Intravitreal Triamcinolone for the Treatment of Macular Edema AssociatedWith Central Retinal Vein Occlusion | Macular Diseases | JAMA Ophthalmology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Klein  MLFinkelstein  D Macular grid photocoagulation for macular edema in central retinalvein occlusion.  Arch Ophthalmol. 1989;1071297- 1302PubMedGoogle ScholarCrossref
2.
Central  Vein Occlusion Study Group Baseline and early natural history report: the Central Vein OcclusionStudy.  Arch Ophthalmol. 1993;1111087- 1095PubMedGoogle ScholarCrossref
3.
The  Central Vein Occlusion Study Group Natural history and clinical management of central retinal vein occlusion.  Arch Ophthalmol. 1997;115486- 491PubMedGoogle ScholarCrossref
4.
The  Central Vein Occlusion Study Group Evaluation of grid pattern photocoagulation for macular edema in centralvein occlusion: the Central Vein Occlusion Study Group M Report.  Ophthalmology. 1995;1021425- 1433PubMedGoogle ScholarCrossref
5.
Green  WRChan  CCHutchins  GMTerry  JM Central Retinal Vein Occlusion: a prospective histopathologic studyof 29 eyes in 28 cases.  Trans Am Ophthalmol Soc. 1981;79371- 422PubMedGoogle Scholar
6.
Hockley  DJTripathi  RCAshton  N Experimental branch vein occlusion in rhesus monkeys, III.  Br J Ophthalmol. 1979;63393- 411PubMedGoogle ScholarCrossref
7.
Aiello  LPBursell  SEClermont  A  et al.  Vascular endothelial growth factor–induced retinal permeabilityis mediated by protein kinase C in vivo and suppressed by an orally effectivebeta-isoform-selective inhibitor.  Diabetes. 1997;461473- 1480PubMedGoogle ScholarCrossref
8.
Antonetti  DABarber  AJHollinger  LAWolpert  EBGardner  TW Vascular endothelial growth factor induces rapid phosphorylation oftight junction proteins occludin and zonula occluden 1.  J Biol Chem. 1999;27423463- 23467PubMedGoogle ScholarCrossref
9.
Vinores  SAYoussri  AILuna  JD  et al.  Upregulation of vascular endothelial growth factor in ischemic andnon-ischemic human and experimental retinal disease.  Histol Histopathol. 1997;1299- 109PubMedGoogle Scholar
10.
Pe'er  JFolberg  RItin  AGnessin  HHemo  IKeshet  E Vascular endothelial growth factor upregulation in human central retinalvein occlusion.  Ophthalmology. 1998;105412- 416PubMedGoogle ScholarCrossref
11.
Nauck  MKarakiulakis  GPerruchoud  APPapakonstantinou  ERoth  M Corticosteroids inhibit the expression of the vascular endothelialgrowth factor gene in human vascular smooth muscle cells.  Eur J Pharmacol. 1998;341309- 315PubMedGoogle ScholarCrossref
12.
Nauck  MRoth  MTamm  M  et al.  Induction of vascular endothelial growth factor by platelet-activatingfactor and platelet-derived growth factor is downregulated by corticosteroids.  Am J Respir Cell Mol Biol. 1997;16398- 406PubMedGoogle ScholarCrossref
13.
Greenberg  PBMartidis  ARogers  AHDuker  JSReichel  E Intravitreal triamcinolone acetonide for macular oedema due to centralvein occlusion.  Br J Ophthalmol. 2002;86247- 248PubMedGoogle ScholarCrossref
14.
Ip  MSKumar  KS Intravitreous triamcinolone acetonide as treatment for macular edemafrom central retinal vein occlusion.  Arch Ophthalmol. 2002;1201217- 1219PubMedGoogle ScholarCrossref
15.
Jonas  JBKreissig  IDegenring  RF Intravitreal triamcinolone acetonide as treatment of macular edemain central retinal vein occlusion.  Graefes Arch Clin Exp Ophthalmol. 2002;240782- 783PubMedGoogle ScholarCrossref
16.
Ip  MSKahana  AAltaweel  MA Treatment of central retinal vein occlusion with triamcinolone acetonide.  Semin Ophthalmol. 2003;1867- 73PubMedGoogle ScholarCrossref
