Posterior Subtenon Injection Of Triamcinolone Acetonide Research Articles

Suprachoroidal triamcinolone versus posterior subtenon triamcinolone either alone or formulated in the management of diabetic macular edema

PurposeThis study aims to compare posterior subtenon triamcinolone acetonide injection either formulated or alone versus suprachoroidal triamcinolone in the management of diabetic macular edema.MethodsThis study is a prospective interventional study that included 75 patients, divided into three groups, each group with 25 patients. Group I received a combination of triamcinolone acetonide (TA) (40 mg) and VISCOAT, which is a combination of sodium chondroitin sulfate (20 mg) and sodium hyaluronate (15 mg). The injection was done in the posterior subtenon space using the NAGATA cannula. Group II received TA (40 mg) in the posterior subtenon space. Group III underwent an injection of 4 mg/100µl of TA in the supra choroidal space.ResultsWe found a statistically significant difference between the three studied groups regarding BCVA (P = 0.001) and CMT at six months postoperative (P = 0.001) with the highest median BCVA and lowest median CMT observed in the formulated TA group.ConclusionWe concluded that early treatment of DME by formulated TA is better than TA alone, and suprachoroidal TA in the form of increasing the BCVA and decreasing the CMT without any elevation of IOP.Trial registration number NCT05464953.Date of registration 17/7/2022 (retrospectively registered).

Posterior sub-Tenon triamcinolone acetonide injection for annular choroidal detachment resistant to systemic immunosuppressive treatment.

Posterior sub-Tenon triamcinolone acetonide injection for annular choroidal detachment resistant to systemic immunosuppressive treatment.

Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema

BackgroundThe goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation.MethodsRetrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 μm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months).ResultsAfter 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030).ConclusionsCombined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.

Anterior Migration of Triamcinolone Acetonide after Posterior Subtenon Injection for Macular Edema Predisposes to Intraocular Pressure Elevation

ABSTRACT Purpose To evaluate the effect of anterior migration of triamcinolone acetonide on intraocular pressure (IOP) elevation after posterior subtenon injection of triamcinolone acetonide (PSTA) for macular edema. Methods One hundred and ten eyes from 89 patients who received PSTA for macular edema were prospectively enrolled. The extent of anterior migration of triamcinolone acetonide was recorded immediately after the injection. If TA particles were visible in the subtenon space (or subconjunctival space), it was recorded as “anterior subtenon migration” (or “anterior subconjunctival migration”). The correlation between anterior migration of triamcinolone acetonide and severe IOP elevation, which was defined as an increase of 8 mm Hg or more in IOP, was evaluated. Results A total of 159 PSTAs were given to 110 eyes. After PSTA, anterior subtenon migration occurred in 70.4% and anterior subconjunctival migration occurred in 12.0% of injection. Severe IOP elevation occurred in 7.1% of those without anterior migration, in 25.9% of those with anterior subtenon migration, and in 31.6% of those with anterior subconjunctival migration after PSTA (P = .052). Compared to those without anterior migration of triamcinolone acetonide, the hazard ratio for severe IOP elevation was 3.307 in those with anterior subtenon migration (P = .12) and 5.289 in those with anterior subconjunctival migration (P = .042). Conclusions Anterior migration of triamcinolone acetonide after PSTA predisposes eyes to severe IOP elevation. Careful injection to restrict the triamcinolone particle within the subtenon space and behind the equator may lower the rate of IOP elevation after PSTA.

