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J.C. Yeh, S.M. Hariprasad, J. Benevento, W.F. Mieler; Comparison of Efficacy Between Intravitreal and Periocular Injection of Triamcinolone Acetonide for Refractory Pseudophakic Cystoid Macular Edema . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4244.
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Cystoid macular edema is the most common cause of suboptimal visual acuity after cataract surgery. Most cases resolve spontaneously or after topical NSAID and steroid treatment. In cases refractory to medical management, intravitreal administration of triamcinolone acetonide (IVTA) has been reported to be effective in improving visual acuity and central macular thickness. However, to our knowledge, the efficacy of periocular triamcinolone acetonide injection for pseudophakic cystoid macular edema compared to IVTA has not been previously described. The purpose of this investigation is to compare the efficacy of intravitreal versus periocular (sub–Tenon’s capsule and posterior juxtascleral) injection of triamcinolone acetonide for pseudophakic cystoid macular edema.
This study is a retrospective analysis of eight eyes with pseudophakic cystoid macular edema refractory to topical therapies. Five eyes received 4 mg (0.1 ml) IVTA injection, two received 40 mg (1 ml) anterior sub–Tenon’s capsule injection, and one received 40 mg (1 ml) posterior juxtascleral injection. Patients with macular edema from other etiologies or eyes with media opacity were excluded. The outcome measures included changes in Snellen visual acuity and central macular thickness determined on optical coherence tomography testing.
IVTA achieved a greater magnitude of improvement in both visual acuity and central macular thickness compared to the two periocular injection methods. In the IVTA group, mean visual improvement was 2.8 lines while eyes which received periocular injections improved an average of 1.3 lines. The mean reduction in central macular thickness in the IVTA group was 112 µm compared to 3 µm in the periocular injection group. Average follow up for all patients was 16 weeks and no patient included in this series had any complications or a decrease in vision.
IVTA injection is more effective than periocular injections for the treatment of pseudophakic cystoid macular edema. However, IVTA has a more concerning side–effect profile compared to periocular administration. A larger randomized trial may be warranted to determine if the increased visual benefits of IVTA compared to periocular triamcinolone acetonide injection warrants the greater risk and side–effect profile.
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