Comparison of Bevacizumab and Combined Low-dose Bevacizumab and Triamcinolone in Central Retinal Vein Occlusion

PURPOSE: To report the effects and intraocular pressure (IOP) results of intravitreal injection of bevacizumab alone compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with central retinal vein occlusion. METHODS: In total, 40 eyes of 40 patients diagnosed with central retinal vein occlusion were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL), and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness (CMT), and IOP of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. RESULTS: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, CMT decreased significantly at 1 month, 2 months, and 3 months after injection (p 0.05). The BCVA, IOP, and CMT at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05). CONCLUSIONS: The CMT of both groups decreased significantly, and BCVA of both groups increased significantly in patients with central retinal vein occlusion. Injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of central retinal vein occlusion.

Management of macular epiretinal membrane by vitrectomy and intravitreal triamcinolone.

A patient underwent successful vitrectomy for macular epiretinal membrane with anatomical and functional improvement. 10 weeks later, there was a recurrence of macular edema with corresponding visual decline. An intravitreal injection of triamcinolone acetonide not only restored the macular anatomy but also improved the visual outcome beyond that achieved after surgery.

Comparison of Intravitreal Bevacizumab Alone Injection and Intravitreal Combination Low-Dose Bevacizumab-Triamcinolone Injection or Diabetic Macular Edema

PURPOSE: To report the effects and intraocular pressure results of intravitreal bevacizumab alone injection compared with intravitreal low-dose bevacizumab combined with low-dose triamcinolone injection in patients with diabetic macular edema. METHODS: In total, 40 eyes of 40 patients diagnosed with diabetic macular edema were evaluated. Of these, 20 eyes of 20 patients were injected with intravitreal bevacizumab (1.25 mg/0.05 mL) and 20 eyes of 20 patients were injected with low-dose bevacizumab (0.625 mg/0.025 mL) combined with low-dose triamcinolone (1 mg/0.025 mL). The best corrected visual acuity (BCVA), central macular thickness, and intraocular pressure of treated eyes were measured before injection and at 1 month, 2 months, and 3 months after injection. RESULTS: In both the intravitreal bevacizumab and the low-dose bevacizumab combined with low-dose triamcinolone groups, BCVA increased significantly at 1 month, 2 months, and 3 months after injection (p 0.05). The BCVA, IOP, and central macular thickness (CMT) at 1 month, 2 months, and 3 months after injection showed no significant differences between the intravitreal bevacizumab group and the low-dose bevacizumab combined with low-dose triamcinolone group (p > 0.05). CONCLUSIONS: The BCVA of both groups increased significantly, and the CMT of both groups decreased significantly in patients with diabetic macular edema. The injection of low-dose intravitreal bevacizumab combined with low-dose intravitreal triamcinolone may be useful for the treatment of diabetic macular edema.

Delayed diagnosis of ocular syphilis that manifested as retinal vasculitis and acute posterior multifocal placoid epitheliopathy.

A 55‑year‑old female presented with bilateral progressive retinal vasculitis. She was on systemic and intravitreal steroids on the basis of uveitis work‑up result (negative result including rapid plasma reagin), but her visual acuity continued to deteriorate to light perception only. Ocular examination showed retinal vasculitis, multiple yellow placoid lesions and severe macula edema in both eyes. Repeated work‑up revealed positivity of fluorescent treponemal antibody‑absorption in serum and subsequently in cerebrospinal fluid. Ocular syphilis was diagnosed. And intravenous penicillin G resulted in rapid resolution of vasculitis and macular edema. To avoid delay in the diagnosis of ocular syphilis, high index of suspicion and repeating serological tests (including both treponemal and non‑treponemal tests) are warranted.

