Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration.

PURPOSE: To report on the follow-up of patients who received an intravitreal triamcinolone acetonide injection (IVTA) as treatment of exudative age-related macular degeneration. METHODS: The clinical interventional case-series study included 205 patients (222 eyes) with progressive exudative age-related macular degeneration with subfoveal neovascularization who consecutively received an IVTA of about 20 mg as only therapeutic procedure and for whom follow-up was at least 3 months. Mean follow-up was 10.4+/-7.1 months (range, 3-35.7 months). RESULTS: Visual acuity improved significantly (P<0.001) from baseline (0.90+/-0.45 logarithm of the minimum angle of resolution (LogMar)) to a mean minimum of 0.79+/-0.42 LogMar during follow-up. In 86 (38.7%) eyes and in 55 (24.8%) eyes, best visual acuity increased by at least two and three Snellen lines, respectively. Comparing the measurements at specific postinjection examination dates showed that visual acuity measurements taken at 1, 2, and 3 months after injection were not significantly different from the baseline value. Measurements taken at 6, 9, and 12 months after the injection were significantly (P<0.001) lower than the measurements at baseline. Mean loss at 6 months was 1.4+/-3.8 Snellen lines, at 9 months, 2.5+/-4.6 lines, and at 12 months after the injection, 2.6+/-4.0 lines. Intraocular pressure increased significantly (P<0.001) during the first 6 months, and returned to baseline at 9 months after injection. CONCLUSIONS: Single injection high-dosage IVTA did not show an apparent benefit at 12 months after injection in patients with neovascular age-related macular degeneration.

Bevacizumab for occult subfoveal neovascularization in age-related macular degeneration.

PURPOSE: To report on the treatment of exudative age-related macular degeneration by intravitreal bevacizumab (Avastin). METHODS: A 78-year-old patient experienced a progressive loss of visual acuity in her right eye due to an occult subfoveal neovascular membrane in age-related macular degeneration. She received an intravitreal injection of 1.5 mg bevacizumab. RESULTS: Within 4 weeks after the injection, visual acuity improved from 0.40 to 0.60 with complete resolution of subretinal and intraretinal leakage and edema as shown on optical coherence tomography. Pre-existing metamorphopsias disappeared. Intraocular pressure remained in the normal range. During the follow-up, there were no sings of intraocular inflammation or any other intraocular pathology induced by the intravitreal injection. CONCLUSIONS: Intravitreal bevacizumab may potentially be helpful in the treatment of exudative age-related macular degeneration and may deserve further evaluation.

Follow-up after intravitreal triamcinolone acetonide for diabetic macular edema.

PURPOSE: To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema. METHODS: The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 +/- 6.2 months. RESULTS: Visual acuity improved significantly (p<0.001) from 0.89 +/- 0.33 logMAR to a best minimum of 0.65 +/- 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, respectively. Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p<0.001), 2 months (p<0.001), 3 months (p<0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure >21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected. CONCLUSIONS: The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.

[Fluctuations depending on time of day in measurements of the optic disc using confocal laser canning tomography]. / Tageszeitliche Schwankungen von Messungen der Papilla Nn. optici mit dem konfokalen Laser-Scanning-Tomographen.

PURPOSE: The aim of this study was to evaluate whether confocal laser scanning tomographic measurements of the optic nerve head depend on the time of day when the examinations are performed. PATIENTS: Thirty-two eyes of 20 subjects repeatedly underwent optic disc confocal laser scanning tomography using the Heidelberg Retina Tomograph I. Operated by a single examiner, measurements were performed at 10 a.m. and 4 p.m. on the same day. RESULTS: Comparing both measurements, differences in optic cup area (0.119+/-0.126 mm(2); p=0.89), neuroretinal rim area (0.120+/-0.131 mm(2); p=0.86), cup volume (0.069+/-0.086 mm(3); p=0.86), rim volume (0.083+/-0.090 mm(3); p=0.51), and retinal nerve fiber layer thickness (0.075+/-0.063 mm; p=0.31) were statistically not significant. Intraocular pressure differences between morning and afternoon ranged between 0 and 14 mmHg. CONCLUSIONS: Confocal laser scanning tomographic measurements of the optic nerve head are not markedly influenced by the time of day.

Intravitreal triamcinolone acetonide for treatment of central retinal vein occlusion.

