Intravitreal Triamcinolone Group Research Articles

A Comparison of Ocular Complications after 0.7 mg Dexamethasone Implant versus 2 mg of Intravitreal Triamcinolone in Vitrectomized Eyes

To compare the rates of complications in eyes that received a dexamethasone (DEX) implant (0.7mg) or intravitreal triamcinolone (IVT) (2 mg) to treat postvitrectomy macular edema (ME). Retrospective, comparative, case series. A total of 148 eyes (147 patients); 75 eyes (75 patients) in the DEX group and 73 eyes (72 patients) in the IVT group. The medical records of patients who received an intravitreal DEX 0.7 mg (Ozurdex) or triamcinolone (2 mg) (Triesence) for postvitrectomy ME between July 2014 and December 2021 with a minimum follow-up of 3 months were reviewed. Ocular hypotony and ocular hypertension were defined as intraocular pressure of <6mmHg and > 24 mmHg, respectively. The rates of complications. The follow-up duration was 2.5 ± 1.6 years, with no significant difference between the groups (P=0.398). The rate of transient ocular hypotony per eye and per injection was significantly higher in the DEX group (10 eyes [13%], 30 of 443 injections [7%]) compared with the IVT group (2 eyes [3%], 2 of 262 injections [0.8%]) (P= 0.039 and < 0.001, respectively). Mean visual acuity significantly decreased at the time of ocular hypotony (P= 0.031), but returned to preinjection level after resolution of the hypotony after a median of 12 days. The incidence of ocular hypertension was higher in the DEX group (23 eyes [31%]) than the IVT group (16 eyes [22%]), but this was not statistically significant (P= 0.307). Ocular hypertension was controlled with observation or topical medication. There were no between-group differences in the incidence of vitreous hemorrhage (DEX, 3eyes [4%]; IVT, 1 eye [1%]; P= 0.632) or rhegmatogenous retinal detachment (DEX, 3 eyes [4%]; IVT, 0 eyes [0%]; P= 0.253). Four eyes (5%) experienced migration of the DEX implant into the anterior chamber. No eye developed endophthalmitis. The incidence of ocular hypotony, which causes transient visual impairment, was significantly higher in vitrectomized eyes treated with DEX compared with eyes treated with IVT. Injections other than the inferotemporal quadrant or rotating injection sites may be recommended. Proprietary or commercial disclosure may be found after the references.

Resolution of Pseudophakic Cystoid Macular Edema: 2 mg Intravitreal Triamcinolone Acetonide versus 40 mg Posterior Sub-Tenon Triamcinolone Acetonide

ABSTRACT Purpose To compare 2 mg intravitreal triamcinolone (IVT) versus 40 mg posterior sub-Tenon triamcinolone acetonide (STT) for the treatment of eyes with pseudophakic cystoid macular edema. Methods A retrospective, single-center review of eyes receiving 2 mg IVT between 3/1/2012-3/1/2017 and 40 mg STT between 1/1/2015-3/1/2017. Visual acuity (VA) and central macular thickness (CMT) were recorded at baseline, 1-, 3-, and 6-month follow-up visits. Results Forty-five eyes were included in the IVT group and 50 eyes in the STT group. Change in VA from baseline to 1, 3, and 6 months was not significantly different between IVT and STT (6 months: 2.3 lines vs. 2.4 lines, p = .10). The IVT group achieved significantly better CMT improvement from baseline compared to STT at 1 month (255 μm vs. 187 μm; p = .03), but this difference was not present at month 3 (214 μm vs. 212 μm; p = .79) or month 6 (176 μm vs. 207 μm; p = .29). During the 6-month follow-up period, approximately 7% of eyes in the IVT group and 12% of eyes in the STT group developed ocular hypertension (p = .43), and all cases were successfully managed with topical anti-ocular hypertensive therapy or observation. Conclusions 2 mg IVT and 40 mg STT both achieved significant improvement in vision and CMT with no significant difference between interventions at 3- and 6-month follow-up.

