Non-steroidal anti-inflammatory drug in adjuvant treatment of intravitreal triamcinolone acetonide for macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To study the clinical value of non-steroidal anti-inflammatory drug in adjuvant treatment of intravitreal triamcinolone acetonide ( IVTA ) for macular edema caused by retinal vein occlusion ( RVO) .?METHODS: Forty - eight eyes in 48 patients were randomly divided into trial and control group ( 24 eyes each ) in this prospective study. In the trial group, additional pranoprofen drops was administered from 1d before IVTA to 30d after injection. Central foveal thickness ( CFT ) was measured with optical coherence tomography ( OCT ) . Available documents of best corrected visual acuity ( BCVA ) , CFT, intraocular pressure and complications pre- and post-injection at 3d, 1,2wk, 1 and 3mo were evaluated.?RESULTS: After IVTA, BCVA was improved in both groups at different levels; but there was no statistically significant between two groups at each time point ( P>0. 05). The CFT values were 629 ± 43μm vs 605 ± 57μm before IVTA in the trail vs control groups (P>0. 05). The values were 432±74μm vs 511±32μm (t=7. 533, P<0. 05), and 275±54μm vs 379±29μm (t=13. 212, P<0. 05) of the trial vs control groups at 1 and 3mo after IVTA, respectively. Ocular hypertension occurred in 5 eyes after injection in trail group, and was controlled with anti-glaucoma medication and one eye with filtration surgery. Progression of cataract was noted in 3 of 35 phakic eyes and cataract surgery was performed in 2 eyes at 4-12mo after injection in trail group. Progression of cataract was noted in 4 eyes and cataract surgery was performed in 2 eyes at 4- 12mo after injection in control group. No retinal detachment and endophthalmitis happened during the whole period of follow-up.?CONCLUSION: Application of non - steroidal anti -inflammatory eye drops in perioperative period can be useful to improve the outcome of IVTA for macular edema, which needs further evaluation.

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.

Complicaciones de la triamcinolona intravítrea en pacientes con afecciones maculares secundarias a neovascularización / Complications of intravitreal triamcinolone in patients with macular disorders secondary to neovascularization

Se realizó un estudio descriptivo y retrospectivo en 109 pacientes con enfermedades maculares, atendidos en el Centro Oftalmológico del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, desde septiembre de 2011 hasta julio de 2012, a los cuales se les administró 4 mg de triamcinolona intravítrea (vía pars plana), en dosis única, a fin de describir las complicaciones presentadas después del tratamiento. En la casuística predominaron el sexo femenino (64,3 %), el grupo etario de 65-84 años (49,5 %) y la degeneración macular asociada a la edad (húmeda) como antecedente oftalmológico (76,1 %). Entre las complicaciones más frecuentes figuraron: hipertensión ocular secundaria (13,7 %) y catarata (11,9 %).

A descriptive and retrospective study in 109 patients with macular diseases, assisted in the Ophthalmological Center of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba was carried out from September, 2011 to July, 2012, to whom 4 mg of triamcinolone intravitreal (via pars plana) were administered in unique dose, in order to describe the complications presented after the treatment. Female sex (64.3%), the age group 65-84 years (49.5%) and macular degeneration associated with age (wet) as ophthalmological history (76.1%) prevailed in the case material. Among the most frequent complications there were: secondary ocular hypertension (13.7%) and cataract (11.9%).

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.

Efficacy of Intravitreal Anti-vascular Endothelial Growth Factor or Steroid Injection in Diabetic Macular Edema According to Fluid Turbidity in Optical Coherence Tomography

PURPOSE: To determine if short term effects of intravitreal anti-vascular endothelial growth factor or steroid injection are correlated with fluid turbidity, as detected by spectral domain optical coherence tomography (SD-OCT) in diabetic macular edema (DME) patients. METHODS: A total of 583 medical records were reviewed and 104 cases were enrolled. Sixty eyes received a single intravitreal bevacizumab injection (IVB) on the first attack of DME and 44 eyes received triamcinolone acetonide treatment (IVTA). Intraretinal fluid turbidity in DME patients was estimated with initialintravitreal SD-OCT and analyzed with color histograms from a Photoshop program. Central macular thickness and visual acuity using a logarithm from the minimum angle of resolution chart, were assessed at the initial period and 2 months after injections. RESULTS: Visual acuity and central macular thickness improved after injections in both groups. In the IVB group, visual acuity and central macular thickness changed less as the intraretinal fluid became more turbid. In the IVTA group, visual acuity underwent less change while central macular thickness had a greater reduction (r = -0.675, p = 0.001) as the intraretinal fluid was more turbid. CONCLUSIONS: IVB and IVTA injections were effective in reducing central macular thickness and improving visual acuity in DME patients. Further, fluid turbidity, which was detected by SD-OCT may be one of the indexes that highlight the influence of the steroid-dependent pathogenetic mechanism.