17.
Hee  MRPuliafito  CADuker  JS  et al.  Topography of diabetic macular edema with optical coherence tomography.  Ophthalmology. 1998;105360- 370PubMedGoogle ScholarCrossref
18.
Muscat  SParks  SKemp  EKeating  D Repeatability and reproducibility of macular thickness measurementswith the Humphrey OCT system.  Invest Ophthalmol Vis Sci. 2002;43490- 495PubMedGoogle Scholar
19.
McAllister  ILConstable  IJ Laser-induced chorioretinal venous anastamosis for treatment of nonischemiccentral retinal vein occlusion.  Arch Ophthalmol. 1995;113456- 462PubMedGoogle ScholarCrossref
20.
Opremcak  EMBruce  RALomeo  MDRidenour  CDLetson  ADRehmar  AJ Radial optic neurotomy for central retinal vein occlusion.  Retina. 2001;21408- 415PubMedGoogle ScholarCrossref
21.
Glacet-Bernard  ACoscas  GChabanel  AZourdani  ALelong  FSamama  MM A randomized, double-masked study on the treatment of retinal veinocclusion with troxerutin.  Am J Ophthalmol. 1994;118421- 429PubMedGoogle Scholar
22.
Wolf  SArend  OBertram  B  et al.  Hemodilution therapy in central retinal vein occlusion.  Graefes Arch Clin Exp Ophthalmol. 1994;23233- 39PubMedGoogle ScholarCrossref
23.
Weiss  JN Treatment of central retinal vein occlusion by injection of tissueplasminogen activator into a retinal vein.  Am J Ophthalmol. 1998;126142- 144PubMedGoogle ScholarCrossref
24.
Lit  ESTsilimbaris  MGotzaridis  ED'Amico  DJ Lamina puncture: pars plana optic disc surgery for central retinalvein occlusion.  Arch Ophthalmol. 2002;120495- 499PubMedGoogle ScholarCrossref
25.
McCuen  BWBessler  MTano  YChandler  DMachemer  R The lack of toxicity of intravitreally administered triamcinolone acetonide.  Am J Ophthalmol. 1981;91785- 788PubMedGoogle Scholar
26.
Schindler  RHChandler  DThresher  RMachemer  R The clearance of intravitreal triamcinolone acetonide.  Am J Ophthalmol. 1982;93415- 417PubMedGoogle Scholar
27.
Scholes  GNO'Brien  WJAbrams  GWKubicek  MF Clearance of triamcinolone from vitreous.  Arch Ophthalmol. 1985;1031567- 1569PubMedGoogle ScholarCrossref
28.
Hida  TChandler  DArena  JEMachemer  R Experimental and clinical observations of the intraocular toxicityof commercial corticosteroid preparations.  Am J Ophthalmol. 1986;101190- 195PubMedGoogle Scholar
29.
Penfold  PLGyory  JFHunyor  ABBillson  FA Exudative macular degeneration and intravitreal triamcinolone: a pilotstudy.  Aust N Z J Ophthalmol. 1995;23293- 298PubMedGoogle ScholarCrossref
30.
Challa  JKGillies  MCPenfold  PLGyory  JFHunyor  ABLBillson  FA Exudative macular degeneration and intravitreal triamcinolone: 18 monthfollow up.  Aust N Z J Ophthalmol. 1998;26277- 281PubMedGoogle ScholarCrossref
31.
Danis  RPCiulla  TAPratt  LMAnliker  W Intravitreal triamcinolone acetonide in exudative age-related maculardegeneration.  Retina. 2000;20244- 250PubMedGoogle ScholarCrossref
32.
Jonas  JBHayler  JKPanda-Jonas  S Intravitreal injection of crystalline cortisone as adjunctive treatmentof proliferative vitreoretinopathy.  Br J Ophthalmol. 2000;841064- 1067PubMedGoogle ScholarCrossref
33.
Jonas  JBSofker  A Intraocular injection of crystalline cortisone as adjunctive treatmentof diabetic macular edema.  Am J Ophthalmol. 2001;132425- 427PubMedGoogle ScholarCrossref
34.
Martidis  ADuker  JSGreenberg  PB  et al.  Intravitreal triamcinolone for refractory diabetic macular edema.  Ophthalmology. 2002;109920- 927PubMedGoogle ScholarCrossref
Clinical Sciences
August 2004