Ocular hypertension following 40 mg sub-Tenon triamcinolone versus 0.7 mg dexamethasone implant versus 2 mg intravitreal triamcinolone

ObjectiveTo compare rates of ocular hypertension (OHT) in eyes receiving 40 mg sub-Tenon triamcinolone (STT), 0.7 mg dexamethasone implant (DEX), and 2 mg intravitreal triamcinolone (IVT). MethodsThis study is a single-centre, retrospective case series. All patients receiving STT and DEX between 4/1/2014 and 3/1/2017 and IVT between 3/1/2012 and 3/1/2017 with a minimum of 3 months’ follow-up were included. OHT was defined as an intraocular pressure (IOP) >24 mm Hg. Patients receiving any other form of topical, oral, or intravitreal steroid were excluded. Results113 eyes from 104 patients in the STT group, 122 eyes from 109 patients in the DEX group, and 109 eyes from 103 patients in the IVT group were included. The mean number of injections for each eye was 1.7 in the STT group, 2.6 for the DEX group, and 2.8 for the IVT group (p < 0.001). Twenty eyes (17.7%) developed OHT in the STT group, 19 eyes (15.6%) developed OHT in the DEX group, and 14 eyes (12.8%) developed OHT in the IVT group (p = 0.60). IOP was controlled in all eyes with observation, topical IOP-lowering medication, or surgical intervention. The rate of incisional glaucoma surgery was 1.7% in the STT group, 1.6% in the DEX group, and 0% in the IVT group (p = 0.55). ConclusionsThe rate of OHT was similar across treatment groups. The proportion of OHT in patients with a history of glaucoma was no different from that in patients without a history of glaucoma. All cases were successfully managed with observation, medical treatment, or incisional surgery.

Treatment of Eyes With Diabetic Macular Edema That Had a Suboptimal Response to Antivascular Endothelial Growth Factor Therapy: 2-mg Intravitreal Triamcinolone Acetonide vs 0.7-mg Dexamethasone Implant.

This article compares 2-mg intravitreal triamcinolone (IVT) and 0.7-mg dexamethasone (DEX) implant for the treatment of diabetic macular edema in eyes that had a suboptimal response to antivascular endothelial growth factor therapy. A single-center, retrospective review was conducted of patients receiving either IVT between January 1, 2013, and January 1, 2018, or patients receiving DEX between October 1, 2015, and January 1, 2018. Visual acuity and central macular thickness (CMT) were recorded at visit of first injection and all subsequent visits. Twenty-five eyes were included in the DEX group and 32 eyes were included in the IVT group. Change in vision from baseline was similar between DEX and IVT at 6-month follow-up (1.1 lines vs 2.3 lines, respectively; P = .24). Mean decrease in CMT from baseline was not different at 6-month follow-up (DEX: 120 µm vs IVT: 185 µm; P = .17). DEX and 2-mg IVT both achieved improvement in vision and CMT with no significant differences between treatment groups at 6-month follow-up.

Intravitreal dexamethasone implant versus triamcinolone acetonide for macular oedema of central retinal vein occlusion: quantifying efficacy and safety

