1.Intravitreal Triamcinolone Reinjection for Refractory Diabetic Macular Edema.
Alireza RAMEZANI ; Hamid AHMADIEH ; Homa TABATABAEI
Korean Journal of Ophthalmology 2006;20(3):156-161
PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide (IVT) reinjection on clinical and optical coherence tomographic features in refractory diabetic macular edema. METHODS: In a prospective interventional case series, all IVT treated patients enrolled in a previous clinical trial were recalled to have a new ophthalmologic examination and optical coherence tomography (OCT) performed. Eyes found suitable for reinjection received 4 mg IVT. Complete clinical examination and OCT were repeated at 2 and 4 months post-injection. The changes were statistically analyzed using a paired t test and were compared to the results of the first injections. RESULTS: Of all returning patients, 12 cases with complete records were considered candidates for reinjection. Visual acuity (VA) changes were not significant after the first and second interventions, although there was a relative improvement (0.14 logMAR) 2 months after the first injection. Reductions of central macular thickness (CMT) were 43+/-69 micrometer, and 40+/-69 micrometer after the first injection and 27+/-48 micrometer, 49+/-58 micrometer after the reinjection at 2 and 4 months, respectively. None of the mentioned changes was significant. After the second injection, however, intraocular pressure was elevated at both 2 and 4 months (3.6 and 2.4 mmHg respectively, P<0.05). Two months after the first administration, intraocular pressure was found to be raised significantly (5.58 mmHg, P=0.001). CONCLUSIONS: The transient beneficial effects of IVT on diabetic macular edema are not repeated with second injections. However, IVT-related ocular hypertension is more persistent after reinjection.
Vitreous Body
;
Visual Acuity
;
Triamcinolone/*administration & dosage
;
Treatment Outcome
;
Tomography, Optical Coherence
;
Time Factors
;
Retreatment
;
Prospective Studies
;
Male
;
Macular Edema, Cystoid/*drug therapy/etiology/pathology
;
Intraocular Pressure
;
Injections
;
Humans
;
Glucocorticoids/*administration & dosage
;
Follow-Up Studies
;
Female
;
Diabetic Retinopathy/*complications/pathology
2.Triamcinolone-Induced Intraocular Pressure Elevation: Intravitreal Injection for Macular Edema and Posterior Subtenon Injection for Uveitis.
Seung Youn JEA ; Ik Soo BYON ; Boo Sup OUM
Korean Journal of Ophthalmology 2006;20(2):99-103
PURPOSE: To assess the effect of intravitreal and posterior subtenon injections of triamcinolone acetonide (TA) on intraocular pressure (IOP). METHODS: we reviewed 42 consecutive eyes after intravitreal TA injection (IVTA) and 43 eyes following posterior subtenon TA injection (PSTA). All cases had a minimum follow-up time of three months. After injection, the value and time of the maximal IOP, the amount of IOP elevation and the needs of the medication were assessed. RESULTS: The IOP increased significantly (p<0.001) from 16.3+/-2.5 mmHg preoperatively to a mean maximum of 21.7+/-5.3 mmHg in the IVTA group, and from 15.3+/-4.5 mmHg to 20.6+/-3.0 mmHg in the PSTA group. An elevation in the IOP of more than 5 mmHg from the baseline IOP was seen in 52.4% of the IVTA group at a mean time of 3.1 weeks postoperatively, and 44.2% of the PSTA group displayed an IOP elevation at 5.9 weeks. CONCLUSIONS: Both developed significant elevations of IOP, but this appeared at a later date in the PSTA group. Careful follow-up after local injection of steroids is necessary.
Vitreous Body
;
Uveitis, Posterior/*drug therapy/pathology
;
Triamcinolone Acetonide/administration & dosage/*adverse effects
;
Time Factors
;
Retrospective Studies
;
Orbit
;
Ocular Hypertension/*chemically induced/physiopathology
;
Middle Aged
;
Male
;
Macular Edema, Cystoid/*drug therapy/pathology
;
Intraocular Pressure/*drug effects
;
Injections
;
Humans
;
Glucocorticoids/administration & dosage/*adverse effects
;
Follow-Up Studies
;
Female
;
Aged, 80 and over
;
Aged
;
Adult
3.Intravitreal versus Posterior Subtenon Injection of Triamcinolone Acetonide for Diabetic Macular Edema.
Young Jae CHOI ; In Kyung OH ; Jae Ryung OH ; Kuhl HUH
Korean Journal of Ophthalmology 2006;20(4):205-209
PURPOSE: To compare the short-term effects of intravitreal versus posterior subtenon injection of triamcinolone acetonide for diabetic macular edema. METHODS: This is a prospective and interventional study. Sixty eyes of 60 patients who had diffuse diabetic macular edema were assigned to receive a single intravitreal injection (4 mg) or a single posterior subtenon injection (40 mg) of triamcinolone acetonide. The central retinal thickness was measured using optical coherent tomography before injection and at 1 and 3 months after injection. Visual acuity and intraocular pressure (IOP) were also measured. RESULTS: Both intravitreal and posterior subtenon injections of triamcinolone acetonide resulted in significant improvements in visual acuity at 1 month and 3 months after injection. Both groups resulted in a significant decrease in central macular thickness (CMT) at 1 month and 3 months post-injection. IOP in the intravitreal injection group was significantly higher than in the posterior subtenon injection group at 3 months after injection. CONCLUSIONS: The posterior subtenon injection of triamcinolone acetonide had a comparable effect to the intravitreal triamcinolone injection and showed a lower risk of elevated IOP. Posterior subtenon injection of triamcinolone acetonide may be a good alternative for the treatment of diffuse diabetic macular edema.
Vitreous Body
;
Visual Acuity
;
Triamcinolone Acetonide/*administration & dosage/therapeutic use
;
Treatment Outcome
;
Tomography, Optical Coherence
;
Prospective Studies
;
Orbit
;
Middle Aged
;
Male
;
Macular Edema, Cystoid/*drug therapy/etiology/pathology
;
Injections
;
Humans
;
Glucocorticoids/*administration & dosage/therapeutic use
;
Fundus Oculi
;
Follow-Up Studies
;
Fluorescein Angiography
;
Female
;
Diabetic Retinopathy/*complications/pathology
;
Aged