Intravitreal Triamcinolone for the Treatment of Macular Edema AssociatedWith Central Retinal Vein Occlusion

Author Affiliations

From the Department of Ophthalmology and Visual Science (Drs Ip, Gottlieb,Kahana, Altaweel, and Blodi) and Department of Biostatistics and Medical Informatics(Dr Gangnon), University of Wisconsin, Madison; and the Bascom Palmer EyeInstitute, Department of Ophthalmology, University of Miami School of Medicine,Miami, Fla (Drs Scott and Puliafito). The authors have no relevant financialinterest in this article.

Arch Ophthalmol. 2004;122(8):1131-1136. doi:10.1001/archopht.122.8.1131
Abstract

Objective  To investigate the safety and efficacy of intravitreal triamcinoloneacetonide as treatment for macular edema associated with central retinal veinocclusion (CRVO).

Methods  We reviewed the medical records of 13 consecutive patients (13 eyes)with macular edema associated with CRVO who were treated with an injectionof intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsinand the Bascom Palmer Eye Institute. Each intravitreal injection was deliveredthrough the pars plana using a 27- or 30-gauge needle.

Main Outcome Measures  Change in Snellen visual acuity, clinical appearance of macular edema,measurement of foveal thickening with optical coherence tomography (OCT),and frequency of complications.

Results  The median age of the 13 patients was 67 years (interquartile range,57-77 years), and the median duration of symptoms before injection was 8 months(interquartile range, 4-9 months). Mean baseline visual acuity was 20/500in the affected eye. Mean visual acuity at the 6-month follow-up examinationwas 20/180 in the affected eye. All 13 patients completed the 6-month examination.Eyes with nonischemic CRVO (n = 5) demonstrated a significant improvementin visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificantvisual acuity improvement. No patient had a decrease in visual acuity. Meanbaseline foveal thickness as measured by OCT was 590 µm (retinal thickening= 416 µm). Mean foveal thickness as measured by OCT at the 1-month follow-upexamination in 12 patients was 212 µm (retinal thickening = 38 µm).At the 3-month follow-up examination, mean foveal thickness as measured byOCT for 13 patients was 193 µm (retinal thickening = 19 µm). Betweenthe 3- and 6-month follow-up examinations, 4 patients developed a recurrenceof macular edema. Three of the 4 patients were retreated with a second injectionof triamcinolone. Two of these 3 patients experienced an improvement in visualacuity following retreatment. At the 6-month follow-up examination, mean fovealthickness as measured by OCT for 13 patients was 281 µm (retinal thickening= 107 µm). No adverse effects such as retinal detachment or endophthalmitisoccurred. One patient experienced an increase in intraocular pressure thatwas controlled with 2 aqueous suppressants.

Conclusions  Intravitreal injection of triamcinolone appears to be a possibly effectivetreatment in some patients with macular edema associated with CRVO. Patientswith nonischemic CRVO may respond more favorably than patients with ischemicCRVO, and retreatment may be necessary in some patients. In this case series,severe complications were not noted.

×