Intravitreal Triamcinolone for the Treatment of Macular Edema Due to Central Retinal Vein Occlusion

Abstract

Abstract: : Purpose: To evaluate the efficacy of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema (ME) due to central retinal vein occlusion (CRVO). Methods:Retrospective study included 46 eyes with perfused (22) and non perfused (24) CRVO. Visual acuity was 20/50 or worse. Four mg of triamcinolone acetonide were injected. Follow up evaluations were performed 1 month, 3 months and 6 months after each injection. Measurement of visual acuity on the Snellen chart, intraocular pressure, macular thickness using optical coherence tomography (Stratus OCT3, Zeiss, Dublin CA), and fluorescein angiography were performed at each visit. Main outcome measures were changes in visual acuity and macular thickness. Results: The perfused CRVO group included 22 eyes. Mean duration from the time of diagnosis to the IVTA was 6.4 months (1–24). Mean visual acuity improved from 20/100 at baseline to 20/50 at 3 months and 20/40 at 6 months. Eleven eyes (50%) had final visual acuity ≥ 20/40. Mean macular thickness decreased from 702 µm at baseline to 364 µm at 3 months and 318 µm at 6 months. At 3 and 6 months, ME recurred in 9 patients (40%). Seven of them were given a second injection. Reinjection criteria were improved visual acuity after the first injection, no severe adverse events, macular thickness ≥ 300 µm and visual acuity ≤ 20/50. The 2 other patients were not retreated because their visual acuity was better than 20/50. At 6 months, 13 patients (60%) maintained good visual acuity without any recurrence of ME. Seven of the 22 original patients were evaluated at 9 and 12 months. Four of them were reinjected. For the 24 eyes in the non–perfused CRVO group, mean visual acuity did not improve significantly at 3 and 6 months (20/500, 20/200 and 20/640 respectively). Mean macular thickness decreased from 770 µm at baseline to 398 µm at 3 months and 367 µm at 6 months. ME recurred in 12 eyes (50%). No reinjections were performed. No endophthalmitis or uncontrolled glaucoma occurred in either of the 2 groups Conclusions:IVTA is effective in reducing ME due to CRVO. This decrease in macular thickness only correlated with an improvement in visual acuity in perfused CRVO group. In that group, 60% of patients did not need any reinjection at 6 months and at least 42% at 12 months. Further evaluation is required to assess the rate of recurrence after 12 months and the safety of IVTA reinjection.

Keywords: corticosteroids • vascular occlusion/vascular occlusive disease • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled