Intravitreal triamcinolone for acute branch retinal vein occlusion: a randomized clinical trial

To evaluate the therapeutic effect of intravitreal triamcinolone [IVT] injection for recent branch retinal vein occlusion [BRVO]. In a randomized controlled clinical trial, 30 phakic eyes with recent [less than 10 weeks' duration] BRVO were assigned to two groups. The treatment group [16 eyes] received 4 mg IVT and the control group [14 eyes] received subconjunctival sham injections. Changes in visual acuity [VA] were the main outcome measure. VA and central macular thickness [CMT] changes were not significantly different between the study groups at any time point. Within group analysis showed significant VA improvement from baseline in the IVT group up to three months [P < 0.05]; the amount of this change was 0.53 +/- 0.46, 0.37 +/- 0.50, 0.46 +/- 0.50, and 0.29 +/- 0.45 logMAR at 1, 2, 3, and 4 months, respectively. Corresponding VA improvements in the control group were 0.20 +/- 0.37, 0.11 +/- 0.46, 0.25 +/- 0.58, and 0.05 +/- 0.50 logMAR [all P values > 0.05]. Significant reduction in CMT was noticed only in the treatment group [-172 +/- 202 micro m, P = 0.029] and at 4 months. Ocular hypertension occurred in 4 [25%] and 2 [14.3%] eyes in the IVT and control groups, respectively. A single IVT injection had a non-significant beneficial effect on VA and CMT in acute BRVO as compared to the natural history of the condition. The 3-month deferred treatment protocol advocated by the Branch Vein Occlusion Study Group may be a safer option than IVT injection considering its potential side effects

Intravitreal Triamcinolone Reinjection for Refractory Diabetic Macular Edema

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.