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S. Shulman, J. Ferentz, Y. Ton, G. Gilady, E. Assia; Prognostic Factors for Visual Acuity Improvement After Intravitreal Triamcinolone Injection for Macular Edema . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3940.
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Intravitreal Triamcinolone Acetonide injections were previously shown to be effective in improving visual acuity in patients suffering from macular edema due to Diabetic retinopathy, Retinal vein occlusion and more. Nevertheless, in some of the patients the edema improves clinically and angiograffically but there is no improvement in visual acuity. Furthermore, a signifficant precentage of the patients develop unwanted side effects , mainly intraocular pressure rise, cataract developement and rerely , endophthalmitis. Purpose:To identify prognostic factors for visual acuity improvement after intravitreal triamcinolone injections for macular edema. Methods: Retrospective review of medical charts of patients who underwent intravitreal triamcinolone injection for macular edema. Patients were divided into two groups according to visual acuity change 3 monthes after the injection : imroved VA group who gained two or more snellen lines and non–improved group whose visual acuity was unchanged or worse. Demographic data, clinical examination and fluorescein angiography (performed on most patients) before and after the injection were analysed and copmared between the two groups. Statistical analysis was peformed using SPSS software. Results: 57 eyes of 57 patients were included. 27 patients improved (47%) and 30 patients did not improved (53%). Initial visual acuity was good (>6/15) in 5 patients (9%), moderate (6/15–6/60) in 39 patients (68%) and low (<6/60) in 13 (23%). The initial diagnosis was Diabetic macular edema in 42 patients (74%), macular edema associated with retinal vein occlusion in 7 patients (12%) and pseudophakic macular edema in 4 (7%). There was no statistically significant differance between the two groups regarding these factors. 20 patients (35%) were pseudophakic and 65 % of them improved comparing to 38% of the phakic patients (P=0.046). 22 patients had clinical evidence of cystoid macular edema and 35 eyes had diffuse retinal thickening.70% of the eyes with clinical CME improved comparing to 30% of the eyes with diffuse retinal thickening (P=0.04). 66% of the patients with angiographic CME improved comparing to 15% of the patients with diffuse leakage on fluorescein angiography (P=0.02). Conclusions:Pseudophakia,clinical and angiographic CME were associated with visual acuity improvement after intravitreal triamcinolone injection for macular edema.Initial visual acuity and diagnosis were not associated with any statistically significant differance.
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