Intravitreal Triamcinolone for the Treatment of Macular Edema AssociatedWith Central Retinal Vein Occlusion | Macular Diseases | JAMA Ophthalmology | JAMA Network
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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

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.