our meta-analysis revealed that BCVA and CMT at 4, 12, and 24 weeks after treatment did not vary significantly between the IVB groups and IVTA groups (BCVA: at 4 weeks, P=0.27; at 12 weeks, P=0.51; at 24 weeks, P=0.64; CMT at 4 weeks, P=0.88; at 12 weeks, P=0.57; at 24 weeks, P=0.64). However, the rate of intraocular pressure rise after intravitreal injection varied significantly between the IVB groups and IVTA groups (P<0.001). Our results showed a similar improvement in BCVA and CMT among CRVO patients was obtained after intravitreal injections of both IVB, or IVTA, while the rate of IOP rise was significantly higher in the latter.