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.

Retinal sensitivity improvement after intravitreal triamcinolone acetonide injection for macular edema secondary to branch retinal vein occlusion.

Purpose: To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on retinal sensitivity in cases of macular edema(ME) secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Total of 14 eyes of 14 cases of BRVO were included in this prospective study. In each eye, at baseline and 1, 3, and 6 months after IVTA injection, logMAR visual acuity, central 4° retinal sensitivity by MP-1 microperimetry, and optical coherence tomography foveal thickness were assessed. Results: Cases ages ranged from 60 to 79 years (mean 68 ± 8 years). At 1, 3, and 6 months, the logMAR visual acuity had increased from 0.71 ± 0.21 to 0.42 ± 0.21, 0.46 ± 0.30, and 0.46 ± 0.27; the mean foveal thickness had decreased from 540 ± 88 μm to 254 ± 51 μm, 288 ± 84 μm, and 280 ± 91 μm; and the mean retinal sensitivity had increased from 4.7 ± 2.5 dB to 7.9 ± 2.7 dB, 8.2 ± 3.6 dB, and 8.3 ± 4.6 dB, respectively. Conclusion: In eyes with ME secondary to BRVO, IVTA injections result in a significant increase in not only the visual acuity but also the central 4° retinal sensitivity in 6 months follow-up.

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.

Fulminant toxoplasmic retino-choroiditis following intravitreal triamcinolone administration.

We report two cases of fulminant toxoplasmic retinochoroiditis following intravitreal triamcinolone acetonide (IVTA) administration. Case 1: A 42-year-old female received IVTA for presumed non-infectious panuveitis. Within 2 months, she developed diffuse macular retinochoroiditis with optic disc edema. Upon starting anti-toxoplasmic therapy (ATT), her intraocular inflammation resolved with catastrophic damage to the disc and macula. Case 2: A 30-year-old male received IVTA for presumed reactivation of previously scarred toxoplasmic retinochoroiditis. Despite simultaneous ATT, within 6 weeks, he developed extensive, multifocal macular retinochoroiditis. He continued to require ATT for 18 months and later underwent vitrectomy with silicone oil placement for severe epiretinal proliferation. Aqueous tap polymerase chain reactions were found positive for Toxoplasma gondii in both cases. In conclusion, IVTA administration can lead to fulminant toxoplasmic retinochoroiditis even when used with appropriate ATT. Extreme caution should be exercised while administering depot corticosteroids in eyes with panuveitis of unknown origin.

Prognostic Factors after Intravitreal Triamcinolone Injection for Macular Edema due to Branch Retinal Vein Occlusion

PURPOSE: To evaluate prognostic factors for improvement of visual acuity after intravitreal triamcinolone acetonide injection (IVTA) for treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO). METHODS: Sixty-eight eyes of 68 consecutive patients treated with IVTA for ME due to BRVO were retrospectively reviewed. Patients were categorized into 2 groups according to the final visual acuity. The 'gainer group' consisted of eyes with a gain of 2 or more Snellen chart lines and the 'non-gainer group' consisted of eyes with less than 2 lines improvement or which had worsened at the last follow-up visit. Comparative clinical characteristics and ophthalmoscopic examinations were analyzed between the 2 groups. RESULTS: Out of the 68 eyes, 38 (56%) showed improved vision and were categorized as the gainer group; 30 eyes (44%) were categorized as the non-gainer group. The duration of symptoms in the non-gainer group was longer than the gainer group. Additionally, patients with a better baseline vision were expected to show greater improvement. The number of early visual acuity gainers who showed visual improvement at 1 month after IVTA was significantly higher in the gainer group. The number of eyes with angiographically documented macular ischemia was significantly higher in the non-gainer group. Existence of subretinal fluid has been identified as a positive factor for visual improvement. CONCLUSIONS: The cases with early treatment, good baseline visual acuity, case of favorable response to the initial IVTA, absence of macular ischemia, and baseline subretinal fluid are favorable prognostic factors for the outcome of visual acuity after IVTA for ME due to BRVO.

Complications after Intravitreal Triamcinolone Acetonide Injection: Incidence and Risk Factors

PURPOSE: To reduce complications and provide proper management for better clinical outcomes in the treatment of macular edema through a large-scale analysis of the incidence and risk factors for complications of intravitreal triamcinolone injection. METHODS: The medical records of 490 eyes that received intravitreal triamcinolone (4.0 mg) injection for treatment of macular edema caused by various diseases were retrospectively reviewed, and relevant parameters were included in a multivariate regression model. RESULTS: Vitrectomized (p < 0.001) and pseudophakic (p = 0.054) eyes were less likely to exhibit an intraocular pressure increase, but glaucoma (p < 0.001) and young age (p = 0.073) were found to be significant risk factors for this complication. Vitrectomized eyes (p = 0.011), diabetic macular edema (p < 0.001), secondary ocular hypertension (p = 0.029) and old age (p = 0.059) were associated with cataract progression. Three consecutive case of sterile endophthalmitis, which differs from bacterial endophthalmitis in clinical course and prognosis, occurred during the same period. CONCLUSIONS: Risk factors and the incidence of complications after intravitreal triamcinolone injection should be evaluated through regular follow-up evaluation to ensure proper management and a better prognosis.