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and intraocular pressure in patients with central retinal vein occlusion. METHODS: This prospective comparative non-randomized clinical interventional study included 32 patients (33 eyes) with central retinal vein occlusion. The study group (12 patients; 13 eyes) received an intravitreal injection of about 20 mg of triamcinolone acetonide. The control group (20 patients) did not receive any treatment. Mean follow-up was 10.1+/-8.6 months in the study group and 6.0+/-5.2 months in the control group. RESULTS: In the study group, mean visual acuity increased significantly (p=0.018) from 0.11+/-0.11 preoperatively to a best visual acuity during follow-up of 0.18+/-0.15. An improvement in visual acuity by at least 2 Snellen lines and 3 Snellen lines, respectively, was found for 8 (62%) eyes and 5 (38) eyes. Visual acuity measurements determined 1 month (p=0.038) and 3 months (p=0.046) after the injection were significantly higher than the baseline values. Increase in visual acuity was higher in the non-ischemic subgroup than in the ischemic subgroup. In the control group, baseline visual acuity and best visual acuity during the followup did not vary significantly (p=0.33). Visual acuity decreased significantly (p=0.007) towards the end of the follow-up. Comparing study group and control group, gain in visual acuity was significantly (p=0.01) higher in the study group. In the study group, intraocular pressure increased significantly (p=0.018) from 14.4+/-3.9 mmHg to a mean maximal value of 21.6+/-9.2 mmHg (range, 10-44 mmHg), and re-decreased (p=0.012) towards the end of follow-up to 15.3+/-5.1 mmHg (range, 10-21 mmHg). CONCLUSIONS: Intravitreal triamcinolone acetonide temporarily increases visual acuity in central retinal vein occlusion. It is accompanied by an increase in intraocular pressure.

Potential of the 1 CU accommodative intraocular lens.

AIM: To assess the accommodative power of a new foldable monofocal intraocular lens. METHOD: A prospective randomised non-masked clinical interventional study. The study included 40 patients attending the hospital for cataract surgery and who were randomly distributed into a study group receiving a new foldable monofocal intraocular lens with flexible haptics, and a control group receiving a standard foldable intraocular lens. Mean follow up period was 8.51 (SD 1.34) months (range 4-11 months) Standard cataract surgery consisted of clear cornea incision, capsulorrhexis, phacoemulsification, and intraocular lens implantation, with topical anaesthesia. The main outcome measures were preoperative and postoperative visual acuity for near and distance; range of accommodation; change in anterior chamber depth. RESULTS: In the study group compared with the control group, range of accommodation was significantly (p = 0.01) higher (1.01 (SD 0.4) dioptres versus 0.50 (0.11) dioptres) and change in anterior chamber depth was significantly more pronounced (0.82 (0.30) versus 0.40 (0.32), p = 0.01). Both groups did not vary significantly in best corrected vision (0.94 (0.12) versus 0.93 (0.18); p = 0.74). CONCLUSION: During a mean follow up period of 8 months after implantation, the new foldable monofocal intraocular lens with flexible haptics showed an accommodative power of about 1 dioptre, which was significantly higher than the accommodative power of a conventional monofocal flexible intraocular lens. The difference in the accommodative power between the two intraocular lenses was paralleled by a difference in the change of the anterior chamber depth.

Frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide.

PURPOSE: To evaluate the frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide in elderly patients. METHODS: This clinical interventional case series study included 144 phakic eyes that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide for diffuse diabetic macular edema (n=42 eyes), exudative age-related macular degeneration (n=98), and branch retinal vein occlusion (n=4). Mean age was 72.3-/+8.9 years. Mean follow-up was 11.0-/+6.8 months (median, 8.8 months; range, 3 to 35.5 months). Reinjections were carried out in 12 (8.3%) eyes. RESULTS: Cataract surgery was performed in 20 (13.9%) eyes 17.4-/+9.1 months (median, 12.7 months; range, 8.0 to 35.5 months) after the first intravitreal injection. Out of the 20 eyes undergoing cataract surgery, 19 (95%) eyes had received one intravitreal injection, and 1 (5%) eye had received two previous injections. CONCLUSIONS: In the elderly population of patients with exudative age-related macular degeneration, diffuse diabetic macular edema, or branch retinal vein occlusion, intravitreal high-dosage injection of triamcinolone acetonide leads to clinically significant cataract with eventual cataract surgery in about 15% to 20% of eyes within about 1 year after the intravitreal injection.

Contrast and glare sensitivity after implantation of AcrySof and Human Optics 1CU intraocular lenses.