Effect of posterior sub-tenon injection of triamcinolone acetonide as ‎an adjunct therapy to intravitreal anti-vascular endothelial growth ‎factor in the management of diabetic macular oedema

ABSTRACT Background: to monitor and compare the effect of posterior sub-tenon triamcinolone acetonide injection as an adjunct therapy to intravitreal ranibizumab injection on patients with diabetic macular oedema. Aim of the Work: To assess the effect of combined intravitreal ranibizumab injection, and sub-tenon triamcinolone acetonide injection in the management of diabetic macular oedema. Patients and Methods: Patients with diabetic retinopathy associated with DME (Central macular thickness over 300 um) which are randomly allocated into two groups. In group 1, three monthly doses (0.5 mg) of intravitreal ranibizumab are received. In group 2, the anti-VEGF injection was performed 3times monthly with the sub-tenon steroid injection [triamcinolone acetonide] during the 1st injection. All patients’ best-corrected visual acuity (BCVA), IOP and CMT were followed up for six months. Results: The combined treatment showed improved best-corrected visual acuity from baseline 0.15 ± 0.15 log MAR to 0.46 ± 0.19 log MAR (p 0.001). When comparing the combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant (p <0.001‎). Conclusion: sub-tenon triamcinolone addition to the routine anti-VEGF therapy is an effective method for the treatment of diabetic macular oedema not only in rapid and great improvement but also in decreased frequent injections.

Ocular hypertension and severe intraocular pressure elevation after posterior subtenon injection of triamcinolone acetonide for various diseases.

To evaluate and compare the incidences of ocular hypertension and severe intraocular pressure (IOP) elevation after posterior subtenon injection of triamcinolone acetonide (PSTA) for various diseases. Totally 179 eyes that had received PSTA for diabetic macular edema (n=108), pseudophakic cystoid macular edema (n=20), branch retinal vein occlusion (n=16), central retinal vein occlusion (CRVO, n=14), choroidal neovascularization (n=14) or noninfectious uveitis (n=7) were retrospectively enrolled. The primary outcomes included ocular hypertension defined as an IOP>21 mm Hg, and severe IOP elevation defined as a rise of 10 mm Hg or more in IOP compared with baseline. Cox regression models were used to analyze the hazard ratios (HRs) among different diseases. After PSTA, the mean IOPs from month 1 to month 6 all significantly increased (P<0.05). Ocular hypertension occurred in 30.7% of eyes (median time: 8wk), and severe IOP elevation occurred in 16.2% of eyes (median time: 9wk). Patients receiving PSTA for CRVO or uveitis had a significantly higher risk for ocular hypertension (HR=3.049, P=0.004 for CRVO; HR=5.464, P=0.019 for uveitis) and severe IOP elevation (HR=2.913, P=0.034 for CRVO; HR=7.650, P=0.009 for uveitis). IOP significantly increases within 6mo after PSTA, with the onset of ocular hypertension happening mostly at 2 to 3mo. Patients of CRVO or noninfectious uveitis have a higher risk of ocular hypertension or severe IOP elevation after PSTA and should be monitored for IOP more carefully.

Phacoemulsification with Posterior Sub-Tenon Triamcinolone Acetonide Injection for Prevention of Progression of Diabetic Macular Edema after Cataract Surgery

Background: diabetic macular edema (DME) is the most common cause of visual loss in diabetic patients. The pathogenesis of DME is multifactorial. It results from multiple biochemical and cellular changes that eventually cause leakage and exudation. A number of patient characteristics such as increasing age, females, duration of DM, poor glycemic control and moderate to severe retinopathy have been found associated with poor prognosis after cataract surgery in diabetic patients. Objective: the aim of this study was to evaluate the efficacy of phacoemulsification with posterior sub-Tenon’s triamcinolone acetonide injection for prevention of progression of diabetic macular edema following uneventful cataract surgery by phacoemulsification. Patients and Methodology: this interventional study included 20 eyes of 20 diabetic patients with visually significant cataract and coexisting DME during the period from December 2017 to October 2018. Preoperative and postoperative best corrected visual acuity (BCVA) using LogMAR and intraocular pressure (IOP) were recorded. Results: statistically significant improvement in BCVA was detected when comparing postoperative values at one week, one month and three months to corresponding preoperative values. In addition, values at one month and three months were significantly improved when compared to values at one week post-operative. On other hand, values at three months revealed non-significant difference when compared to values at one month. Conclusion: this study suggests that posterior sub-Tenon’s triamcinolone acetonide injection can be given safely and easily at the time of phacoemulsification surgery in patients with visually significant cataract and DME.

