Subtenon Triamcinolone Acetonide Research Articles

Early Intraocular Pressure Control Via Capsule Revision of a Failed Valved Aqueous Shunt During Concurrent Placement of a Nonvalved Aqueous Shunt

To describe the novel strategy of performing a concurrent capsule revision of a failed pre-existing valved aqueous shunt with implantation of an additional nonvalved aqueous shunt for early postoperative intraocular pressure (IOP) control. Case report of a single patient. An 87-year-old man with severe primary open-angle glaucoma in both eyes presented to our clinic. His pseudophakic left eye had a failed superonasal trabeculectomy and an encapsulated superotemporal Ahmed FP7 (New World Medical) aqueous shunt in the anterior chamber. He had previously undergone micropulse cyclophotocoagulation 3 times and excisional goniotomy. Visual acuity in his left eye was 20/30, and IOP was 24 mmHg on 4 topical IOP-lowering medications. An inferonasal Baerveldt 350 (Advanced Medical Optics) aqueous shunt was placed with concurrent revision of the Ahmed capsule. A large block of capsule tissue was excised from the surface of the plate, and 20 mg of subtenon triamcinolone acetonide (Kenalog, Bristol-Myers Squibb) was injected overlying the plate. His IOP ranged between 6 and 15 mmHg in the immediate postoperative period. There were no hypotony-associated complications at any time point. At postoperative month 18, his IOP was 10 mmHg on zero medications. In patients with a failed valved aqueous shunt undergoing an additional nonvalved aqueous shunt, a concurrent capsule revision of the valved aqueous shunt can provide early IOP lowering before the nonvalved tube opens.

Involvements of choroidal vascular structures with local treatments in patients with diabetic macular edema.

To examine changes of the choroidal morphology in patients with diabetic macular edema (DME) before and after local treatments. This study was on 20 eyes with DME, observed for more than 24 months. All patients underwent laser photocoagulation (Laser), sub-tenon triamcinolone acetonide injection (TA), or intravitreal aflibercept injection (IVA). Central macular and choroidal thicknesses (CMT/CCT), and choroidal vascular structures consisting of the total choroidal area (TCA), luminal area (LA), and stromal area (SA) were measured by a binarization method. The ratios of LA in TCA were eventually determined as the L/C ratio in each case. The L/C ratio significantly decreased for 24 months in patients with DME (p = 0.01), whereas no significant differences were noted in other parameters including TCA, LA, SA, or CCT. Among patients treated with Laser ± TA ± IVA, a significant correlation was found between a high L/C ratio at pretreatment and a lower cumulative number of injections (1-2 times/24 months) (p = 0.04). The L/C ratio in pretreatment showed a significantly inverse correlation with CMT (-0.60, p = 0.02) and subsequent BCVA (logMAR) (-0.59, p = 0.03). This study highlighted that the L/C ratio in pretreatment might predict a change of the visual acuity in DME.

Three cases of brolucizumab-associated retinal vasculitis treated with systemic and local steroid therapy.

To describe three Japanese cases of retinal vasculitis that occurred following intravitreal brolucizumab injections and the systemic and local steroid treatment administered. Three patients developed intraocular inflammation (IOI) and retinal vasculitis following the first injection of brolucizumab for age-related macular degeneration. For two eyes, monthly aflibercept injections did not control exudation, and therapy was changed to brolucizumab; one eye was treatment-naïve. All three patients noticed blurry vision and floaters 11-18 days after brolucizumab injections, and the treated eyes exhibited anterior chamber cells, fine keratic precipitates, vitreous cells, and vitreous haze. Ultra-widefield color images of the fundus showed retinal hemorrhage in the peripheral retina and, in two cases vascular sheathing. Ultra-widefield fluorescein angiography (FA) showed segmental vascular leakage in all eyes and leakage from the optic disc in two eyes. Vascular filling defects were noted in the peripheral retinae of two eyes. Brolucizumab-associated retinal vasculitis was diagnosed, and treated with 30 mg/day of oral prednisolone, subtenon triamcinolone acetonide injection (20 mg/0.5 ml), and 0.1% betamethasone sodium phosphate solution. After 1 week, color fundus images and FA showed improvements in vascular sheathing, leakage from retinal vessels, and optic disc leakage, but the vascular filling defects remained. Visual acuity was restored in all three eyes 6 weeks after the onset. Brolucizumab-associated IOI, including retinal vasculitis and retinal occlusion, is a rare but important adverse event that can cause severe vision loss. Prompt diagnosis with FA and treatment with systemic or local steroids should be considered.