PURPOSE: To evaluate contrast and glare sensitivity of a newly developed, potentially accommodative intraocular lens. METHODS: The clinical interventional prospective randomized study included 20 patients (23 eyes) undergoing standard phacoemulsification with clear cornea incision in topical anesthesia. In the study group (10 eyes), the 1CU Human Optics intraocular lens (optics diameter 5.5 mm) was implanted. The control group (13 eyes) received the monofocal AcrySof intraocular lens (optics diameter: 6.0 mm). Using a newly developed contrast measuring device, contrast and glare sensitivity were tested 4 weeks after surgery. RESULTS: The study group and control group did not vary significantly in contrast (p=0.38) or glare sensitivity (p=0.52). CONCLUSIONS: The results suggest that the newly developed 1CU Human Optics intraocular lens and the standard AcrySof intraocular lens do not vary significantly in glare and contrast sensitivity.

Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide.

PURPOSE: To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity in branch retinal vein occlusion. METHODS: The prospective comparative nonrandomized clinical interventional study included 28 patients (28 eyes) with branch retinal vein occlusion. The study group consisting of 10 consecutive patients received an intravitreal injection of 20-25 mg of triamcinolone acetonide. The control group including 18 patients did not receive an intravitreal injection. The mean follow-up was 8.7+/-4.4 months. RESULTS: In the study group, mean visual acuity increased significantly (P=0.02) from 0.27+/-0.11 preoperatively to a best postoperative visual acuity of 0.45+/-0.27. Visual acuity measurements determined 1 month after the injection were significantly (P=0.027) higher than baseline values. Nine (90%) eyes gained in visual acuity, with six (60%) eyes showing an increase in visual acuity of at least two Snellen lines. In the ischaemic subgroup, visual acuity did not change significantly (0.18+/-0.18 to 0.13+/-0.04; P=0.66), while, in the nonischaemic subgroup, visual acuity increased significantly (P=0.012) from the baseline value to the best postoperative measurement (0.29+/-0.09 to 0.53+/-0.24). In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (P=0.27). Comparing the study and control groups with each other, the gain in visual acuity was significantly higher in the study group at 1 month (P=0.016) and 2 months (P=0.012) after baseline. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide can increase visual acuity in patients with branch retinal vein occlusion.

[Intravitreal triamcinolone acetonide for the treatment of intraocular edematous and neovascular diseases]. / Intravitreales Triamcinolonacetonid zur Behandlung intraokulärer ödematöser und neovaskulärer Erkrankungen.

BACKGROUND: Within the last 2 years, intravitreal application of triamcinolone acetonide has exponentially increased as a treatment option for various intraocular neovascular and edematous proliferative disorders. METHODS AND RESULTS: The best response to intravitreal triamcinolone acetonide injection in terms of gain in visual acuity was obtained for eyes with intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. Visual acuity increased and degree of intraocular inflammation decreased in eyes with various types of noninfectious uveitis including sympathetic ophthalmia. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischemic retinopathies. Possibly, intravitreal triamcinolone may be helpful for exudative age-related macular degeneration, alone or in combination with photodynamic therapy. In eyes with chronic, therapy-resistant, ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure and may stabilize the eye. The complications of intravitreal triamcinolone therapy, such as secondary ocular hypertension in about 40% of the eyes injected, cataractogenesis, postoperative infectious and noninfectious endophthalmitis, and pseudo-endophthalmitis will be covered in another article. Intravitreal triamcinolone injection can be combined with other intraocular surgeries including cataract surgery. Cataract surgery performed some months after the injection did not show a markedly elevated rate of complications. If vision increases after the intravitreal triamcinolone injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone ranges between 2 and 9 months, probably depending on the dosage used. CONCLUSIONS: Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular oedematous and neovascular disorders. One has to take into account the side effects and the lack of long-term follow-up observations.

[Readaptation time after photo-stress in normal subjects and glaucoma patients]. / Readaptationszeit nach Photostress bei Normalpersonen und Glaukompatienten.

PURPOSE: A photo-stress test was conducted at the subjective contrast threshold to evaluate whether psychophysical differences could be detected between chronic open-angle glaucoma patients and normal subjects. METHODS: The prospective, comparative, clinical observational study included 20 patients (29 eyes) with chronic open-angle glaucoma and 20 control subjects (29 eyes). The study groups did not vary significantly in age and refractive error, but visual acuity showed a difference of 0.16. All participants underwent photo-stress using the Kontrastometer BA4. RESULTS: In the glaucoma group compared with the control group, the mean contrast threshold was significantly higher and the readaptation time significantly longer. The latter correlated significantly with the papillo-morphological glaucoma stage. CONCLUSIONS: In patients with chronic open-angle glaucoma, the foveal recovery time after a photo-stress test is significantly prolonged compared with normal subjects. It may suggest involvement of the fovea in glaucoma even if the visual acuity is 20/20.