Phacoemulsification with Posterior Sub-Tenon Triamcinolone Acetonide Injection for Prevention of Progression of Diabetic Macular Edema after Cataract Surgery

Phacoemulsification with Posterior Sub-Tenon Triamcinolone Acetonide Injection for Prevention of Progression of Diabetic Macular Edema after Cataract Surgery

Cystoid macular edema secondary to gyrate atrophy in a child treated with sub-tenon injection of triamcinolone acetonide

Purpose: Gyrate atrophy (GA) of the fundus is a rare, progressive metabolic disease secondary to the deficiency of the pyridoxal phosphate-dependent enzyme, ornithine aminotransferase. GA may lead to cystoid macular edema (CME) resulting from chronic inflammation. We aimed to report a child case with CME secondary to gyrate atrophy. Methods: Herein we presented a GA case treated with posterior sub-Tenon triamcinolone acetonide injection. Results: Optical coherence tomography examination revealed the disappearance of the macular edema that is a vision-threatening complication in GA. Conclusion: The present case showed that the posterior sub-Tenon injection of long acting steroids might be a promising treatment in CME secondary to GA.

Comparison between intravitreal bevacizumab and posterior sub-tenon injection of triamcinolone acetonide in macular edema secondary to retinal vein occlusion.

AimTo compare the efficacy and safety between posterior sub-tenon injection of triamcinolone acetonide (PSTA) and intravitreal injection of bevacizumab (Avastin) (IVIA) in the treatment of macular edema secondary to retinal vein occlusion.Patients and methodsA total of 45 eyes were retrospectively enrolled (23 eyes with intravitreal bevacizumab and 22 eyes with posterior sub-tenon triamcinolone acetonide). Main endpoints included logMAR of best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) before and after treatment at 6 months.ResultsThe mean logMAR improved from 0.78 to 0.56 at 6 months for intravitreal bevacizumab (p=0.001), and from 0.91 to 0.79 and 0.87 at 3 and 6 months (p=0.038 and 0.13), respectively, for sub-tenon triamcinolone acetonide. At 6 months, the BCVA was significantly better in the bevacizumab group (p=0.02). Both groups’ mean CMT significantly improved, from 478 µm at baseline to 295 µm at 6 months in IVIA group (p<0.001) and from 419 µm at baseline to 350 µm in PSTA group (p=0.012); however, this was not different between the groups at 6 months (p=0.065). Recurrence of macular edema was not different between the groups either (p=0.08). Poorer final vision was associated with poorer baseline BCVA and diagnosis of central retinal vein occlusion after adjustment for age and sex (p<0.001 and 0.012, respectively). Significant elevation of IOP was noted at 3 months in the PSTA group, but declined at 6 months compared with baseline (p=0.002 and 0.41, respectively).ConclusionIntravitreal bevacizumab seemed to achieve better visual acuity compared with posterior sub-tenon injections of triamcinolone acetonide at 6 months, while CMT was comparable. PSTA still resulted in transient IOP elevation.

Real-life experience of ranibizumab for diabetic macular edema in Taiwan.