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.

Intravitreal Ranibizumab versus Intravitreal Ranibizumab Combined with Posterior Subtenon Triamcinolone Acetonide in Diabetic Macular Edema

Objectives:This is a retrospective, comparative evaluation of the short-term efficacy and safety of intravitreal ranibizumab (IVR) and IVR combined with posterior subtenon triamcinolone acetonide (STA) in the treatment of diabetic macular oedema (DME).Methods:A total of 79 pseudophakic eyes of 57 patients with DME who underwent IVR injection treatment were examined retrospectively. All of the patients were treatment-naive. In the study group (STA+IVR), consisting of 30 eyes of 39 patients, the STA and IVR were administered in the first treatment session simultaneously, followed by 2 consecutive monthly IVR injections. In the control group (IVR only) comprised 40 eyes of 27 patients, 3 consecutive monthly IVR injections were administered. Patients with serous retinal detachment (SRD) according to optical coherence tomography images were identified in both groups for subgroup analyses. The primary outcome measures were changes in central macular thickness (CMT), best corrected visual acuity (BCVA), and the intraocular pressure (IOP) at 1, 2, and 3 months post-injection.Results:There was no statistically significant difference between the demographic characteristics of the patients’ baseline BCVA and CMT measurements (p>0.05). For the IVR group, the mean pre-treatment CMT and BCVA was 421.20±89.10 μm and 0.42±0.24 logMAR, respectively. After the third injection, the mean was 308.12±59.07 μm and 0.20±0.12 logMAR, respectively. The combined treatment group baseline measurements were 454.50±122.52 μm and 0.54±0.29 logMAR, respectively. After the third injection, the mean was 294.22±50.33 μm and 0.27±0.21 logMAR, respectively. The decrease was statistically significant for both groups (p=0.001). Comparison of the CMT within groups revealed a statistically significant difference in favor of the combined group after the second injection (p=0.017). There was no statistically significant difference in the BCVA gains between groups (p>0.05). Patients with SRD were evaluated as a subgroup, and at the first month, the mean gain in CMT was -71.63±57.98 μm in the control group and -123.61±93.46 μm in the study group (p=0.048). The required anti-glaucomatous treatment was statistically significant in the combined group (p=0.008).Conclusion:Both treatments provided improvement in BCVA and CMT and can be considered functional and anatomically effective treatment options for DME.

Combined intravitreal ranibizumab and posterior subtenon triamcinolone acetonide injections for patients with diabetic macular edema refractory to intravitreal ranibizumab monotherapy.

