Korean J Ophthalmol.  2007 Dec;21(4):208-212. 10.3341/kjo.2007.21.4.208.

Efficacy of Intravitreal Triamcinolone Acetonide for Eyes with Postvitrectomy Diabetic Vitreous Hemorrhage

• Lee SY
• Lee HG
• Chung H
• Yoon YH
• Kim JG

• KMID: 754637
• DOI: http://doi.org/10.3341/kjo.2007.21.4.208

Abstract

PURPOSE: To evaluate the efficacy of intravitreal triamcinolone acetonide (IVT) for the management of postvitrectomy diabetic vitreous hemorrhage. METHODS: The authors conducted a retrospective study of patients with postvitrectomy diabetic vitreous hemorrhage who were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. Ocular history, adverse events, BCVA, intraocular pressure, external eye examination, slit-lamp biomicroscopy, fundus examination, B-scan ultrasonography, and fundus photography were assessed on day 1, weeks 1, 2, and 4 and months 2 and 3. RESULTS: There were 19 eyes of 18 consecutive patients with mean follow-up after IVT injection of 28 weeks. Of the 19 eyes, 17 eyes (89%) experienced clearing of vitreous hemorrhage within 1 to 5 weeks (mean, 1.7 weeks) with visible triamcinolone precipitates along with blood clot in the inferior aspect of fundus. Of these 17 eyes, 12 eyes (63%) maintained vitreous hemorrhage-free condition at last follow-up with a mean visual acuity of 20/63 (range, 20/320 20/25), whereas 5 (29%) developed recurrent vitreous hemorrhage after clearing of vitreous hemorrhage. Vitreous hemorrhage was not cleared in 2 eyes, which required surgical procedures. CONCLUSIONS: IVT injection may be beneficial for clearing recurrent postvitrectomy Diabetic Vitreous Hemorrhage.

Keyword

Diabetic vitreous hemorrhage; Intravitreal triamcinolone injection; Postvitrectomy; Recurrent vitreous hemorrhage

MeSH Terms

Adult
Aged
Diabetic Retinopathy/*complications/diagnosis
Female
Follow-Up Studies
Glucocorticoids/*administration & dosage
Humans
Injections
Male
Microscopy, Acoustic
Middle Aged
Postoperative Hemorrhage/diagnosis/*drug therapy/etiology
Retrospective Studies
Time Factors
Treatment Outcome
Triamcinolone Acetonide/*administration & dosage
Visual Acuity
Vitrectomy/*adverse effects
Vitreous Body
Vitreous Hemorrhage/diagnosis/*drug therapy/etiology

Figure

• 

  Fig. 1 Fundus photograph of patient No. 17 showing the inferior peripheral aspect of retina at 1 week after intravitreal triamcinolone injection for recurrent postvitrectomy diabetic hemorrhage. Previous laser photocoagulation scars (upward) and whitish precipitation of triamcinolone with reddish blood clots on the precipitation (downward, arrow) can be seen.

Reference

1. Yang CM. Surgical treatment for diabetic retinopathy: 5-year experience. J Formos Med Assoc. 1998. 97:477–484.

2. Novak MA, Rice TA, Michels RG, Auer C. Vitreous hemorrhage after vitrectomy for diabetic retinopathy. Ophthalmology. 1984. 91:1485–1489.

3. West JF, Gregor ZJ. Fibrovascular ingrowth and recurrent haemorrhage following diabetic vitrectomy. Br J Ophthalmol. 2000. 84:822–825.

4. Bustros S. Ryan SJ, editor. Intraoperative and postoperative control of hemorrhage. Retina. 2001. Vol 3:3rd ed. St Louis: Mosby;2477–2483.

5. Hershberger VS, Augsburger JJ, Hutchins RK, et al. Fibrovascular ingrowth at sclerotomy sites in vitrectomized diabetic eyes with recurrent vitreous hemorrhage: ultrasound biomicroscopy findings. Ophthalmology. 2004. 111:1215–1221.

6. Martin DF, McCuen BW 2nd. Efficacy of fluid-air exchange for postvitrectomy diabetic vitreous hemorrhage. Am J Ophthalmol. 1992. 15:457–463.

7. Cooper B, Shah GK, Grand MG, et al. Visual outcomes and complications after multiple vitrectomies for diabetic vitreous hemorrhage. Retina. 2004. 24:19–22.

8. Chieh JJ, Roth DB, Liu M, et al. Intravitreal triamcinolone acetonide for diabetic macular edema. Retina. 2005. 25:828–834.

9. Jonas JB, Kreissig I, Sofker A, Degenring RF. Intravitreal injection of triamcinolone for diffuse diabetic macular edema. Arch Ophthalmol. 2003. 121:57–61.

10. Jonas JB, Hayler JK, Panda-Jonas S. Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative vitreoretinopathy. Br J Ophthalmol. 2000. 84:1064–1067.

11. Antcliff RJ, Spalton DJ, Stanford MR, et al. Intravitreal triamcinolone for uveitic cystoid macular edema: an optical coherence tomography study. Ophthalmology. 2001. 108:765–772.

12. Spaide RF, Sorenson J, Maranan L. Photodynamic therapy with verteporfin combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization. Ophthalmology. 2005. 112:301–304.

13. Hood PP, Cotter TP, Costello JF, Sampson AP. Effect of intravenous corticosteroid on ex vivo leukotriene generation by blood leucocytes of normal and asthmatic patients. Thorax. 1999. 54:1075–1082.

14. Ozaki NK, Beharry KD, Nishihara KC, et al. Regulation of retinal vascular endothelial growth factor and receptors in rabbits exposed to hyperoxia. Invest Ophthalmol Vis Sci. 2002. 43:1546–1557.

15. Penfold PL, Wen L, Madigan MC, et al. Triamcinolone acetonide modulates permeability and intercellular adhesion molecule-1 (ICAM-1) expression of the ECV304 cell line: implications for macular degeneration. Clin Exp Immunol. 2000. 121:458–465.

16. Sears JE, Hoppe G. Triamcinolone acetonide destabilizes VEGF mRNA in Muller cells under continuous cobalt stimulation. Invest Ophthalmol Vis Sci. 2005. 46:4336–4341.

17. Diabetic Retinopathy Vitrectomy Study (DRVS). Two-year course of visual acuity in severe proliferative diabetic retinopathy with conventional management. Report No 1. Ophthalmology. 1985. 92:492–502.

18. Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology. 1983. 90:522–530.

19. Enaida H, Hata Y, Ueno A, et al. Possible benefits of triamcinolone-assisted pars plana vitrectomy for retinal diseases. Retina. 2003. 23:764–770.

20. Jonas JB, Hayler JK, Sofker A, Panda-Jonas S. Regression of neovascular iris vessels by intravitreal injection of crystalline cortisone. J Glaucoma. 2001. 10:284–287.

21. Jonas JB, Kreissig I, Degenring RF. Neovascular glaucoma treated by intravitreal triamcinolone acetonide. Acta Ophthalmol Scand. 2003. 81:540–541.