To evaluate the visual and anatomical outcomes of intravitreal ranibizumab for diabetic macular edema (DME) in the healthcare system of Taiwan. A total of 39 eyes from 39 patients were retrospectively enrolled in the study. All eyes that fulfilled the key criteria, including a baseline vision between 20 and 70 ETDRS letters and a minimum central macular thickness (CMT) of 300µm, had at least 3 monthly loading injections of ranibizumab in a year. Macular laser or posterior subtenon injections of triamcinolone acetonide (PSTA) could be performed as supplementary treatments following loading injections. Primary outcomes include best-corrected visual acuity and CMT. Patients' vision improved from 46.5 ± 15.3 letters at baseline to 51.4 ± 16.6 letters at 12months (p = 0.031). Mean CMT at baseline was 406 ± 105µm, which decreased to 329 ± 108µm (p = 0.002). At 12months, 44.4% of eyes with total injection number < 5 and 42.9% with injection number ≥ 5 achieved a gain in vision that was 10 letters or more. A total of 5 injections or more did not lead to a better visual gain in comparison with only 3-4 injections (p = 0.71), and both had similar number of supplementary treatments (p = 0.43). Monthly reinjections of ranibizumab resulted in a lower likelihood of visual loss of 10 or 15 letters (p = 0.019 and 0.015, respectively, adjusted for age, baseline vision, severity of diabetic retinopathy and the presence of previous treatments); however, supplementary macular lasers, PSTA or ranibizumab without monthly reinjections did not (all p > 0.05). The average number of injections was 4.3 ± 1.0. Treatment for DME with at least three monthly ranibizumab loading injections, with or without other supplementary treatments, is effective at 12months thereafter. Two monthly reinjections of ranibizumab, while not significantly increasing vision, may have a role in preventing visual loss.

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.

Efficacy and safety of triamcinolone acetonide posterior subtenon injection in patients with diabetic maculopathy

Introduction: Diabetic maculopathy (DM) is the main cause of visual impairment of the working population. Optical coherence tomography and fluorescein angiography give us a precise insight into retinal changes. In recent years, pharmacological treatment of DM is increasing. Posterior subtenon application is accompanied by a smaller percentage of complications compared to intravitreal application. Aim: The aim is to assess the efficacy and safety of triamcinolone acetonide (TA) posterior subtenon injection in the treatment of DM, by measuring intraocular pressure (IOP), central macular thickness (CMT) and visual acuity, before and two months after. Material and methods: The retrospective study included 49 patients admitted during 2016, for posterior subtenon injection of TA in the DM treatment, at Daily Hospital, for the treatment of vascular diseases of the eye and the macula Department of Ophthalmology, Clinical Center of Serbia. Data were collected from medical records on gender, age, type of retinopathy and visual acuity, IOP and CMT, before and two months after intervention. Results: The average age of patients was 63 ± 9.5 years. Out of 49 patients tested, 30.61% were female and 69.39 % were male. The frequency of non-proliferative diabetic retinopathy (NPDR) in the study was 53.6%. There was a statistically significant difference in visual acuity and CMT, before and two months after the intervention, but there was no correlation between the improvement of visual acuity and CMT reduction. There was no statistically significant difference in IOP, before and two months after intervention. Conclusion: The most common type of diabetic retinopathy in this study was NPDR. After posterior subtenon application of TA, there was a significant increase in visual acuity and CMT reduction, but reduction of CMT is not connected with the increase of visual acuity. Posterior subtenon TA application is not accompanied by a significant increase in IOP, and it is an effective and relatively safe way of treating DM.

Bevacizumab and Panretinal photocoagulation protect against ocular hypertension after posterior subtenon injection of triamcinolone acetonide for diabetic macular edema.