PURPOSE:The purpose of this study is to compare the efficacy of intravitreal ranibizumab (IVR) alone and concurrent IVR with posterior subtenon triamcinolone acetonide (PSTA) injection for patients with diabetic macular edema (DME) refractory to IVR monotherapy.MATERIALS AND METHODS:We enrolled 43 eyes of 43 patients with DME who received at least three times of IVR, which resulted in poor anatomical responses, with central foveal thickness (CFT) reduction <10% and postinjection CFT >300 μm. All the eyes received initial 3 monthly then pro re nata (PRN) IVR 0.5-mg injections. Twenty eyes continued PRN injections and 23 eyes received combined IVR 0.5 mg and PSTA 40 mg with at least 1-year follow-up. Best-corrected visual acuity (BCVA) and CFT were recorded from 1-month to 1-year follow-up.RESULTS:Following switch to combined therapy, the mean BCVA significantly improved from 0.61 ± 0.32 logarithm of the minimum angle of resolution (logMAR) to 0.45±0.39 logMAR at 6 month (P = 0.003), 0.43±0.35 logMAR at 9 months (P < 0.001), and 0.48±0.45 logMAR at 1 year (P = 0.03). In eyes with IVR alone, no significant VA improvement was noted throughout the year. Significantly better BCVA was noted in the combined group at 6-month, 9-month, and 1-year follow-up compared to IVR-alone group. The timing of combined therapy showed a significant association with 1-year BCVA (t = 3.25, P = 0.018).CONCLUSION:Concurrent IVR and PSTA resulted in significantly better visual outcomes in 1-year follow-up for those refractory to preceding ranibizumab monotherapy for DME. Early addition of PSTA predicted a better visual outcome.

Comparative study on pharmacokinetics and toxicity of intravitreal and sub-Tenon injection of triamcinolone acetonide in ocular tissues.

To compare the differences in kinetics, distribution, and toxicity of triamcinolone acetonide (TA) between the injection methods, sub-Tenon and intravitreal injections in rabbit ocular tissues. TA was injected into the vitreous or the sub-Tenon in rabbits. For pharmacokinetic study, rabbits were sacrificed periodically and then TA in blood and ocular tissues (retina/choroids, vitreous, and aqueous humor) were measured over 91d. For toxicological study, clinical signs, slit-lamp microscopic examination, ophthalmological test were performed. The eyeballs and surrounding tissues were collected and fixed with glutaraldehyde-formalin solution, and then paraffin embedded for histological investigation. Higher levels of TA were distributed in the intraocular tissues when injected into the vitreous compared to the sub-Tenon. Conversely, TA level was remarkably lower in the rabbits which received intravitreal TA injections than those treated with sub-Tenon injection throughout the study period in plasma. Optical discharge probably caused by systemic circulation of TA was observed by receiving sub-Tenon TA injection. Meanwhile, technic-associated toxicological ocular symptoms and findings were more frequently observed in intravitreal injection than in sub-Tenon injection. There are significant differences in kinetics and distribution of TA in vitreous body, aqueous humor and plasma, between the two injection methods. Although further study is needed to explain the species difference between human and rabbit, it is assumed that the difference in the frequency of intraocular pressure elevation and cataract formation by TA between the two injection methods are directly related to the TA concentrations in aqueous humor and vitreous body in each injection methods. Systemic toxicity and technic-associated toxicity are also closely related to kinetics of TA in plasma and each injection method itself, respectively.

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.

Management of Cystoid Macular Edema After Vitrectomy for Proliferative Vitreoretinopathy

To assess therapies for cystoid macular edema (CME) following pars plana vitrectomy for proliferative vitreoretinopathy (PVR). Retrospective analysis of 42 eyes developing CME after PVR surgery. Treatments included topical therapy, sub-Tenon's triamcinolone acetonide (STTA), intravitreal bevacizumab and combinations thereof. Best-corrected visual acuity (BCVA) as well as central subfield thickness (CST) were tracked. Mean Snellen BCVA improved from 20/598 to 20/297 (logMAR change -0.21; confidence interval [CI], -0.39 to -0.03; P = .03). Mean CST improved from 448 µm to 260 µm (CI, -248.70 to -126.06; P < 0.01). There was no difference in efficacy between treatment subgroups (analysis of variance, P = 0.16, 0.43), but STTA yielded statistically significant improvement in both categories (CI, -0.79 to -0.11; P = 0.01; and CI, -333.74 to 166.51; P < .01). Treatment of CME following PVR surgery is possible with a variety of different options. STTA appears to yield anatomical and visual improvement. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:436-443.].

Outcomes of 25-Gauge Vitrectomy for Tractional and Nontractional Diabetic Macular Edema with Proliferative Diabetic Retinopathy.