Purpose Among the retinal vascular diseases, burden of retinal vein occlusion is most common immediately after diabetic retinopathy. Intravitreal corticosteroids are gaining popularity in managing macular edema (ME) of RVO. Our study compares efficacy and safety of intravitreal triamcinolone (IVTA) and dexamethasone implant (IVD) over 6 months.MethodsThis comparative, prospective, randomized study on 40 patients of non-ischemic central RVO with significant ME (> 330 μm) of < 3 months duration. Study was done at Army Research Hospital between Sep-2012 and May-2014 in accordance to Helsinki Declaration. IVD group (n = 20) received Ozurdex® while IVTA group (n = 20) received triamcinolone-acetonide (4 mg/0.1 ml), followed up at day-1 and weeks 4, 8, 12, 24.ResultsAt 6 months, mean improvement in best corrected visual acuity and retinal thickness (CMT) in the IVD group was 0.43 logmar and 323 μm and in IVTA group was 0.49 logmar and 322 μm respectively. Proportion of patients achieving ≥ 15 letters was about 40% in both groups. IOP rise was significantly higher in IVTA group at 12 and 24 weeks. In IVTA group ≥ 10 mmHg IOP rise was seen in 60% of patients, 41.6% among them had > 35 mmHg and 66% needed combination treatment and failed to reach baseline line IOP at 6 months. In IVD group, 5 pts had IOP rise with all being < 26 mmHg and were easily managed with single agent with IOP reaching baseline by 6th month in all pts. Relative risk of IOP rise with IVTA is 2.4 times higher compared to IVD. Cataract progression and cataract surgeries were required at significantly higher rates in IVTA group. In IVTA group, cataract progression was seen in 35% patients, with 71.5% requiring cataract surgery at 6 months. IVD group, 10% patients had cataract progression while none required surgery at 6 months. Relative risk of cataract progression with IVTA is 3.5 times higher compared to IVD.ConclusionIntravitreal steroids are effective in managing macular edema of retinal vein occlusion, while newer formulation of sustained release dexamethasone implant is significantly safer than IVTA.

The combination of phacoemulsification surgery and intravitreal triamcinolone injection in patients with cataract and diabetic macular edema

PurposeTo assess the safety and efficiency of combined phacoemulsification (PHACO) surgery and intravitreal triamcinolone (IVTA) injection with or without macular grid laser photocoagulation in patients with cataract and diabetic macular edema. Material and methodsThis prospective study included 41 eyes of 36 diabetic patients with cataract and coexisting clinically significant macular edema (CSME). After PHACO and IVTA injection eyes were divided into two groups: the laser and IVTA group (Group 1) and only IVTA group (Group 2). Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. Paired sample t-test was used to compare data in the groups and C square test for qualitative variables. ResultsPostoperative BCVA was significantly higher than the initial BCVA during the follow-up period in both groups (p<0.01). The BCVA 6months after surgery was significantly higher in group 1 than in group 2 (p<0.01). There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (p>0.05). There was no statistically significant difference between both groups in mean CMT preoperatively and 2nd week, 2nd month and 3rd month after surgery (p>0.05). The mean CMT 6months after surgery was statistically significantly lower in group 1 than in group 2 (p<0.01). ConclusionsPHACO surgery combined with IVTA injection improves BCVA and provides a decrease in CMT in diabetic patients with CSME. Additional macular grid laser photocoagulation after surgery helps to preserve this improvement in BCVA and decrease in CMT.

Comparison between Intravitreal Triamcinolone with Grid Laser Photocoagulation versus Bevacizumab with Grid Laser Photocoagulation Combinations for Branch Retinal Vein Occlusion

Purpose. To compare the efficacy of intravitreal triamcinolone (IVT) and intravitreal bevacizumab (IVB), both combined with grid laser photocoagulation (GLP) for macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods. Retrospective, comparative study. The newly diagnosed patients with ME secondary to BRVO who were treated with IVT and GLP or IVB and GLP were included. The main outcome measures were changed in the best corrected visual acuity (BCVA) and central retinal thickness (CRT) from the baseline to month 24. Results. Ninety-nine eyes of 99 patients were included. The change in BCVA was not statistically different in any time points between the two groups (P > 0.05, for all). The change in CRT was not statistically different in any time points between the two groups (P > 0.05, for all). The mean number of injections at month 24 was 2.38 ± 1.06 in the IVT+GLP group and 4.17 ± 1.30 in the IVB+GLP group (P = 0.0001). The need for cataract surgery (P = 0.01) and secondary glaucoma (P = 0.03) occurrence were more common in IVT group. Conclusion. Both treatment modalities were effective in the treatment of ME secondary to BRVO. The number of injections was significantly lower in the IVT group than in the IVB group; however cataract and secondary glaucoma were more frequent in the IVT+GLP group than in the IVB+GLP group.