To analyze the prognostic factors for ocular hypertension after posterior subtenon injection of triamcinolone acetonide (PSTA) for the treatment of diabetic macular edema (DME). Patients who received PSTA for DME from January 2006 to December 2011 were enrolled retrospectively and were followed until December 2012 in one hospital. Modified Cox regression models were used to analyze the factors associated with ocular hypertension, which was defined as an intraocular pressure>21mmHg after PSTA. A total of 180 PSTA injections were given to 114 eyes from 73 adults with DME. During a mean follow-up of 50.4 weeks after each injection, ocular hypertension occurred in 20.6% of injections (28.1% of eyes). Treatment-naïve patients with proliferative diabetic retinopathy (PDR) had a higher risk of ocular hypertension after PSTA than those with nonproliferative diabetic retinopathy (NPDR) [hazard ratio (HR)=3.255, p=0.030]. Intravitreal injection of bevacizumab (IVB) before PSTA had a significant effect in lowering the risk of ocular hypertension after PSTA in patients with PDR who had received panretinal photocoagulation (PRP) (HR=0.107, p=0.035). Both prompt PRP and IVB following PSTA had a protective effect against ocular hypertension in treatment-naïve patients with PDR (HR=0.086, p=0.0002 and HR=0.155, p=0.049, respectively). Treatment-naïve patients with PDR had a higher risk of ocular hypertension after PSTA than those with NPDR. Bevacizumab and prompt PRP both had a protective effect against ocular hypertension after PSTA in patients with PDR.

Short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide in macular edema due to ischemic retinal vein occlusions

Objective To observe the short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide (PSTA) in the treatment of macular edema due to ischemic retinal vein occlusions (RVO). Methods A retrospective clinical study. A total of 53 eyes of 53 patients with RVO macular edema diagnosed by fundus color photography, fundus fluorescein angiography and optical coherence tomography (OCT) were included in the study. The best corrected visual acuity (BCVA) was detected by the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by OCT. Among 53 eyes, there were 27 eyes with ischemic RVO macular edema (ischemic group) and 26 eyes with non-ischemic RVO macular edema (non-ischemic group). The mean logMAR BCVA was 0.82±0.37, mean CMT was (662.1±216.7) μm in ischemic group. The mean logMAR BCVA was 0.41±0.23, mean CMT was (548.0±161.9) μm. The differences of logMAR BCVA and CMT between the two groups were both statistically significant (t=4.745, 2.258; P<0.05). All eyes were treated with a single sub-Tenon injection of 0.4 ml triamcinolone acetonide suspension (100 mg/ml). The mean logMAR BCVA, CMT before and 1, 3 months after the treatment between the two groups were observed and compared. Results On 1 and 3 months after treatment, the mean logMAR BCVA in the non-ischemic group (0.32±0.25 and 0.27±0.29) were improved compared with ischemic group (0.76±0.37 and 0.41±0.79), the difference was statistically significant (t=5.052, 5.240; P 0.05), but had a statistically significant difference in non-ischemic group (F=7.685, P 0.05). On 1 month after the treatment, there were 3 and 5 eyes had a higher intraocular pressure than 21 mmHg (1 mmHg=0.133 kPa) in ischemic and non-ischemic group, respectively; but all of them returned to normal after drug treatment. There were no drugs and ocular injection related complications. Conclusion PSTA of ischemic RVO macular edema can lower the CMT in the short term, but can′t significant improve the visual acuity. Key words: Retinal vein occlusion/drug therapy; Macular edema /drug therapy; Triamcinolone acetonide/therapeutic use

Subtenon Triamcinolone Acetonide Removal for Uncontrolled Ocular Hypertension After Posterior Subtenon Injection of Triamcinolone Acetonide

To report the control of intraocular pressure (IOP) after removal of subtenon triamcinolone acetonide (TA) plaques in patients with uncontrolled ocular hypertension after posterior subtenon injection of triamcinolone acetonide (PSTA) and to evaluate the factors associated with rapid IOP normalization after subtenon TA removal. Data from 8 eyes of 7 patients receiving excision of subtenon TA plaques for uncontrolled ocular hypertension after PSTA in 1 hospital from June 2010 to December 2012 were retrospectively collected. The percentage of IOP lowering on postoperative day 1 and the time to IOP normalization after subtenon TA removal were reported. Pearson correlation analysis was used to analyze the factors for rapid IOP normalization after subtenon TA removal. The IOP lowering on postoperative day 1 ranged from 12% to 75%. All cases achieved IOP normalization within a mean of 2.5±1.9 days (range, 1 to 5 d) after subtenon TA removal. Fewer kinds of antiglaucoma agents used before subtenon TA removal was associated with greater IOP lowering on postoperative day 1 (P=0.01) and more rapid return to normal IOP (P=0.01). Older age and more time from PSTA to ocular hypertension were both correlated with shorter time to achieve IOP normalization after operation (P=0.01 and 0.02, respectively). In medically uncontrolled ocular hypertension after PSTA, excision of subtenon TA plaques provided IOP normalization as rapidly as 1 to 5 days. Fewer preoperative antiglaucoma agents, older age, and more time from PSTA to ocular hypertension were correlated with more rapid IOP normalization after subtenon TA removal.

