The Use of Intravitreal Triamcinolone Acetonide in Idiopathic Juxtafoveal Retinal Telangiectasia (IJRT) Type 2a

Abstract

Purpose: : To report the visual acuity, contrast sensitivity, mean foveal thickness and multifocal ERG (mfERG) findings in the first 12 months after intravitreal injection of triamcinolone acetonide in patients with IJRT type 2a.

Methods: : In this prospective case series, patients were identified who had IJRT type 2a who had received a single intravitreal triamcinolone acetonide (4mg) and had reached 12 months of follow up. Patients received logMAR ETDRS visual acuity(VA) contrast sensitivity (CS) central foveal thickness measurements and mfERG recordings at baseline and at 3 monthly intervals up–to 12 months.

Results: : 7 eyes of 5 patients were included. Six eyes had stage 3 and one eye had stage 4 disease. At 4 and 13 weeks post injection, the median VA had improved by 0.125 (range 0.24 to –0.08) and 0.1 (range 0.2 to –0.14) logMAR units compared to baseline, respectively. By 26 weeks, the median VA had returned to baseline. The median CS improved by 1 letter (range 6 to –1) at 13 weeks and had returned to baseline at 26 weeks. The mfERG was evaluated by means of the scalar response density of the central elements (1^st order kernels). It showed considerable variation between patients, although the general pattern was for a gradual increase, followed by a decline to baseline value over the succeeding months. On OCT examination, 2 eyes had evidence of sub–retinal fluid, while the remainder had characteristic hyporeflective intra–retinal cystoid areas. The median baseline central foveal thickness was 154 microns (range 105–406). At 4 and 13 weeks, the median foveal thickness had reduced by 7 (range +6 to –193) and 14 (range +14 to –270) microns respectively. At 26 weeks, the value had returned to baseline. At 13 weeks post injection, 1 eye required topical anti–ocular hypertensive treatment as monotherapy for 3 months. No eyes required cataract surgery during the follow–up period.

Conclusions: : This small series suggests that treatment of IJRT type 2a with intravitreal triamcinolone acetonide shows a short lived, modest improvement in visual acuity, contrast sensitivity and foveal thickness.

Keywords: clinical (human) or epidemiologic studies: outcomes/complications • macula/fovea • retina