Vogt-Koyanagi-Harada Disease in a Pregnant Patient Successfully Treated with Intravitreal Triamcinolone Injection

PURPOSE: To report a case of Vogt-Koyanagi-Harada (VKH) disease in a pregnant patient treated with intravitreal triamcinolone injection. CASE SUMMARY: A 21-year-old female in the 19th week of gestation presented with bilateral blurring of vision associated with mild headache and tinnitus. Her initial best corrected visual acuity was 0.15 in the right eye and 0.3 in the left eye. Multiple serous retinal detachment and anterior chamber inflammation were observed, and VKH disease was diagnosed. Because of her pregnancy, the patient did not want high-dose systemic prednisolone therapy which may cause an abortion or low birth weight infant when used in a pregnant patient. Therefore, an intravitreal triamcinolone (4 mg/0.1 ml) injection was given in the right eye and topical steroid eye drops were used in the left eye. After 1 day, serous retinal detachment was significantly decreased and anterior chamber inflammation disappeared in the right eye. After 1 week, no serous retinal detachment was observed. In the left eye, serous retinal detachment was decreased after using steroid eye drops. After 10 days, serous retinal detachment disappeared but anterior chamber inflammation was still observed. After 1 month, best corrected visual acuity was 1.0 in both eyes and serous retinal detachment had not recurred. On follow-up, VKH disease had not recurred and a healthy normal weight infant was delivered. CONCLUSIONS: Intravitreal triamcinolone injection is an effective and safe treatment for VKH disease in pregnant women.

Treatments of Stage 1 Retinal Angiomatous Proliferation

PURPOSE: To evaluate the results of single or combined treatment methods administered to patients with stage 1 retinal angiomatous proliferation (RAP). METHODS: A retrospective clinical study was performed in 9 eyes of 8 patients with stage I RAP. According to fundus angiography findings taken regularly after treatment, the results were categorized as closure of stage 1, recurrence of stage 1, or progress to stage 2. RESULTS: The mean follow-up period was 25 (14~40) months. In two eyes treated with laser photocoagulation only, the lesions progressed to stage 2. In two eyes treated with laser photocoagulation and intravitreal triamcinolone injection, the lesions also progressed to stage 2. In four eyes treated with photodynamic therapy and intravitreal triamcinolone injection, stage 1 lesions recurred in 3 eyes, and the lesion progressed to stage 2 in one eye. In one eye treated with photodynamic therapy, intravitreal triamcinolone injection, and laser photocoagulation, the stage 1 lesion recurred. Final visual acuity was stable in the case of stage 1 recurrence but was lower than the pretreatment level when the lesion progressed to stage 2. CONCLUSIONS: With either single or combined therapy, temporary closure of the stage 1 RAP lesion was possible, but complete closure could not be achieved for a long period because the lesion either recurred or progressed.

The Focal Aggravation of the Macular Edema on Optical Coherence Tomography After Intravitreal Triamcinolone Injection

PURPOSE: To evaluate the relationship between focal aggravation of the macular edema on retinal thickness change analysis (RTCA) of optical coherence tomography (OCT) and fluorescein angiographic findings in patients after an intravitreal triamcinolone injection (IVTA). METHODS: From May 2004 to April 2005, RTCA in a fast macular thickness map (FMTM) of OCT was performed before and 4 weeks after IVTA in patients who had macular edemas caused by diabetic retinopathy and retinal vein occlusion. Patients underwent IVTA, and focal aggravation of the edema was detected. After overlapping the OCT findings onto angiographic pictures, the relationship between the focal aggravation on OCT and the leaking point on angiography was investigated. RESULT: In the patient group, focal aggravation was found in 5 of 27 eyes (18.5%); in the control group, only 2 of 30 eyes (6.7%) showed focal aggravation. As compared with angiographic pictures, 4 eyes with focal aggravation showed no relation to the leakage on angiography. CONCLUSIONS: Focal aggravation of macular edemas after IVTA on RTCA are not related to the leakage on angiography and could be an error from several artifacts.

