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H. Kalm, E. Byhr; Ischemic–Crvo and Triamcinolone: Early Treatment and Tight Time Frames May Prolong Visual Survival . Invest. Ophthalmol. Vis. Sci. 2006;47(13):5169.
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© ARVO (1962-2015); The Authors (2016-present)
To report the outcome of early treatment (2 weeks of manifest CRVO) and multiple injections with Triamcinolone 4 mg (0.1ml) for ischemic–CRVO in two otherwise healthy male patients age 61 and 49. Both were blind in their first eye due to ischemic–CRVO with secondary glaucoma about one year previous to CRVO in their second eye.
Super Selective Ophthalmic Artery Fibrinolysis was performed in both patients without any effect on visual acuity and OCT (Optical Coherence Tomography). Triamcinolone 4 mg (0.1ml) was then injected in to the vitreous after one–week delay. Regular follow–up was scheduled one week, one, 2, 3, 6 and 12 month after the injection. The patients were however seen more frequently because of re–injections. Patient A received re–injection after 6 and 11 month and patient B after 4.5–6.5–10 and 12 month. Each injection was given no more than ten days after onset of symptoms e.g. sudden decreased reading ability and an increase in OCT. Visual acuity at long distance (VA–L), near vision i.e. reading at 30 cm (VA–N), ETDRS, OCT and biomicroscopy of the anterior segment was performed at the visits and retinal photographs were taken at regular intervals. Fluoresceine angiography was also included.
Baseline data for patient A were VA–L: 0.13 (=log MAR 0.9), VA–N: 24p, ETDRS: 45, OCT: 705 and at 12 month VA–L: 0.65 (=log MAR 0.18), VA–N: 5p, ETDRS: 79, OCT: 220. Baseline data for patient B were VA–L: 1.0 (=log MAR 0.0), VA–N: 5p, ETDRS: 88, OCT: 469 and at 12 month VA–L: 0.5 (=log MAR 0.3), VA–N: 5p, ETDRS: 74, OCT: 237. Iris hyperemia was transient in both patients and both patients needed glaucoma medication but no trabeculectomy. Cataract developed in both patients. At 15 month patient A remain rather stable. Patient B had a recurrence of oedema. A combined vitrectomy and cataract operation was performed.
The drop in VA may be sudden and severe in ischemic–CRVO but prompt treatment with Triamcinolone – even at recurrences – may offer good reading vision throughout the disease and prolong visual survival. Steroid induced glaucoma and cataract should be taken into consideration.
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