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.

Different Effect of IVTA in the Management of Macular Edema Secondary to Perfusion and Ischemic Type BRVO

PURPOSE: To investigate the improvement of visual acuity with the different effects of ischemic and perfusion type branched retinal vein occlusion (BRVO), and explore the relationship between defects of the macular capillary network and intravitreal injection of triamcinolone acetonide (IVTA) for treatment of BRVO secondary to macular edema. METHODS: We compared macular capillary network condition, improvement of visual acuity due to ischemic range, and decrease of macular edema between 23 perfusion type BRVO patients and 21 ischemic type BRVO patients who were treated with IVTA for BRVO secondary to macular edema. RESULTS: Both ischemic and perfusion type BRVO exhibited decreased macular edema and showed meaningful improvements in visual acuity (P<0.01), but did not show a relationship between the defects in the macular capillary network and improvement of visual acuity. No differences were seen in macular capillary network defects between ischemic and perfusion type BRVO. CONCLUSIONS: IVTA had an effect on the decrease in macular edema and improvement of visual acuity for both ischemic and perfusion type BRVO. However, defects in the macular capillary network do not seem to have any effect on the improvement of visual acuity.

Intraocular Pressure Elevation after Intravitreal Triamcinolone Acetonide Injection

PURPOSE: This study investigated firstly the change of intraocular pressure (IOP) after injection of intravitreal triamcinolone acetonide (IVTA) for the treatment of macular edema and secondly the factors that influence these changes. METHODS: A prospective, non-comparative study was performed in 60 patients at Kangnam Sacred Heart Hospital from October 2003 to September 2004. All the patients received 4-mg IVTA injection. RESULTS: Mean IOP was elevated from the day after injection and peaked at 20.5 mmHg after 2 months (p=0.000). Twenty-six eyes (43.3%) showed significant IOP elevation. IOP was not controlled despite full glaucoma medication in 7 (11.7%) eyes. Two eyes underwent filtering surgery. Younger age was a statistically significant predictive factor for IOP elevation (p=0.009). CONCLUSIONS: In this study, patients who needed filtering surgery developed an IOP spike within one week after the injection. Therefore, clinicians should consider checking IOP at the end of the first week. Furthermore, greater cautions is mandatory with relatively younger patients.

The Efficacy of Intravitreal Triamcinolone Acetonide for Macular Edema in Branched Retinal Vein Occlusion

PURPOSE: To investigate the administration of an intravitreal injection of triamcinolone acetonide (IVTA) for the treatment of macular edema in branch retinal vein occlusion (BRVO). METHODS: Forty-four patients with BRVO were enrolled in this study. At the first and third month after the injection of triamcinolone acetonide (4 mg/0.1 cc), the best corrected visual acuity (BCVA) was measured by Snellen chart and the thickness of macula by OCT. RESULTS: BCVA and the macular thickness were not correlated in BRVO. Average BCVA was 0.99 (log MAR), and the mean macular thickness was 498 micrometer before injection. At the third month after injection, the results were 0.7 (log MAR) and 258 micrometer, respectively. Although 3 eyes experienced a transient increase of intraocular pressure, there were no serious complications affecting visual acuity. CONCLUSIONS: Macular edema and various other factors are considered as the causes of decreased visual acuity in BRVO. IVTA is effective in treating macular edema but not in improving visual acuity.