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Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion

  • Retinal Disorders
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To determine the efficacy of combined intravitreal triamcinolone (TA) injection and laser photocoagulation in persistent macular edema after branch retinal vein occlusion (BRVO).

Methods

Follow-up analysis of a case series of 24 patients with macular edema after BRVO (15 of 24 non-ischaemic, 9 of 24 ischaemic). Patients received an intravitreal injection of 4 mg TA followed by laser photocoagulation within the previously edematous area, applied in one or two sessions. Standardized clinical examinations included best corrected visual acuity testing, anterior and posterior segment biomicroscopy, intraocular pressure, and optical coherence tomography (OCT). Fluorescein angiography was performed before treatment and 3 and 6 months later.

Results

Median visual acuity improved significantly from 0.58 logMAR (95%-confidence interval (KI): 0.54 – 0.75, decimal 0.27) at baseline to 0.41 logMAR (KI: 0.37 – 0.64, decimal 0.39) at 1 month (p = 0.001), 0.33 logMAR (KI: 0.32 – 0.62, decimal 0.47) at 3 months (p = 0.002), and 0.41 logMAR (KI: 0.33 – 0.67, decimal 0.39) at 6 months (p = 0.016). A gain of one or more logarithmic lines was evaluated in 16/24 eyes (67 %) and a gain of 3 lines or more in 8/24 eyes (33 %) at 6 months. Three eyes had lost more than 1 line during the follow-up period. Median change of visual acuity at 6 months was +2.0 lines (KI: 0.2 – 2.4). Median central foveal thickness (OCT-CFT) was 423 μm (KI: 378 – 456, n = 24) at baseline and decreased to 270 μm (KI: 249 – 311, n = 24) at 1 month (p < 0.0001), 265 μm (KI: 254 – 344, n = 24) at 3 months (p < 0.0001), and 266 μm (KI: 259 – 365, n = 18) at 6 months (p = 0.001).

Conclusions

Macular edema after BRVO can effectively be treated by a combination of intravitreal TA injection and subsequent laser photocoagulation. During a 6-month follow-up this combination treatment resulted in a significant reduction of central foveal thickness and improvement of visual acuity.

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References

  1. The Branch Vein Occlusion Study Group (1984) Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol 98:271–282

    Google Scholar 

  2. Mitchel P, Smith W, Chang A (1996) Prevalence and association of retinal vein occlusion in Australia: The Blue Mountains Eye Study. Arch Ophthalmol 114:1243–1247

    Google Scholar 

  3. Greer DV, Constable IJ, Cooper RL (1980) Macular oedema and retinal branch vein occlusion. Aust J Ophthalmol 8:207–209, doi:10.1111/j.1442-9071.1980.tb00340.x

    Article  PubMed  CAS  Google Scholar 

  4. Özkiris A, Evereklioglu C, Erkilic K, Ilhan O (2005) The efficacy of intravitreal triamcinolone acetonide injection of persistent macular edema in branch retinal vein occlusion. Eur J Ophthalmol 15:96–101

    PubMed  Google Scholar 

  5. Cekic O, Chang S, Tseng JJ, Barile GR, Del Piore LV, Weissmann H et al (2005) Intravitreal triamcinolone injection for treatment of macular edema secondary to branch retinal vein occlusion. Retina 25:851–855, doi:10.1097/00006982-200510000-00006

    Article  PubMed  Google Scholar 

  6. Chen SD, Sundaram V, Lochhead J, Patel CK (2006) Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 141:876–883, doi:10.1016/j.ajo.2005.12.011

    Article  PubMed  CAS  Google Scholar 

  7. Jonas JB, Akkoyun I, Kamppeter B, Kreissing I, Degenring RF (2005) Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide. Eye 19:65–71, doi:10.1038/sj.eye.6701395

    Article  PubMed  CAS  Google Scholar 

  8. Rabena MD, Pieramici DJ, Castellarin AA, Nasir MA, Avery RL (2007) Intravitreal bevacizumab (Avastin) in the treatment of macular edema secondary to branch retinal vein occlusion. Retina 27:419–425, doi:10.1097/IAE.0b013e318030e77e

    Article  PubMed  Google Scholar 

  9. Tang WM, Han DP (2000) A study of surgical approaches to retinal vascular occlusions. Arch Ophthalmol 118:138–143

    PubMed  CAS  Google Scholar 

  10. Mason J, 3rd, Feist R, White MJ et al (2004) Sheathotomy to decompress branch retinal vein occlusionA matched controlled study. Ophthalmology 111:540–545, doi:10.1016/j.ophtha.2003.05.032

    Article  PubMed  Google Scholar 

  11. Saika S, Tanaka T, Miyamoto T et al (2001) Surgical posterior vitreous detachment combined with gas/air tamponade for treating macular edema associated with branch retinal vein occlusion: retinal tomography and visual outcome. Graefes Arch Clin Exp Ophthalmol 239:729–732, doi:10.1007/s004170100344