Intravitreal triamcinolone versus intravitreal bevacizumab for diabetic macular edema: a meta-analysis.

To compare the efficacy of the sole intravitreal triamcinolone (IVT) versus intravitreal bevacizumab (IVB) alone or IVB combined with IVT in the treatment of diabetic macular edema (DME). Pertinent publications were identified through systematic searches of database and manually searching. Methodological quality of the literatures was valuated according to the Jadad Score. RevMan 5.1.0 was used to do the meta-analysis. Heterogeneity was determined and sensitivity was conducted. Six studies were ultimately included in the meta-analysis. The results of our analysis showed IVT had a statistically significant improvement in vision over the IVB at 1 month and 3 months (P<0.01). However, the reduction was not significant regarding central macular thickness (CMT) during the earlier (1 month and 3 months) follow-up period (P=0.12, P=0.41, respectively). At later visit (6 months), IVT had a significant decrease in CMT when compared to IVB (P<0.01) while no significant improvement in visual acuity (VA) was observed (P=0.14). The incidence of intraocular hypertension was 13/102 in IVT group during follow-up period while 0/103 in IVB group. The difference was significant (P<0.01). With regards to IVT versus IVB combined with IVT, there were no significant differences in CMT at 1 month (P=0.86) and 3 months (P=0.06). The incidence of intraocular hypertension was 6/67 in IVT group during follow-up period while 4/66 in IVB+IVT group. But the difference was not significant (P=0.53). Current evidence shows IVT is superior in improving VA at earlier follow-up (1 month and 3 months) and in reducing CMT at later follow-up (6 months) for DME. At other time, it is in favor of IVT treatment but there are no statistically significances. However, IVT has the side-effect of ocular hypertension. There is no adequate evidence of the benefit adding IVB to IVT in contrast to IVT alone.

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.

Triamcinolone and Bevacizumab as Adjunctive Therapies to Panretinal Photocoagulation for Proliferative Diabetic Retinopathy

Purpose. To evaluate efficacy of intravitreal triamcinolone (IVT) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP) in proliferative diabetic retinopathy (PDR). Methods. In 60 eyes of 45 patients with PDR, PRP (PRP group), PRP with IVT (IVT group), or PRP with IVB (IVB group) was performed. Regression of new vessels (NV), changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and contrast sensitivity at 1,2, and 6 months were evaluated. Results. Initial mean numbers of active NV and BCVA were 3.45 and 67.35 in the PRP group, 4.35 and 76.65 in the IVT group, and 4.79 and 75.53 in the IVB group. At the 6-month follow-up, numbers of active NV were 2.5 (P = 0.064), 1.11 (P = 0.000), and 1.11 (P = 0.002), and there was a mean loss of 2,6 (P = 0.055), 3.9 (P = 0.011), and 0.9 letters (P = 0.628) in the PRP, IVT, and IVB groups, respectively. Changes in CMT in the PRP and IVT groups were not significant, but significantly increased in the IVB group (P = 0.032). Contrast sensitivity remained stable in PRP and IVB groups and slightly decreased in IVT group. Conclusions. Adjunctive use of both triamcinolone and bevacizumab with PRP lead to a greater reduction of active NV than PRP alone in PDR, although no differences were seen between the two of them.

A prospective, randomised, multicenter trial for surgical treatment of central retinal vein occlusion: results of the Radial Optic Neurotomy for Central Vein Occlusion (ROVO) study group