The Changes of Aqueous Vasopermeability Factors After Intravitreal Triamcinolone Injection for Branch Retinal Vein Occlusion

PURPOSE: To investigate the changes of aqueous vascular endothelial growth factor (VEGF) and interleukin (IL)-6 in patients with acute macular edema secondary to recent-onset branch retinal vein occlusion (BRVO) after a single intravitreal injection of triamcinolone acetonide (IVTA) METHODS: Aqueous and plasma levels of VEGF and IL-6 were measured by ELISA in ten controls and thirty patients at the time of IVTA and 3 months afterward. We compared the aqueous levels of VEGF and IL-6 and the clinical course between responders and non-responders. RESULTS: The aqueous levels of VEGF and IL-6 were significantly higher in non-responders than in responders at baseline measurements (495+/-259 pg/ml vs. 223+/-110 pg/ml, P<.001; 36+/-32 pg/ml vs. 16+/-19 pg/ml, P=.037, respectively). The aqueous levels of VEGF were still higher in non-responders (303+/-75 pg/ml) 3 months after IVTA, while the aqueous levels of VEGF in responders returned to normal (77+/-23 pg/ml, P<.001). The aqueous levels of IL-6 normalized in all patients 3 months after IVTA. In non-responders, central foveal thickness was significantly higher, and foveal ischemia and a wide non-perfused area were more common. CONCLUSIONS: Non-IL6-dependent VEGF may contribute to persistent or recurrent ischemic macular edema associated with BRVO after IVTA.

Comparison of Combination Posterior Sub-Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

PURPOSE: To compare the efficacy of posterior sub-Tenon's capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). MATERIALS AND METHODS: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. RESULTS: The ETDRS scores at baseline were 25.2 +/- 13.6 (mean +/- SD) letters in the PSTI + MP group, whereas 21.7 +/- 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 +/- 15.9, 34.7 +/- 16.6 and 30.9 +/- 19.0 letters in the PSTI + MP group whereas by 30.9 +/- 15.4, 30.1 +/- 17.9 and 31.5 +/- 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p 0.05, Student's t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 +/- 148.3, 309.1 +/- 131.3, 319.3 +/- 93.3, 340.4 +/- 123.5micrometer (mean +/- SD) in the PSTI + MP group vs. 369.1 +/- 123.1, 241.4 +/- 52.3, 277.5 +/- 137.4, 290.2 +/- 127.9micrometer in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the PSTI + MP group, and at both 1 month (p 0.05, Student's t-test). In contrast to the PSTI + MP group, where no complications were noted, the elevation of intra-ocular pressure in 3 of 20 eyes (15%) and a significant increase in average cataract grading were observed in the IVTA group. CONCLUSION: PSTI + MP treatment provides significant improvement of vision in patients with diffuse DME over 3 months, and achieves outcomes comparable to those after IVTA treatment, however, with fewer complications.

The Effect of Intravitreal Triamcinolone Injection According to the OCT Patterns of Diabetic Macular Edema

PURPOSE: To determine the preoperative factors of different types of diabetic macular edema (DME) classified using Optical Coherence Tomography (OCT) and to evaluate the short-term therapeutic effects and pattern changes of intravitreal triamcinolone acetonide injection (IVTA). METHODS: Seventy-seven eyes of 60 patients, who had been previously diagnosed with DME through fundoscopy and fluorescein angiography, were enrolled, and each patient was classified as one of three DME types according to his/her OCT features: Type 1, diffuse retinal thickening; Type 2, cystoid macular edema; and Type 3, serous macular detachment. We compared age, sex, the duration of diabetes mellitus (DM), and decreased visual acuity (VA). We analyzed VA, intraocular pressure (IOP), foveal thickness (FT), total macular volume (TMV), and pattern changes that occurred between pre-operation and 1 month post-operation. RESULTS: The duration of DM was short in Type 3 DME patients. There were no differences in age or the duration of decreased VA. Pre-operative VA was higher in Type 1 than in Type 2 or 3 patients. FT and TMV increased in thickness from Type 1 through Type 3. VA after IVTA improved in Types 2 and 3. FT and TMV after IVTA decreased in each type. However, the extent of the changes in Types 2 and 3 was greater than that in Type 1. Seventy-four percent of Type 2 and 83% of Type 3 changed to Type 1 after IVTA. CONCLUSIONS: This study found that there were differences in the therapeutic effect of IVTA among patients with different DME patterns. According to our results, the effectiveness of IVTA can be predicted, which we believe will help to objectively determine DME treatment.

