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PA Kurz, RS Moorthy, JA Fountain; Treatment of Refractory Macular Edema With Intraocular Triamcinolone Acetonide . Invest. Ophthalmol. Vis. Sci. 2002;43(13):507.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the response of refractory macular edema to intravitreal injection of triamcinolone acetonide. Methods: Fifteen eyes of eleven patients with refractory macular edema (either diabetic clinically significant macular edema (CSME) or cystoid macular edema (CME), pseudophakic CME, or inflammatory CME) were identified. These patients all had little or no response to conventional treatments including focal grid laser, topical prednisolone acetate, topical ketorolac, subtenons injections of triamcinolone acetonide, oral diamox, and pars plana vitrectomy. Pre-injection Snellen visual acuity was recorded. In some cases, pre-injection fluorescein angiograms were done. Informed consent was obtained and these patients were treated with trans pars plana intravitreal injection of 0.1 cc of triamcinolone acetonide (40mg/cc). Pre and post-injection fluorescein angiograms, clinical exams, and visual acuities were compared to monitor response to therapy. Patients' subjective responses were also recorded to determine if there was any functional improvement in vision. Results: Patients' visual acuity improved an average of 1.7 Snellen lines at an average of 5 weeks after treatment. Patients that showed improvement did so by 1 month after treatment. One eye showed improvement at one month but return to baseline visual acuity by 6 weeks after injection. Two eyes which were each injected 3 times over 7 and 8 months respectively showed considerable improvement (4 and 5 lines of Snellen visual acuity respectively) for approximately 2 months after each injection, but then a gradual waning of improvement by 3 months after injection. The functional vision in 10 eyes was described by patients as slightly to somewhat better. The functional vision in 5 eyes was not noted to change at all. In all cases, on clinical exam and/or fluorescein angiography the macular edema either improved or completely resolved. No patients have yet developed cataracts, intraocular pressure spikes, vitreous hemorrhage, or retinal detachment. Conclusion: Intravitreal triamcinolone acetonide appears to be effective at reducing or eradicating refractory macular edema. However, the improvement in visual function appears less dramatic. There is suggestion that the effect is temporary, and repeat injections are likely to be necessary. Further study and monitoring of these patients will add to our knowledge of efficacy and complication rates.
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