To compare the surgical outcomes and evaluate the effectiveness of two treatments for central retinal vein occlusion (CRVO), radial optic neurotomy (RON) and intravitreal triamcinolone (IVT), in comparison to natural history. A prospective, placebo-controlled, randomised and multi-center study. Patients with CRVO were treated in three groups - with either RON, a single intravitreal injection of 4 mg triamcinolone acetonide, or a placebo treatment. The main outcome measures were change of VA (visual acuity) and proportion of eyes with a significant improvement (defined as > 3 lines logMAR scale) of VA from baseline to month 12. Ninety patients were included. Due to insufficient data, seven were excluded. Forty-seven percent (n = 18) of patients treated with RON showed an increase in VA, in comparison to 10 % (n = 2) of placebo-treated patients, and 20 % (n = 5) of patients treated with IVT. Significantly more patients showed an improvement in VA following RON than in the placebo group (p = 0.009). Significantly more patients showed an improvement in VA following RON than in the IVT group (p = 0.034). No significant difference was found when directly comparing improvement in VA following IVT and placebo (p = 0.667) treatment.Significantly (p = 0.007) more patients in the placebo group (35 %, n = 7) showed a deterioration (defined as > 3 lines LogMAR scale) in VA than patients in the RON group (8 %, n = 3). Our study showed that following treatment with RON, patients with CRVO display a significantly better long-term VA than untreated patients and patients treated with a single dose of IVT.

Nine-month results of intravitreal bevacizumab versus triamcinolone for the treatment of diffuse diabetic macular oedema: a retrospective analysis

To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME). This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline. After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group. In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline.

Intravitreal triamcinolone and bevacizumab as adjunctive treatments to panretinal photocoagulation in diabetic retinopathy

Background/aimsTo evaluate efficacy of intravitreal triamcinolone (IVTA) and bevacizumab (IVB) as adjunctive treatments to panretinal photocoagulation (PRP).MethodsIn 91 eyes of 76 patients (clinically significant macular oedema (CSME) 46 eyes; no...

Visual Outcomes in Five Different Approaches for Treatment of Central Retinal Vein Occlusion

Four treatment methods for central retinal vein occlusion were compared with its natural course. In this partially prospective, comparative, interventional case series on 63 eyes with central retinal vein occlusion, five approaches were compared: intravitreal triamcinolone injection; radial optic neurotomy; combined radial optic neurotomy and intraocular triamcinolone injection; combined internal limiting membrane peeling, radial optic neurotomy, and intraocular triamcinolone; and observation. Final visual acuity in the intravitreal triamcinolone group was better compared with the observation (P = .025), radial optic neurotomy (P = .037), combined radial optic neurotomy/intraocular triamcinolone injection (P = .401), and combined internal limiting membrane peeling, radial optic neurotomy, and intraocular triamcinolone injection (P = .023) groups. However, after adjustment for baseline visual acuity, the only treatment method with significant visual acuity improvement in relation to the observation group was the combined radial optic neurotomy/intraocular triamcinolone injection (P = .025, .023, and .054 at 1, 3, and 6 months, respectively). Among the five different approaches analyzed in this study, combined radial optic neurotomy and intraocular triamcinolone injection may provide a better visual outcome in the management of central retinal vein occlusion.

Comparison of Intravitreal Triamcinolone Acetonide With Photodynamic Therapy and Intravitreal Bevacizumab with Photodynamic Therapy for Retinal Angiomatous Proliferation

To compare the efficacy of combined therapy with intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT; IVTA plus PDT) with intravitreal bevacizumab (IVB) and PDT (IVB plus PDT) for patients with retinal angiomatous proliferation (RAP). Retrospective, observational case series. We retrospectively reviewed 25 treatment-naïve eyes of 22 Japanese patients (11 men, 11 women) with retinal angiomatous proliferation. Twelve eyes of 11 patients were treated with combined therapy of IVTA plus PDT from September 1, 2004, through July 31, 2006. Thirteen eyes of 11 patients were treated with combined therapy of IVB plus PDT from February 1, 2007, through January 31, 2008. In 12 eyes treated with IVTA plus PDT, the mean best-corrected visual acuity (BCVA) levels at baseline and 12 months were 0.29 and 0.13, respectively. A significant (P < .05) decline in the mean BCVA from baseline was observed at 12 months. In 13 eyes treated with IVB plus PDT, the mean BCVA levels at baseline and 12 months were 0.25 and 0.37. A significant (P < .05) improvement in the mean BCVA from baseline was observed. At 12 months, the difference in BCVA between the 2 groups was significant (P < .05). The mean numbers of treatments at 12 months in the IVTA plus PDT group and the IVB plus PDT group were 2.7 and 1.6, respectively. The difference between the 2 treatments reached significance (P < .05). No complications developed. Compared with IVTA plus PDT, IVB plus PDT was significantly more effective in maintaining and improving visual acuity and in reducing the number of treatment for patients with retinal angiomatous proliferation.

