Abstract
Purpose: :
There is currently wide–spread use of intra–vitreous triamcilone (IVK) for age related macular degeneration, diabetic macular edema, cystoid macular edema secondary to retinal vein occlusions and uveitis. The proposed mechanisms of reduced macular edema with corticosteroid is local reduction of inflammatory mediators, increased diffusion by modulation of calcium channels, decreased levels of VEGF and improvement of blood–retinal barrier function.
Methods: :
Retrospective interventional case series of all patients from 2 retina specialists undergoing IVK in a clinic setting from 2002 to 2005. All disease entities were included. Pre–op antibiotics and 10% Betadine were applied to conjuncitive, lids and lashes, 10 minutes prior to procedure. Sub–conjunctival injection of 0.3 ml of 1% Lidocaine was performed, 3mm from limbus in superotemporal quandrant. Using sterile technique, a 30 gauge needle with 4 mg (0.1 ml) of non–filtered Triamcinolone Acetonide (Kenolog) was injected at 3.5 mm posterior to limbus into mid–vitreous cavity.
Results: :
352 eyes of 315 patients received IVK between 2002 and 2005. The mean age was 71yrs. Disease entities treated were as follows: diabetic macular edema (33.0 %); exudative AMD con–current with PDT (30.2%); CRVO with cystoid macular edema (CME) (16.8%); BRVO with CME (14.3%); hemi–vein occlusion with CME (1.9%); CME from posterior uveitis (3.8%). Mean follow–up for all eyes was 9.8 months. Number of IVK treatments was 508. Single injection was performed in 315 eyes (62.0%); 2 IVK in 119 eyes (23.4%) and 3 IVK’s in 44 eyes (8.7%) and 5.9 % of eyes had more than 3 injections at a minimal interval of 3mos. The only immediate complication was a single injection (0.2%) was associated with a temporary occlusion of the central retinal artery, which opened immediately following anterior paracentesis. Late complications included endophthalmitis in 1/508 (0.2%), cataract surgery in 22/508 (4.3%). A steroid response requiring glaucoma medications occurred in 115/508 (22.6%). In eyes with pre–existing glaucoma , 44.3% required additional glaucoma medication. Glaucoma filtering surgery was required in 3/508 eyes (0.6%) and all 3 eyes had pre–existing glaucoma.
Conclusions: :
In the study centre, intra–vitreous injection of triamcinolone is extremely safe in patients without a history of glaucoma. Pre–existing glaucoma with progressive optic neuropathy may be a contraindication to IVK. In the presence of nuclear sclerosis, IVK may accelerate cataract changes.