Treatment of Central Retinal Vein Occlusion with Intravitreal Triamcinolone Acetonide

Abstract

Abstract: : Purpose: This study investigated the safety and efficacy of intravitreal injection(s) of triamcinolone acetonide as treatment for macular edema due to CRVO. Methods: A retrospective review of 13 consecutive patients treated with intravitreal triamcinolone acetonide for macular edema associated with CRVO. Each patient was treated with 1 or 2 injections of intravitreal triamcinolone acetonide (4mg/0.1cc) (Kenalog, Bristol-Meyers-Squibb, Princeton NJ). Each injection was delivered 4.0mm posterior to the limbus via a 27 or 30 gauge needle. Results: The mean age of the 13 patients was 66 years and the mean duration of symptoms before injection was 9 months (range 1-36 months). Mean baseline visual acuity was 20/500. Mean visual acuity at the 6 month follow up was 20/260. The average gain in visual acuity was 2.2 lines (range 0 to +8). Five of 13 patients experienced a visual acuity gain of 3 or more lines at the 6 month follow up. The CRVO in these 5 patients was judged to be non-ischemic prior to treatment. The visual acuity in 8 of 13 patients was unchanged (either no gain or a less than 3 line increase from baseline) at the 6 month follow up. The CRVO in these 8 patients was judged to be ischemic prior to treatment. No patient had a decrease in visual acuity. Mean baseline foveal thickness as measured by OCT was 590 microns. Between the 3 and 6 month follow up, five patients developed recurrence of macular edema. Four of these 5 patients were re-treated with a second injection of triamcinolone acetonide; all four re-treated patients experienced reduction of foveal thickness as measured by OCT and clinical examination. Mean foveal thickness, as measured by OCT, at the 6 month follow up was 292 microns. No adverse effects such as retinal detachment or endophthalmitis were noted. One patient experienced an increase in IOP that was controlled with 2 aqueous suppressants. Two patients experienced progressive lens opacification. Conclusions: Intravitreal injection of triamcinolone acetonide may be a safe and effective treatment in some patients with macular edema due to CRVO. It appears that non-ischemic CRVO responds more favorably than ischemic CRVO and that re-treatment may be necessary in some patients.

Keywords: vascular occlusion/vascular occlusive disease • clinical (human) or epidemiologic studies: tre • pharmacology