Effect of Posterior Subtenon Triamcinolone Acetonide Injection on Diabetic Macular Edema Refractory to Intravitreal Bevacizumab Injection.

PurposeTo evaluate the effects of posterior subtenon triamcinolone acetonide injection on refractory diabetic macular edema (DME) after intravitreal bevacizumab (IVB) injection failure.MethodsPatients with DME and central subfield thickness (CST) >300 µm who did not respond to IVB injections were retrospectively included. Specifically, we enrolled patients who were diagnosed with refractory DME and who experienced an increase in CST after 1 to 2 IVB injections or no decrease after ≥3 consecutive IVB injections. One clinician injected 20 mg of triamcinolone acetonide into the posterior subtenon space. All patients received ophthalmic examinations at baseline and at 2, 4, and 6 months post-baseline. Examinations included Snellen visual acuity, intraocular pressure, and spectral-domain optical coherence tomography.ResultsForty eyes of 34 patients were included. The average baseline CST was 476 µm. The average CST decreased to 368 µm at 2 months, 374 µm at 4 months, and 427 µm at 6 months (p < 0.001 for all results, Wilcoxon signed-rank test). The average intraocular pressure increased from 15.50 to 16.92 mmHg at 2 months but decreased to 16.30 mmHg at 4 months and 15.65 mmHg at 6 months. Logarithm of the minimum angle of resolution visual acuity improved from 0.56 to 0.50 at 2 months (p = 0.023), 0.50 at 4 months (p = 0.083), and 0.48 at 6 months (p = 0.133, Wilcoxon signed-rank test). No complications were detected.ConclusionsPosterior subtenon triamcinolone acetonide is an effective and safe treatment for reducing CST in DME refractory to IVB.

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

Objectives: In this study, intravitreal injection of triamcinolone acetonide (TA) was compared with posterior subtenon injection of TA for treatment of diabetic macular edema (DME). Materials and Methods: In this prospective, open, randomized, parallel group, comparative study, 60 patients of diabetic macular oedema visiting the Department of Ophthalmology, Govt. Medical College, Patiala were included. The patients fulfilling the inclusion criteria and having none of the exclusion criteria were enrolled in the study after obtaining written informed consent. Patients were then randomized into two groups (group I, II) and received intravitreal and posterior subtenon injection of triamcinolone acetonide, respectively. The comparison was based on change in best corrected visual acuity and macular thickness using optical coherence tomography (OCT). The results were subjected to statistical analysis and observations thus made in both groups were compared. Results: With intravitreal TA, the mean pre-treatment CMT, mean post-treatment CMT and mean reduction in CMT were 395.53 ± 15.31 ?m, 221.2 ± 10.71 ?m and 174.33 ?m (44.08 %) while the mean pre-treatment VA, mean post-treatment VA and mean improvement in VA were 0.79 ± 0.16, 0.51 ± 0.15 and 0.28 (36.11 %) logMAR units. With posterior subtenon TA, the mean pre-treatment CMT, mean post-treatment CMT and mean reduction in CMT were 394.43 ± 15.03 ?m, 247.3 ± 11.82 ?m and 147.13 ?m (37.3 %) while the mean pre-treatment VA, mean post-treatment VA and mean improvement in VA were 0.81 ± 0.15, 0.58 ± 0.14 and 0.23 (28.24 %) logMAR units. The mean pre-treatment IOP, mean post-treatment IOP and mean rise in IOP with intravitreal TA were 16.67 ± 1.92 mm Hg, 18.87 ± 1.81 mm Hg and 2.2 mm Hg (13.19 %), whereas with posterior subtenon TA were 16.87 ± 1.85 mm Hg, 17.4 ± 1.59 mm Hg and 0.53 (3.14 %). Conclusions: When used in diabetic macular edema, intravitreal triamcinolone acetonide is more effective than posterior subtenon