Ranibizumab for retinal angiomatous proliferation

Dear Editor, We read with great interest the article by Konstantinidis et al. [1] on the efficacy of intravitreal ranibizumab in patients with retinal angiomatous proliferation (RAP). They reported favorable results in a series of 31 patients, with statistically significant improvement of the visual acuity by a mean of 2.7 lines after receiving five injections on average over a mean follow-up period of 13.4 months. We have previously published our data on ranibizumab [2] in patients with RAP in a randomized prospective open-label study comparing intravitreal ranibizumab, intravitreal ranibizumab with PDT and intravitreal triamcinolone (IVT) with PDT. In our study, we found no statistically significant differences in the VA of 13 patients treated with an average of 5.92 injections of ranibizumab over a mean period of 8.38 months, while there was a trend towards better VA at the end of the follow-up in the IVT & PDT group. Konstantinidis et al. tried to explain the different results of the two studies, commenting on the different percentage of PED between the two studies (35% [1] vs 61.5% [2]) and raising concerns about missed treatments in our study due to undetectable changes on the OCT in patients with PED. We agree that when OCT alone is used to dictate treatment in cases of RAP with PED, there is a slight chance of patients having missed treatment. However, we believe that the two studies are not comparable for the following reasons. First, as the authors correctly state, there is a significant difference in the percentage of PED, which has a negative prognostic value in patients with RAP. The presence of PED in RAP represents an advanced stage of the disease with longstanding retinal damage. Second, there is a significant difference in the number of patients with stage III RAP (16% [1] vs 23.1% [2]), a stage that carries a worse prognosis than for the other RAP stages. Third, the authors provide statistical data only for the last follow-up, and not for the previous time-points. One should compare our values at the mean 8.38 months follow-up with their respective time-point values instead of the reported 13.4-month values, in order to draw firm conclusions. Furthermore, Konstantinidis et al. refers to other previously published studies [3–7] that are in agreement with their study. Only two of these studies report the effects of ranibizumab [3, 6], while the rest refer to bevacizumab, a similar molecule to ranibizumab, but with different kinetics in the eye [8]. The ranibizumab studies are small case series with short follow-up, which is the case also for the bevacizumab studies. Based on the above, it is clear that all the previously mentioned studies (including the one by Konstantinidis et al. and our study) provide a low level of evidence regarding the effectiveness of ranibizumab in RAP. The main advantage of our study is the comparison of three different treatments, with the IVT & PDT group achieving A. A. Rouvas 2nd Department of Ophthalmology, Attikon Hospital, Medical School of Athens University, Athens, Greece

Intravitreal triamcinolone injection combined with or without macular grid laser photocoagulation to treat macular edema

Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation (MLGP) to treat macular edema.Methods Consecutive 89 patients (109 eyes)diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving- 0.8 (0.19±0.13);the intraocular pressure(IOP)ranged from 7 mm Hg to 21 mm Hg(1 mm Hg=0.133 kPa)and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations,the central macular thickness was (570±182) μm;the average light sensitivity was (5.07±3.94) dB and the fixation percentage was 70.67% within 4 ° area around the macular fovea.All the patients received IVTA treatment,39 patients (48 eyes)further received MLGP 1 month later (IVTA-MLGP group).The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group.Best corrected visual acuity (BCVA),lOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months,the BCVA in IVTA-MLGP and IVTA group was (0.41±0.20),(0.24±0.19) respectively (P<0.05);the central macular thickness was (309±187) and (487±206) μm respectively(P<0.05);the mean light sensitivity of 4° central macular was (8.24±4.64)and(6.30±3.22) dB respectively (P<0.05);the fixation percentage was (87.01±19.70)% and (78.85±20.41) % respectively (P<0.05).During the follow-up recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTA-MLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema. Key words: Macular edema,cystoid/therapy; Triameinolone acetonide/therapeutic use; Laser coagulation/methods; Treatment outcome

