Abstract
Abstract: :
Purpose: Recent reports suggested that the intravitreal and posterior sub–Tenon’s capsule administrations of triamcinolone acetonide (TA) are effective to resolve macular edema and to improve the vision. Macular edema often recurs several months after the initial treatment partially because the clearance of TA from the vitreous is relatively fast. Simultaneous administration of intravitreal and posterior sub–Tenon’s capsule injections of TA ("sandwich" injection) is considered to enhance the effect of TA and to delay the clearance. We investigated the efficacy of TA "sandwich" injection in the treatment of macular edema due to central retinal vein occlusion (CRVO) and diabetic retinopathy (DR). Methods: Twenty–one eyes of 18 patients with macular edema (CRVO; 13 eyes, DR; 8 eyes) were studied. Vitrectomy was first performed on the all eyes and TA was administered at the end of surgery. Eleven eyes (CRVO; 7eyes, DR; 4eyes) received the intravitreal injection alone and other 10 eyes (CRVO; 6 eyes, DR; 4 eyes) received the "sandwich" administration of intravitreal and posterior sub–Tenon’s capsule injections. We used 4 mg for the intravitreal injection and 20 mg for the posterior sub–Tenon’s capsule injection. The average follow up period was 6 months. Results: Visual acuity was improved two lines or more in 6 eyes (55%) after the intravitreal injection and 9 eyes (90%) after the "sandwich" injection. The average postoperative logMAR visual acuity was significantly better in the "sandwich" group (0.42) than in the intravitreal alone group (0.89, P<0.05). The mean foveal thickness assessed by OCT was 584 µm before the treatment and 206 µm after the treatment in the "sandwich" group. The mean foveal thickness in the intravitreal alone group was 653 µm before the treatment and 340 µm after the treatment. Macular edema recurred in 4 eyes (36%) of the intravitreal alone group and in 3 eyes (30%) of the "sandwich" group. Conclusions: These results suggested that the TA "sandwich" injection is more effective to resolve macular edema and to improve visual acuity in patients with CRVO and DR.
Keywords: corticosteroids • diabetic retinopathy • vascular occlusion/vascular occlusive disease