Presumed Necrotizing Viral Retinitis after Intravitreal Triamcinolone Injection: Case Report

A 56-year-old man presented with anterior chamber inflammation, increased intraocular pressure, peripheral retinal infiltration, and generalized retinal arterial obstruction suggesting acute retinal necrosis five months after intravitreal triamcinolone acetonide injection (IVTA). He was treated with intravenous antiviral agents and aspirin. Shortly after treatment, retinal infiltrations were resolved, and partial recanalization of the obstructed vessel was observed. Viral retinitis may occur as an opportunistic infection following IVTA due to the local immune modulatory effect of the steroid; hence, close observation following IVTA is necessary.

The Effectiveness of Selective Laser Trabeculoplasty in Steroid-Induced Ocular Hypertension

PURPOSE: To report the effectiveness of selective laser trabeculoplasty (SLT) in patients with intraocular hypertension refractory to maximum tolerated medical therapy after intravitreal triamcinolone acetonide (IVTA). CASE SUMMARY: The records of 3 patients with steroid-induced intraocular hypertension that did not respond to maximum tolerated medical therapy were retrospectively reviewed. The patients received SLT instead of filtering surgery or Argon laser trabeculoplasty. The mean intraocular pressure (IOP) of 13.7 mm Hg increased to 30.7 mm Hg within 13 days of IVTA. IOP was uncontrolled despite maximum tolerated medical therapy. Patients underwent SLT 15.3 weeks after IVTA. Mean IOP decreased to 16 +/- 3.0 mm Hg after 1 day, 19.7 +/- 8.0 mm Hg after 1 week, 17 +/- 8.0 mm Hg after 1 month, 12.3 +/- 2.9 mm Hg after 3 months and 12.3 +/- 0.6 mm Hg after 4 to 6 months. The number of IOP lowering drugs were decreased to 1 from 4.3 after 6 months of SLT. CONCLUSIONS: SLT may be effective and safe for the treatment of steroid-induced intraocular hypertension refractory to maximum tolerated medical therapy.

Pegaptanib sodium for macular edema due to retinal-vein occlusion among patients intolerant to intravitreal triamcinolone acetonide

Objective@#To report the efficacy and safety of intravitreal pegaptanib sodium (IVP) on macular edema (ME) due to branch retinal-vein occlusion (BRVO) among patients intolerant to intravitreal triamcinolone acetonide (IVTA). @*Methods@#Four eyes with ME due to BRVO were included in this interventional case series. The main outcome measures were best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and adverse effects.@*Results@#There was a significant decrease in mean CMT from 524.50 ± 141.12 to 293.75 ± 130.75 microns (p = 0.009) after IVP injection. BCVA improved in all 4 eyes after IVP. Mean IOP after IVP was 13.60 ± 3.21. No ocular or systemic complications were observed.@*Conclusion@#IVP appears to be safe and effective in decreasing retinal thickness and improving VA in eyes with ME due to BRVO. IVP is a potential treatment for eyes that are intolerant to IVTA.

Treatment of macular oedema secondary to idiopathic retinitis, vasculitis, aneurysms, and neuroretinitis with intravitreal triamcinolone / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the treatment of macular oedema secondary to idiopathic retinitis, vasculitis, aneurysrns,and neuroretinitis (IRVAN) with intravitreal triamcinolone.METHODS: Case report.RESULTS: A patient diagnosed with IRVAN with visual loss secondary to macular oedema. The macular oedema and her visual acuity was improved dramatically with the administration of intravitreal triamcinolone.CONCLUSION: Previous reports recommend treatment of IRVAN with panretinal photocoagulation, vitrectomy,systemic and periocular steroids. Our case shows that intravitreal triamcinolone appears to be a safe and effective treatment for macular oedema and vasculitis secondary to IRVAN.

