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M. R. Munk, C. Kiss, T. Barisani-Asenbauer, S. Maca, F. Sulzbacher, M. Baratsits, U. Schmidt-Erfurth; Functional and Morphologic Aspects of Intravitreal Triamcinolone for Uveitis-Associated Cystoid Macular Edema. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6028.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on uveitis-associated cystoid macular edema (CME) using high resolution optical coherence tomography (SDOCT) in conjunction with thorough visual function testing.
Ten patients with uveitis-associated CME were examined before intravitreal triamcinolone injection (IVTA) (v1) and at day 1 (v2), week 1 (v3) and month 1 (v4) after injection. Retinal anatomy was evaluated using Cirrus HD-OCT (Carl Zeiss Meditec). Visual function testing consisted of assessing ETDRS distance visual acuity (VA), reading acuity and reading speed using a standardized German-language test (Radner Reading charts), contrast sensitivity using Pelli-Robson Contrast Sensitivity charts and fundus-controlled microperimetry using the MP-1 Microperimeter (Nidek). Here we utilized a cartesian grid consisting of a central locus and three concentric box-shaped stimulation areas. The changes of retinal anatomy over time were compared to the respective outcome of visual function.
Distance VA at v1 was logMAR 0.7±0.38. At v2 the mean VA increased to 0.6±0.41, at v3 the VA was 0.6±0.52 and at v4 it was 0.3±0.21. The contrast sensitivity score (CS-Score) declined from 1.3±0.26 (v1) to 1.2±0.26 (v2) and improved afterwards from 1.3±0.34 (v3) to 1.5±0.32 (v4). The reading acuity (logRAD-score) was at 0.95±0.47 at v1, at v2 0.87±0.6, at v3 1.01±0.07 and at v4 0.82±0.08. The central retinal sensitivity (CRS) was at v1 10.6±5.93dB, at v2 13.93±4.39, at v3 12.78±8.87 and at v4 14.9±4.76. Cirrus OCT central subfield thickness was at v1 507.75±121.32µm, and decreased continuously to 340±107.34µm at v4. The critical print size correlated with Cirrus HD-OCT retinal volume (r=-0.7, p=0.024) and there was a correlation between maximum reading speed and retinal average thickness (r=0.7, p=0.03). Contrast sensitivity and Distance VA were not significantly correlated with retinal anatomic results.The CRS showed a correlation with retinal volume (r=0.78, p=0.05).
IVTA has a fast and positive effect on retinal anatomy. However, visual function improvement lags behind anatomical changes. Parameters of higher order visual function (such as reading, CRS) seem to be more sensitive than standard distance VA and furthermore show a better reflection of changes in retinal anatomy.
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