Comparison of single injection of intravitreal triamcinolone versus single injection of intravitreal bevacizumab in macular edema secondary to branch retinal vein occlusions with regard to changes in best corrected visual acuity and central macular thickness in the short term

Dear Editor, We would like to present our experience of single injection of intravitreal triamcinolone (IVTA) versus single injection of intravitreal bevacizumab (IVB) in macular edema secondary to branch retinal vascular occlusions with regard to changes in best corrected visual acuity and central macular thickness in the short term. Our retrospective study consisted of 18 patients (mean age 55.3 yers, 62% males) who received IVTA (0.1 ml containing 4 mg) or IVB (0.05 ml containing 1.25 mg) during the period October 2007 to February 2008. All the patients included had non-ischemic branch retinal vein occlusion with macular edema which was confirmed on fluorescein angiography. The patients having best corrected visual acuity (BCVA) of 20/40 or poor with persistent macular edema for at least three months were included. (median duration for IVTA 3.8 months; IVB 3.6 months and mean duration IVTA group: 3.5 months;; IVB group 3.1 months). Visual acuity, intraocular pressure (IOP), anterior segment, posterior segment findings and macular thickness (performed on three-dimensional optical coherence tomography) were noted (pre-injection, post-injection Day 1, 7, 30, 90). Of 18 patients, eight received IVTA and the rest were given IVB. The BCVA was similar in both groups at first post-injection day (IVTA P = 0.470; IVB P = 0.100) i.e. majority of patients (six out of eight in the IVTA group and eight out of 10 in the IVB group) had stable visual acuity (no improvement) on first post-injection day. However, at seventh post-injection day (IVTA P = 0.024; IVB P = 0.640), one month (IVTA P = 0.043; IVB P = 0.244) and three months (IVTA P = 0.047; IVB P = 0.290) the BCVA was significantly better in the IVTA group. The percent reduction in central macular thickness was significant at one week, one month and three months (one week: IVTA 32.3% vs. Bevacizumab 24.9% [P = 0.029], one month: 36.2% vs. 21.4%[P = 0.014], three months: 39.8% vs. 25.4% [P = 0.014]). However, at first day post injection there was no significant difference in reduction of central macular thickness (20.36% vs. 20.45% P = 0.922). At all follow-ups except first post-injection day, IOP was significantly higher in the IVTA group (one week: P = 0.021, one month: P = 0.034, three months: P = 0.029). In a study by Pacolla et al.,[1] of 26 patients (26 eyes) with diabetic macular edema, the central macular thickness was significantly reduced in the IVTA group compared with the bevacizumab group at weeks 4, 8, 12 and 24 (P < 0.05). BCVA was significantly higher at eight and 12 weeks in the IVTA group compared with the bevacizumab group (P < 0.05). On similar lines, our short-term results indicate that IVTA has better efficacy over bevacizumab in the management of macular edema secondary to branch retinal vein occlusions, specifically with regard to changes in BCVA and central macular thickness. However, the elevated IOP after IVTA is common[2] and since the prevalence of glaucoma/ocular hypertension is significantly higher in patients with central retinal vein occlusion and hemicentral retinal vein occlusion,[3] the IOP should be closely monitored in patients receiving IVTA.

Reduced fluence versus standard photodynamic therapy in combination with intravitreal triamcinolone: short-term results of a randomised study

Background:To compare early treatment effect of reduced fluence versus standard photodynamic therapy (rPDT, sPDT, respectively) in combination with intravitreal triamcinolone (IVTA) in neovascular age-related macular degeneration.Methods:Forty patients received either sPDT...