Comparison of Effects of Intravitreal Triamcinolone and Bevacizumab in the Treatment of Diabetic Macular Edema

PURPOSE: To compare the effect of an intravitreal injection of triamcinolone acetonide with bevacizumab in the treatment of diabetic macular edema (DME). METHODS: For this study, the medical records of patients with diabetic macular edema, who received intravitreal triamcinolone injection (IVTA) or intravitreal bevacizumab injection (IVB), were reviewed. Best corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) were evaluated before injection and at 1 week, 1 month, 2 months, 3 months, and 6 months after injection. The adverse events, such as increased intraocular pressure, and progression of cataract, were also reviewed. RESULTS: A total of 72 eyes from 72 patients, (IVTA: 40 eyes, IVB: 32 eyes) were included in this study. In the IVTA group, BCVA improved significantly at 1 week after injection and was maintained until 3 months after injection. In the IVB group, BCVA improved significantly at 1 week after injection and was maintained until 2 months after injection. In the IVTA group, CMT and TMV decreased significantly at 1 week after injection and were maintained until 3 months after injection, while in the IVB group CMT and TMV were maintained until 2 months after injection. The IVTA group showed significantly better results in visual improvement, CMT and TMV reduction compared to the results of the IVB group, from 1 month to 3 months after injection. In the IVTA group, intraocular pressure increased to more than 25 mmHg in 12.5% of patients during the follow-up period. CONCLUSIONS: While the functional and anatomical improvements are achieved by both IVTA and IVB for diabetic macular edema, the effect of IVTA is more prominent with longer duration than IVB.

Comparison of Effects of Intravitreal Triamcinolone and Bevacizumab in the Treatment of Diabetic Macular Edema

PURPOSE: To compare the effect of an intravitreal injection of triamcinolone acetonide with bevacizumab in the treatment of diabetic macular edema (DME). METHODS: For this study, the medical records of patients with diabetic macular edema, who received intravitreal triamcinolone injection (IVTA) or intravitreal bevacizumab injection (IVB), were reviewed. Best corrected visual acuity (BCVA), central macular thickness (CMT) and total macular volume (TMV) were evaluated before injection and at 1 week, 1 month, 2 months, 3 months, and 6 months after injection. The adverse events, such as increased intraocular pressure, and progression of cataract, were also reviewed. RESULTS: A total of 72 eyes from 72 patients, (IVTA: 40 eyes, IVB: 32 eyes) were included in this study. In the IVTA group, BCVA improved significantly at 1 week after injection and was maintained until 3 months after injection. In the IVB group, BCVA improved significantly at 1 week after injection and was maintained until 2 months after injection. In the IVTA group, CMT and TMV decreased significantly at 1 week after injection and were maintained until 3 months after injection, while in the IVB group CMT and TMV were maintained until 2 months after injection. The IVTA group showed significantly better results in visual improvement, CMT and TMV reduction compared to the results of the IVB group, from 1 month to 3 months after injection. In the IVTA group, intraocular pressure increased to more than 25 mmHg in 12.5% of patients during the follow-up period. CONCLUSIONS: While the functional and anatomical improvements are achieved by both IVTA and IVB for diabetic macular edema, the effect of IVTA is more prominent with longer duration than IVB.

The Effect of an Intravitreal Triamcinolone Acetonide Injection for Acute Nonarteritic Anterior Ischemic Optic Neuropathy

The purpose of this case report is to evaluate the visual outcome of an intravitreal triamcinolone acetonide injection (IVTA) as a treatment for a patient with acute nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old male patient with severe visual loss due to acute NAION was treated with 4 mg/0.1mL IVTA. Fundus examination and measurements of the patient's best-corrected visual acuity and visual field were performed before and after the injection at 2 weeks, 1 month, 3 months, and 6 months. The best-corrected visual acuity changed from 0.05 before the injection to 0.16 at 2 weeks, 0.3 at 1 month, and 0.4 at 3 months and at the final visit. Optic disc swelling had markedly decreased at 1 week postoperatively and disappeared at 2 weeks after the injection. The clinical course of this patient suggests that an IVTA may be effective in increasing visual acuity following an acute NAION. A large randomized controlled trial is needed to assess the efficacy of IVTA as a treatment for NAION.

Dose Dependent Effects of Intravitreal Triamcinolone Acetonide on Diffuse Diabetic Macular Edema

PURPOSE: To evaluate the effect of different doses of intravitreal triamcinolone acetonide on diffuse diabetic macular edema. METHODS: In a retrospective study, 44 eyes with diffuse diabetic macular edema were treated with an intravitreal injection of 4 mg (n=12 eyes), 8 mg (n=17) or 25 mg (n=15) of triamcinolone acetonide (TA). Optical coherence tomography, best-corrected logMAR visual acuity and Goldmann tonometry were performed at baseline, 1 week, and 1, 3, 6, 9 and 12 months after treatment. Mean follow-up was 9.8 months (standard deviation=2.3) with a range of 5-12 months. RESULTS: The duration of intravitreal TA effects on macular thickness and visual acuity increased with increasing dosage. An observed increase in intraocular pressure induced by TA was not significantly associated with dosage. CONCLUSIONS: In patients with diffuse diabetic macular edema who receive intravitreal TA, effects may last longer after a dosage of 25 mg, than after lower doses of 8 mg or 4 mg.