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J.O. Mason, A.V. Talalight, T.L. Emond, R.M. Feist, M.F. White, Jr, M.L. Thomley, B.W. Roberts, P.A. Nixon, G. McGwin, Jr; Tachyphylaxis of Triamcinolone Acetonide Effectiveness After Multiple Injections . Invest. Ophthalmol. Vis. Sci. 2005;46(13):283.
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Purpose: To evaluate the possible tachyphylactic reduction of the effectiveness of triamcinolone acetonide for branch retinal vein occlusion (BRVO) after multiple intravitreal injections. Methods: Retrospective medical record review of patients receiving serial intravitreal injections of 4mg triamcinolone acetonide in a private vitreoretinal practice. Inclusion criteria included a diagnosis of BRVO of <12 months duration, best corrected visual acuity (BCVA) of <20/50, and no prior treatment for BRVO. Patients were excluded if they had any concurrent retinal disease, extensive macular hemorrhage, retinal neovascularization or uncontrolled glaucoma. Minimum follow up was 6 months (mean 13 months). Results: Mean pre–injection BCVA was 20/150. One month after injection #1, #2, and #3, mean BCVA was 20/50, 20/70, and 20/80, respectively. The greatest improvement in BCVA occurred after injection #1 (78% of patients). Best improvement in BCVA after injection #2 and #3 was 22% and 0%, respectively. The greatest reduction in central retinal thickness (CRT) on ocular coherence tomography (OCT) also occurred after injection #1, in 67% of patients (after injection #2 in 22% and after injection #3 in 11%). Conclusions: In this series of patients, the greatest beneficial effect of intravitreal triamcinolone acetonide (IVTA) on reducing CRT and improving BCVA occurred after the first injection. Although IVTA was less effective after a second injection, and least effective after a third injection, 67% of patients had improved vision and 83% had decreased CRT after a third IVTA injection.
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