The benefit of pars plana vitrectomy with internal limiting membrane peeling for tractional macular edema and diffuse nontractional macular edema in diabetic retinopathy has been reported. Although these studies had included various stages, use of conventional 20-gauge vitrectomy system, small number of cases, single-center study, and lack of retinal structure measurements were limitations. We compared one-year outcomes of 25-gauge vitrectomy for refractory diabetic macular edema with or without the tractional proliferative membrane in proliferative diabetic retinopathy (PDR) eyes and examined the prognostic factors for postoperative visual acuity. A total of consecutive 116 PDR eyes of 116 patients that underwent 25-gauge vitrectomy for tractional macular edema (TME group: 56 eyes) or nontractional macular edema (nTME group: 60 eyes) at six centers were retrospectively reviewed. Visual acuity (VA), central macular thickness (CMT), complications, and postoperative treatments before and 12 months after vitrectomy were compared. Mean VA improved significantly in each group (both P < 0.01), and mean CMT decreased significantly in each group (both P < 0.01). Thirteen eyes underwent additional vitrectomy, six eyes developed neovascular glaucoma, six eyes received intravitreal anti-VEGF injection, and thirteen eyes received subtenon triamcinolone acetonide injection. Multiple linear regression analysis showed that baseline VA and CMT in the TME group and kidney function in the nTME group were the predictable factors of the 12-month postoperative VA. Twenty-five-gauge vitrectomy effectively improved VA and macular structure both in TME and nTME groups. Baseline VA, CMT, and kidney function are important factors affecting postoperative VA.

Intraocular pressure elevation after subtenon triamcinolone acetonide injection; Multicentre retrospective cohort study in Japan.

To evaluate real-world evidence for intraocular pressure (IOP) elevation after subtenon triamcinolone acetonide injection (STTA) in 1252 Japanese patients (1406 eyes) in the Japan Clinical REtina STudy group (J-CREST). This was a multicentre retrospective study of the medical records of 1252 patients (676 men (758 eyes); mean age: 63.8 ± 12.9 years) who received STTA in participating centres between April 2013 and July 2017. IOP elevation was observed in 206 eyes (14.7%) and IOP increase ≥ 6 mmHg was found in 328 eyes (23.3%). In total, 106 eyes (7.5%) needed medication and two eyes (0.14%) needed surgical procedures. Younger age, higher baseline IOP, and steroid dose were risk factors associated with IOP elevation. Risk factors associated with IOP increase ≥ 6 mmHg were younger age, lower baseline IOP, steroid dose, and higher incidences of diabetic macular oedema (DME) and uveitis. In contrast, with steroid dose fixed at 20 mg, a lower incidence of DME was a risk factor for increased IOP, suggesting that STTA had dose-dependent effects on IOP increase, especially in patients with DME. Our real-world evidence from a large sample of Japanese patients who received STTA showed that the incidence of IOP elevation after STTA was 14.7%, and was associated with younger age, higher baseline IOP, and steroid dose. Thus, IOP should be monitored, especially in patients with younger age, higher baseline IOP, and higher incidences of DME and uveitis.

Short-term outcomes of subtenon triamcinolone acetonide injections in patients with retinitis pigmentosa-associated cystoid macular edema unresponsive to carbonic anhydrase inhibitors.

