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M. Timmermann, J. Riese, V. Loukopoulos, C. Meier, H. Gerding; Sequential Intravitreal Triamcinolon Injection and Laser Photocoagulation of Previously Edematous Retinal Areas in Cases With Persistend Macula Edema Due to Branch Retinal Vein Occlusion. A 6 Months Follow-Up Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1549. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Persistent macular edema is the most common cause of functional loss in cases with branch retinal vein occlusion (BRVO). The efficacy of a combined treatment consiting of intravitreal injection of triamcinolone (TA) and early photocoagulation was analysed in patients with persistent macular edema due to retinal vascular barrier breakdown in cases with previous BRVO.
Retrospective analysis of 19 patients (mean age 73.3 +/- 11.4 years) with persistent macula edema due to BRVO. In all cases macular edema was including at least one foveal quadrant. Patients received an intravitreal injection of 4 mg TA and laser coagulation after subsequent remission of edema within the previously edematous area. No laser treatment was applied outside previously edematous areas. 14 patients received 1, 5 patients 2 laser treatments after the first injection of triamcinolone. Laser treatment was performed on average 18 days after TA injection (range: 8 - 46 days). Standardized clinical examinations were including best corrected visual acuity testing, anterior and posterior segment biomicroscopy, IOP, and OCT documentation before TA application and postoperatively on day 1, after 1 week, after 2 weeks, 1 month, 2 months, 3 months and 6 months. Fluorescein angiography was performed before TA injection and 3 and 6 months later. 3 patients received a second series of TA injection and laser photocoagulation shortly after the 3 months evaluation.
Visual acuity improved from baseline (mean 0.26 +/- 0.13, n=19) to 0.4 +/- 0.19, n=19) after 1 month, 0.39 +/- 0.26, n=14) after 3 months, and 0.38 +/- 0.25 (n=13) after 6 months. OCT-central retinal thickness of preoperatively 421 +/- 75 µm decreased to 277 +/- 91 µm at 1 month (n=17), 324 +/- 159 µm at 3 months (n=14), and 356 +/- 141 µm (n=9) after 6 months. In all cases a significant reduction of macular edema was observed in the 3 and 6 months fluorescence angiography. 7/19 patients developed secondary increase of IOP that was well controlled by local antioglaucomatous therapy.
According to theses previous results persistent macular edema can effectively be treated by a combination of intravitreal TA injection and laser photocoagulation of the previous edematous retinal areas. Conversely to previous strategies, healthy retinal areas remain untouched and preserved whereas the pharmacological effect of TA allows a photocoagulation to pathological retinal areas during the time period of regressed edema.
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