Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occlusion.

PURPOSE: To assess the long-term safety and efficacy of intravitreal triamcinolone acetonide injection in the management of macular oedema caused by central, hemi-, and branch retinal vein occlusion (CRVO, HRVO, or BRVO). METHODS: This prospective, interventional case series included 13 patients (13 eyes) with retinal vein occlusion and macular oedema. They received an intravitreal injection of 4 mg triamcinolone acetonide. Follow-up was for 1 year with repeat injections where appropriate. Outcome measures were visual acuity and macular thickness measured using ocular coherence tomography (OCT). RESULTS: There were four patients with CRVO, one with HRVO, and eight with BRVO (13 eyes). Mean duration of symptoms before intravitreal triamcinolone acetonide injection was 6.8 months (SD 4.5 months). Eight eyes (62%) responded well with improved visual acuity and macular thickness 1-3 months postinjection. All eight eyes developed recurrent macular oedema and five received repeat injections. Three patients declined a second injection. No improvement in visual acuity or OCT macular thickness was seen after the second injection with visual acuity returning to baseline levels at 1-year follow-up. Three eyes (23%) showed no response to the initial injection (no improvement in macular thickness or visual acuity). Seven patients (54%) had a rise in intraocular pressure with six (46%) requiring treatment. CONCLUSIONS: Intravitreal injection of triamcinolone acetonide is effective as a short-term treatment of macular oedema owing to retinal vein occlusion, improving both visual acuity and macular thickness. However, this effectiveness is not maintained after 1 year despite repeat injections.

Phacoemulsification in vitrectomized eyes under topical anesthesia.

PURPOSE: To study phacoemulsification in vitrectomized eyes under topical anesthesia, assessing anesthetic and intraoperative characteristics and complications. METHODS: A prospective study was performed on 52 eyes of 51 patients who underwent phacoemulsification of cataract with intraocular lens implantation under topical anesthesia, having previously undergone pars plana vitrectomy. Surgical and anesthetic observations and complications were recorded, as were visual outcomes. RESULTS: Ninety-two percent of patients had improved visual acuity postoperatively with only one patient having visual loss as a result of surgery. The most common intraoperative observations were of a deep anterior chamber, posterior capsular plaques, posterior synechiae, and nuclear sclerotic cataracts. Topical anesthesia proved satisfactory in 96%, with only two patients requiring intracameral lignocaine 1%; no patients required conversion to injection anesthesia. There were no major operative or postoperative complications. CONCLUSIONS: Phacoemulsification in vitrectomized eyes can be challenging, but is visually rewarding. Topical anesthesia proved satisfactory for the vast majority of cases, with none of our patients requiring conversion to injection anesthesia.