J Korean Ophthalmol Soc.  2016 Nov;57(11):1731-1737. 10.3341/jkos.2016.57.11.1731.

Short-term Effectiveness of Intravitreal Triamcinolone Injection for Refractory Macular Edema Secondary to Branch Retinal Vein Occlusion

• Ahn HM
• Choi KS

• KMID: 2357728
• DOI: http://doi.org/10.3341/jkos.2016.57.11.1731

Abstract

PURPOSE
To evaluate the short-term efficacy of intravitreal triamcinolone (IVTA) injection for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO) refractory to intravitreal bevacizumab injections.
METHODS
This retrospective, observational study included 23 eyes of 23 patients with macular edema secondary to BRVO. The patients with macular edema unresponsive to 2 or more consecutive monthly intravitreal bevacizumab injections were treated with IVTA. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before IVTA and 1 month and 3 months after IVTA injections.
RESULTS
All patients were previously treated with 3.4 ± 1.2 intravitreal bevacizumab injections. The IVTA injection was performed at 4.3 ± 1.7 weeks after the last bevacizumab injection. The logarithm of the minimal angle of resolution (log MAR) BCVA was also decreased from 0.61 ± 0.45 to 0.52 ± 0.35 after 1 month and to 0.58 ± 0.37 after 3 months of IVTA, although without statistical significance (p = 0.114 and 0.412, respectively). Eight eyes (34.8%) showed more than 3 lines improvement of BCVA and 4 eyes (17.4%) showed stable BCVA increasing 2 lines or less. CFT was significantly improved from 512 ± 166 µm to 310 ± 139 µm after 1 month and to 324 ± 159 µm after 3 months of IVTA injections (p = 0.014 and 0.031, respectively).
CONCLUSIONS
IVTA was beneficial in some patients with macular edema secondary to BRVO refractory to intravitreal bevacizumab therapy. This study indicates that IVTA could be considered as a treatment option for refractory macular edema associated with BRVO.

Keyword

Anti-vascular endothelial growth factor; Bevacizumab; Branch retinal vein occlusion; Refractory macular edema; Triamcinolone

MeSH Terms

Bevacizumab
Humans
Macular Edema*
Observational Study
Retinal Vein Occlusion*
Retinal Vein*
Retinaldehyde*
Retrospective Studies
Tomography, Optical Coherence
Triamcinolone*
Visual Acuity
Bevacizumab
Retinaldehyde
Triamcinolone

Figure

• 

  Figure 1. Changes in logarithm of the minimal angle of resolution best-corrected visual acuity in eyes with macular edema secondary to retinal vein occlusion. Measurements were made at diagnosis (baseline), before intravitreal triamcinolone injection (IVTA) which is after intravitreal bevacizumab injections, 1 month after IVTA, and 3 months after IVTA. Although there was a tendency of improvement of visual acuity after IVTA, no statistical significance was found (paired t-tests).

• 

  Figure 2. Changes in central foveal thickness in eyes with mac-ular edema secondary to retinal vein occlusion. Measurements were made at diagnosis (baseline), before intravitreal triamcinolone injection (IVTA) which is after intravitreal bevacizumab injections, 1 month after IVTA, and 3 months after IVTA. The central foveal thickness was significantly improved after IVTA (paired t-tests).

• 

  Figure 3. Spectral-domain optical coherence tomography images of an eye diagnosed with refractory macular edema secondary to branch retinal vein occlusion. Compared to baseline (A), macular edema showed no definite change after 4 consecutive monthly intravitreal bevacizumab injections (B). A marked decrease in macular edema and improved visual acuity (from 20/200 to 20/25) was noted 1 month after an intravitreal injection of triamcinolone (C).

Reference

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