The Clear Oil-drop Residue After Intravitreal Injection: Comparison between Different Brands of Triamcinolone Acetonide

PURPOSE: To investigate the characteristics of the clear oil-drop residue observed in the vitreous cavity after intravitreal injection of different brands of triamcinolone acetonide (TA), and to compare this ingredient's effects in those products. METHODS: Intravitreal injections of four different brands of triamcinolone acetonide (4 mg/0.1 mL), which are commercially available in Korea, were given to 40 eyes for the treatment of macular edema due to a variety of causes from October 2005 through February 2006. Regular slit-lamp biomicroscopy of fundus had been performed periodically with digital image acquisition equipment after injection of TA for at least two months. We analyzed the characteristics of this residue and compared the number and size of this residue in each product. RESULTS: Four TA products commercially available in Korea were used, with vehicles composed of preservatives and suspending agents. There were differences between products in respect to ingredients and content, as well as the characteristics of the intravitreal clear oil droplet-like residue. CONCLUSIONS: Each TA product has a variable frequency and variable amounts of clear oil droplet-like residue, which seems to be a component of the vehicle. This variation could generate differences in efficacy, side effects, and retaining duration. It should be verified whether commercial TA products are consistently safe and effective.

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

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.

A Case of Intralenticular Triamcinolone Complicated by Intravitreal Triamcinolone Acetonide Injection

PURPOSE: To report a case of intralenticular triamcinolone complicated by intravitreal triamcinolone acetonide (IVTA) injection. METHODS: A 56-year-old man who presented with lens opacity in the right eye following IVTA injection as a treatment for the central retinal vein occlusion with macular edema was referred to our clinic. RESULTS: The visual acuity in his right eye was hand motion, which was not corrected. A slit lamp examination showed that the intralenticular crystalloid powder in the right eye was likely triamcinolone acetonide. Intralenticular crystalloid powder was detected during the phacoemulsification and the posterior capsule of the lens had been already ruptured. CONCLUSIONS: Lens opacity can be complicated by IVTA through intralenticular injection of triamcinolone acetonide.

Intravitreal Triamcinolone Acetonide Injection for Treatment of Macular Edema

PURPOSE: To report the effect and safety of intravitreal triamcinolone acetonide injection for the treatment of macular edema. METHODS: This prospective study included 35 eyes of 35 patients who underwent intravitreal triamcinolone acetonide injection (4 mg) for the treatment of cystoid macular edema in Konyang University Hospital between March 1 and August 31, 2004. Main outcome measures included best corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, fundus examination, OCT and fluorescein angiograph. All outcome measures were assessed at 2 weeks and 1, 2, 3 months postoperatively. RESULTS: The mean preoperative BCVA was 0.25 +/- 0.24 and the mean preoperative macular thickness was 386.57 +/- 93.59 micrometer. The mean BCVA improved by 0.38 +/- 0.24, 0.40 +/- 0.26, 0.41 +/- 0.28 and 0.39 +/- 0.27 and the mean macular thickness decreased by 233.14 +/- 80.32 micrometer, 214.29 +/- 71.34 micrometer, 204.86 +/- 69.13 micrometer and 194.00 +/- 68.01 micrometer at 2 weeks and 1, 2, 3 months, respectively, after injection (all, p<0.05). CONCLUSIONS: Although long-term efficacy has to be further evaluated, intravitreal triamcinolone acetonide injection was an effective and safe treatment for macular edema.