To investigate the functional and anatomical results of subtenon triamcinolone acetonide injection (TA) in eyes with retinitis pigmentosa (RP) that had cystoid macular edema (CME) unresponsive to carbonic anhydrase inhibitors (CAIs). This is a prospective, interventional study. Forty-eight consecutive eyes that underwent subtenon TA for CME due to RP were recorded. Central macular thickness (CMT), best-corrected visual acuities (BCVAs) and intraocular pressures (IOPs) were evaluated before and after injection at 2nd week, 1st month, 2nd month and 3rd month, respectively. Spectral-domain optical coherence tomography (SD-OCT) was used to show anatomic findings. Complications such as cataract and glaucoma were recorded. A total of 48 eyes of 42 patients with a mean age of 36.25 ± 15.59years (range 13 to 63years) and a mean follow-up of 4.45 ± 0.74months (range 4 to 6months) were recorded in the study. The mean initial BCVA increased from 1.09 ± 0.52 to 0.54 ± 0.29 logarithmic minimum angle of resolution (log MAR) (p < 0.001) at 3months after injection and the mean central macular thickness decreased from 591.45 ± 209.55µm to 270.83 ± 95.48µm (p < 0.001). The mean iOP increased from 13.58 ± 2.87mmHg to 15.91 ± 2.47mmHg (p < 0.001). Multiple injections (3 injections) in 1 eye, 2 injections in 4 eyes and 1 injection in rest of the eyes were performed at 3-month intervals. Complications such as glaucoma and cataract were not observed in any patient during and after the treatment. In the present study, a significant improvement in visual acuity and CMT were observed in eyes with subtenon TA for CME due to RP unresponsive to CAIS. Further studies with a long follow-up period of the population are required to investigate the role of subtenon TA of CME due to RP.

Evaluation of The Effect of Combined Intra-Vitreal Ranibizumab Injection and Sub-Tenon Tri-Amcinolone Acetonide Injection in The Management of Diabetic Macular Edema

Background: to monitor and compare the effect of intravitreal ranibizumab injection alone or with sub-tenon triamcinolone acetonide injection on patients with diabetic macular edema. 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 edema. Patients and Methods: Patients with non-proliferative diabetic retinopathy associated with DME (Central macular thickness over 300 um) which are aimlessly divided 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 10 days after the sub-tenon steroid injection [triamcinolone acetonide]. All patients’ visual acuity, IOP and CMT were followed up for 3 months. Results: The combined treatment showed improved best corrected visual acuity from baseline 0.24 ± 0.32 log MAR to 0.56 ± 0.18 log MAR (p = 0.023) which was statistically significant. In addition, there was decreased CMT from baseline 420.1 ± 112.84 to 275.73 ± 90.81 which was highly statistically significant (p > 0.001). When comparing the combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant (p = 0.041 and p = 0.001, respectively). Conclusion: Steroid addition to the routine anti-VEGF therapy is an effective method of treatment of diabetic macular edema

Evaluation of The Effect of Combined Intra-Vitreal Ranibizumab Injection and Sub-Tenon Tri-Amcinolone Acetonide Injection in The Management of Diabetic Macular Edema

Background: to monitor and compare the effect of intravitreal ranibizumab injection alone or with sub-tenon triamcinolone acetonide injection on patients with diabetic macular edema. 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 edema. Patients and Methods: Patients with non-proliferative diabetic retinopathy associated with DME (Central macular thickness over 300 um) which are aimlessly divided 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 10 days after the sub-tenon steroid injection [triamcinolone acetonide]. All patients’ visual acuity, IOP and CMT were followed up for 3 months. Results: The combined treatment showed improved best corrected visual acuity from baseline 0.24 ± 0.32 log MAR to 0.56 ± 0.18 log MAR (p = 0.023) which was statistically significant. In addition, there was decreased CMT from baseline 420.1 ± 112.84 to 275.73 ± 90.81 which was highly statistically significant (p > 0.001). When comparing the combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant (p = 0.041 and p = 0.001, respectively). Conclusion: Steroid addition to the routine anti-VEGF therapy is an effective method of treatment of diabetic macular edema

The Efficacy of Posterior Subtenon Triamcinolone Acetonide Injection in Treatment of Irvine-Gass Syndrome

