J Korean Ophthalmol Soc.  2018 Aug;59(8):730-737. 10.3341/jkos.2018.59.8.730.

Effectiveness of Intravitreal Preservative-free Triamcinolone Injection for Refractory Macular Edema Secondary to Retinal Vein Occlusion

• Lee CH
• Jang MH
• Seo YS

• KMID: 2418499
• DOI: http://doi.org/10.3341/jkos.2018.59.8.730

Abstract

PURPOSE
To evaluate the efficacy of intravitreal preservative-free triamcinolone acetonide (Maqaid®) injection for the treatment of macular edema secondary to retinal vein occlusion (RVO) refractory to intravitreal bevacizumab injections.
METHODS
This retrospective, observational study included 17 eyes of 17 patients with refractory macular edema secondary to RVO. The patients with macular edema unresponsive to intravitreal bevacizumab injections were treated with intravitreal preservative-free triamcinolone acetonide (Maqaid®) injection. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before intravitreal triamcinolone injection (IVTA), 1 month and 3 months after IVTA injection. intraocular pressure (IOP) changes were analyzed up to 6 months.
RESULTS
The logarithm of the minimal angle of resolution (logMAR) BCVA was decreased from 0.56 ± 0.32 to 0.41 ± 0.32 after 1 month with statistical significance (p = 0.006) and to 0.47 ± 0.36 after 3 months of IVTA without statistical significance (p = 0.204). CFT was significantly improved from 474.82 ± 91.91 µm to 262.58 ± 60.11 µm after 1 month and to 339.58 ± 152.48 µm after 3 months of IVTA injection (p ≤ 0.001 and 0.005, respectively). IOP was significantly increased from 13.11 ± 2.66 mmHg to 16.64 ± 5.66 mmHg after 1 month and to 17.05 ± 7.21 µm after 3 months of IVTA injection (p = 0.024 and 0.026, respectively). Treatment-associated IOP elevation was manageable with antiglaucoma medications. IOP was 15.13 ± 3.90 mmHg after 6 months of IVTA injection (p = 0.023).
CONCLUSIONS
Intravitreal preservative-free triamcinolone (Maqaid®) Injection improves BCVA and reduces CFT in some patients with macular edema secondary to RVO refractory to intravitreal bevacizumab therapy. There were no serious vision-threatening complications associated with intravitreal preservative-free triamcinolone (Maqaid®) therapy during the study period. Intravitreal preservative-free triamcinolone (Maqaid®) could be considered as a treatment option for refractory macular edema associated with RVO.

Keyword

Intraocular pressure; Intravitreal injection; Macular edema; Preservative-free triamcinolone; Retinal vein occlusion

MeSH Terms

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

Figure

• 

  Figure 1. Changes in logarithm of the minimal angle of resolution best-corrected visual acuity and central foveal thickness 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. (A) Although the visual acuity was significantly improved 1 month after IVTA, no statistical significance was found 3 months after IVTA. (B) The central foveal thickness was significantly improved after IVTA (Wilcoxon signed-rank test).

• 

  Figure 2. Changes in intraocular pressure 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, 3 months after IVTA, and 6 months after IVTA. The intraocular pressure was significantly increased after IVTA (Wilcoxon signed-rank test).

• 

  Figure 3. Optical coherence tomography (OCT) images of an eye diagnosed with refractory macular edema secondary to central retinal vein occlusion. (A) Compared to baseline. (B) Macular edema remained after 2 consecutive intravitreal bevacizumab injections. (C) A marked decrease in macular edema was noted 1 month after an intravitreal injection of triamcinolone. (D) OCT showed a flat macula without macular edema 3 month after an intravitreal injection of triamcinolone.

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