The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injection in branch retinal vein occlusion-related macular edema

Objective: To investigate the effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide (PSTA) application in branch retinal vein occlusion (BRVO)-related macular edema.Methods: Patients with confirmed BRVO-related macular edema were enrolled in the study. Patients were injected with a single, therapeutic dose of 40 mg PSTA. Detailed ophthalmic examination was performed at baseline and at 1, 3 and 6 months after the treatment. Best corrected visual acuity (BCVA), intraocular pressure (IOP), cataractogenic change (CC) and macular optical coherence tomography (OCT) analysis results were evaluated. The results were compared statistically.Results: Forty-one eyes of 41 patients with a mean age of 63.49 ± 10.99 (55–86) years, 15 (36.6%) females, were included in the study. BCVA in LogMAR values at 1 and 3 months were significantly better than at baseline, while no significant difference from baseline was observed in sixth month values (p < 0.001, p < 0.001 and p = 0.846, respectively). Central macular thickness values obtained using OCT were significantly lower at the first, third and sixth months compared to baseline (p < 0.001 for all). IOP elevation was determined in only two eyes (4.8%) at the end of the study period, and no CC was detected in any case.Conclusion: PSTA application is an effective and safe option in BRVO-related macular edema.

Posterior Subtenon's Capsule Triamcinolone Acetonide Injection for the Treatment of Diabetic Macular Edema.

To evaluate and compare the efficacy of posterior subtenon's triamcinolone injections versus grid laser photocoagulation (GLP) combined with posterior subtenon's triamcinolone injection in eyes with diabetic macular edema (DME). In this prospective clinical study, 42 eyes with DME that showed a decrease in visual acuity (VA) were included. The first group consisted of 22 eyes that received a posterior subtenon's injection of 40 mg of triamcinolone acetonide under topical anesthesia. The second group of 20 eyes received macular GLP applied 1 month after subtenon's triamcinolone acetonide (STTA) injection. All patients were evaluated at baseline and 1 day; 1, 2, 4, 6, and 8 weeks; and 3 and 6 months after injection. In some patients, injections were repeated after 3 months. The main outcome measures were VA, central macular thickness (CMT), intraocular pressure, cataract progression, and frequency of complications. The mean baseline CMT for Group I was 456.85 ± 56.90 μm. The mean baseline CMT for Group II was 455.66 ± 57 μm. In the first group, mean CMTs for second week, 8th week, 12th week, and 6th month were 258.15, 276.50, 280.05, and 433.30 μm, respectively. In the second group, mean CMTs for second week, 8th week, 12th week, and 6th month were 261.42, 272.76, 284.71, and 291.76 μm, respectively. Before treatment, in the first group, the mean best-corrected visual acuity (BCVA) measured using a Snellen chart was 0.19, while the first week, third, and sixth month BCVA means were 0.59, 0.57, and 0.41, respectively. Before treatment, BCVA in the second group was 0.17, while the first week, third, and sixth month means were 0.61, 0.64, and 0.60, respectively. Treatment complications included cataracts in 4 eyes and glaucoma in 1 eye. There is a temporary therapeutic effect of posterior subtenon's triamcinolone injection without laser photocoagulation. GLP improves VA and reduces the risk of recurrent macular edema after posterior STTA injection.