ABSTRACTPurpose: To evaluate the efficacy and safety of posterior 40 mg subtenon triamcinolone acetonide (PST) injection in treating Irvine-Gass syndrome.Methods: The retrospective study included 21 patients (mean age: 76 ± 8.2) with a treatment-naïve eye subjected to topical anesthesia and injection of 40 mg/ml triamcinolone via a blunt tip SubTenon cannula through a single inferonasal peritomy. Best corrected visual acuity (BCVA; logMAR), intraocular pressure (IOP), biomicroscopic and funduscopic findings, and optical coherence tomography (OCT) measurements were recorded.Results: Baseline central macular thickness decreased from 431 ± 136 µm to 300 ± 67 µm (1st month; p = .002), to 292 ± 56 µm (3rd month; p = .002), and to 299 ± 66 µm (6th month; p = .005). Mean BCVA increased from 0.71 ± 0.23 to 0.27 ± 0.11, 0.19 ± 0.06, and 0.24 ± 0.17, respectively (all visits; p < 0.001). Mean IOP values did not change significantly (p = .12).Conclusion: PST injection is an effective and safe treatment for Irvine-Gass syndrome.

Effect of intravitreal or sub-tenon triamcinolone acetonide injection at completion of vitrectomy on peripheral retinochoroidal thickness in eyes with proliferative diabetic retinopathy

The effect of triamcinolone acetonide (TA) on the peripheral retinochoroidal thickness was determined after pars plana vitrectomy (PPV) with scatter photocoagulation in eyes with proliferative diabetic retinopathy. The peripheral retinochoroidal thickness was measured at 5 mm from the limbus in the four quadrants using anterior segment optical coherence tomography before, and 3 days, and 1 and 2 weeks after the surgery. The total peripheral thickness was significantly thicker than the baseline thickness after PPV alone (P < 0.001; 18 eyes), PPV combined with intravitreal TA injection (IVTA; P = 0.011; 19 eyes), and PPV combined with sub-tenon TA injection (STTA; P = 0001; 23 eyes). The total peripheral thickness in the PPV group at 3 days after surgery was significantly thicker than that of the PPV + IVTA (P = 0.015) and of the PPV + STTA groups (P = 0.016). Multiple linear regression analyses showed that the injection of TA by the two routes and the number of photocoagulation burns were significantly correlated with the total peripheral thicknesses at 3 days after the surgery. The results indicate that the PPV with large number of intraoperative scatter photocoagulation burns caused an increase in the total peripheral thickness and an administration of either IVTA and STTA can reduced the degree of thickening.

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.

Oral kallidinogenase improved visual acuity and maintained chorioretinal blood flow levels after treatment for diabetic macular edema.

PurposeThis study was designed to investigate the therapeutic effects of oral kallidinogenase medication as an adjuvant therapy in treating patients with diabetic macular edema (DME).Study designThis was a prospective, open-labeled, randomized study.MethodsAll patients were given posterior sub-Tenon triamcinolone acetonide (STTA) injection and focal laser treatment session for DME. The patients were subdivided into two groups: 1) those treated with oral kallidinogenase for at least 6 months after local treatment (treated group) and 2) those treated without oral kallidinogenase (untreated group). In this study, best-corrected visual acuity (BCVA), central retinal thickness (CRT), subfoveal choroidal thickness (SCT), and chorioretinal blood flow level were measured in 17 patients (19 eyes). Chorioretinal blood flow levels at the disc and macula were measured by laser speckle flowgraphy and evaluated using the mean blur rate (MBR). These data were measured at baseline and at 1, 3, and 6 months after treatment initiation.ResultsBCVA at 6 months after treatment significantly improved in treated group (P<0.05). But the mean CRT after treatment significantly decreased in both groups. There was no significant difference in the mean SCT at baseline between the two groups. The mean SCT after treatment in treated group was significantly thinner than that before treatment (P<0.05). Compared to baseline (100%), MBR at the disc and the macula at 6 months after treatment significantly decreased to 84.8% and 86.2%, respectively, in untreated group (P<0.05), though it remained unchanged at 98.7% and 99.7% in treated group.ConclusionOral kallidinogenase medication is useful as an adjuvant therapy to enhance the therapeutic effect of STTA in DME patients.