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A.V. Arya, J.W. Emerson, R.A. Adelman; Visual improvement Following Intravitreal Triamcinolone Acetonide for Macular Edema in Retinal Vascular Disorders: An Evidence–Based Study . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5202.
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To ascertain various predictive factors those determine visual improvement following intravitreal triamcinolone acetonide for macular edema in diabetes and retinal vein occlusions.
A meta–analysis was performed on the articles reporting functional outcome following intravitreal triamcinolone in macular edema associated with diabetes or retinal vein occlusions. Some studies also provided anatomical outcome based on optical coherence tomography. We retrieved 2244 articles following a systematic search of Cochrane library, PubMed, Medline and Embase databases. We included articles where data on preoperative visual acuity, applied surgical methodology and postoperative visual outcome were available. Articles on macular edema associated with pseudophakia, uveitis or degenerative retinal disorders were not included. Studies with associated cataract surgery, vitrectomy, laser therapy or radial neurotomy were also excluded from this analysis.
Out of 2244 papers, 20 articles matched the inclusion criteria. Of 448 patients, 333 eyes had diffuse macular edema due to diabetes, 61 eyes had central retinal vein occlusion and 54 eyes were with branch retinal vein occlusion. There was an average improvement in visual acuity by 0.312 (CI=0.22–0.39) logMAR units (3 lines on Snellen equivalent) from baseline to 1 month. There were no statistically significant changes in visual acuity from 1 to 3 months. From 3 months to the end of follow up (mean 7.2 months) visual acuity deteriorated by an average of 0.087 (CI=0.016–0.158) logMAR units despite repeat injections. Retinal vein occlusion group had an average improvement of 0.42 logMAR units, while the improvements for the diabetes studies averaged 0.22 logMAR units (p=0.021). Duration of macular edema prior to intravitreal triamcinolone, dosage of triamcinolone and baseline value of optical coherence tomography did not seem to predict amount of functional improvement.
Patients with macular edema due to central or branch retinal vein occlusions are more likely to respond favorably to intravitreal triamcinolone acetonide than diabetic macular edema patients.
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