    Article  PubMed  CAS  Google Scholar 

  12. Fekrat S, Goldberg MF, Finkelstein D (1998) Laser-induced chorioretinal venous anastomosis for nonischemic central or branch vein occlusion. Arch Ophthalmol 116:43–52

    PubMed  CAS  Google Scholar 

  13. Avitabile T, Longo A, Reibaldi A (2005) Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol 140:695–702

    PubMed  CAS  Google Scholar 

  14. Parodi M, Saviano S, Ravalico G (1999) Grid laser treatment in macular branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 237:1024–1027, doi:10.1007/s004170050339

    Article  Google Scholar 

  15. Shilling JS, Jones CA (1984) Retinal branch vein occlusion: a study of argon laser photocoagulation in the treatment of macular oedema. Br J Ophthalmol 68:196–198, doi:10.1136/bjo.68.3.196

    Article  PubMed  CAS  Google Scholar 

  16. Chen SD, Lochhead J, Patel CK, Frith P (2004) Intravitreal triamcinolone acetonide for ischaemic macular oedema caused by branch retinal vein occlusion. Br J Ophthalmol 88:154–155, doi:10.1136/bjo.88.1.154

    Article  PubMed  CAS  Google Scholar 

  17. Jonas JB (2006) Intravitreal triamcinolone acetonide: a change in a paradigm. Ophthalmic Res 38:218–245, doi:10.1159/000093796

    Article  PubMed  CAS  Google Scholar 

  18. Lee H, Shah GK (2005) Intravitreal triamcinolone as primary treatment of cystoid macular edema secondary to branch retinal vein occlusion. Retina 25:551–555, doi:10.1097/00006982-200507000-00001

    Article  PubMed  Google Scholar 

  19. Williamson TH, O’Donnell A (2005) Intravitreal triamcinolone acetonide for cystoid macular edema in nonischemic central retinal vein occlusion. Am J Ophthalmol 139:860–866, doi:10.1016/j.ajo.2005.01.001

    Article  PubMed  CAS  Google Scholar 

  20. Patel PJ, Zaheer I, Karia N (2008) Intravitreal triamcinolone acetonide for macular oedema owing to retinal vein occulsion. Eye 22:60–64, doi:10.1038/sj.eye.6702518

    Article  PubMed  CAS  Google Scholar 

  21. Özkiris A, Evereklioglu C, Erkilic K, Dogan H (2006) Intravitreal triamcinolone acetonide for treatment of persistent macular oedema in branch retinal vein occlusion. Eye 20:13–17, doi:10.1038/sj.eye.6701803

    Article  PubMed  CAS  Google Scholar 

  22. Hayashi K, Hayashi H (2005) Intravitreal versus retrobulbar injections of triamcinolone for macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 139:972–982, doi:10.1016/j.ajo.2004.12.087

    Article  PubMed  CAS  Google Scholar 

  23. Yepremyan M, Wetz FD, Tivnan T, Eversman L, Marx JL (2005) The efficacy of intravitreal triamcinolone acetonide on macular edema in branch retinal vein occlusion. Eur J Ophthalmol 15:96–101

    Google Scholar 

  24. Campochiaro PA, Hafiz G, Shah SM, Nguyen QD et al (2008) Ranibizumab for macular edema due to retinal vein occlusions: implication of VEGF as a critical stimulator. Mol Ther 16:791–799, doi:10.1038/mt.2008.10

    Article  PubMed  CAS  Google Scholar 

  25. Kriechbaum K, Michels S, Prager F et al (2008) Intravitreal Avastin for macular oedema secondary to retinal vein occlusion: a prospective study. Br J Ophthalmol 92:518–522, doi:10.1136/bjo.2007.127282

    Article  PubMed  CAS  Google Scholar 

  26. Wu L, Arevalo JF, Roca JA, Maia M, Berrocal MH, Rodriguez FJ, Evans T, Costa RA, Cardillo J, (PACORES): Pan-American Collaborative Retina Study Group (2008) Comparison of two doses of intravitreal bevacizumab (Avastin) for treatment of macular edema secondary to branch retinal vein occlusion: results from the Pan-American Collaborative Retina Study Group at 6 months of follow-up. Retina 28:212–219

    Article  PubMed  CAS  Google Scholar 

  27. Gündüz K, Bakri SJ (2008) Intravitreal bevacizumab for macular oedema secondary to branch retinal vein occlusion. Eye Mar 14 [Epub ahead of print]

  28. Kreutzer TC, Alge CS, Wolf AH, Kook D, Burger J, Strauss R et al (2008) Intravitreal bevacizumab for the treatment of macular oedema secondary to branch retinal vein occlusion. Br J Ophthalmol 92:351–355, doi:10.1136/bjo.2007.123513

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Retinology, Augenzentrum Klinik Pallas, Louis-Giroud-Strasse 20, CH-4600, Olten, Switzerland

    Juliane Riese, Vlassis Loukopoulos, Cornelia Meier, Melanie Timmermann & Heinrich Gerding

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  1. Juliane Riese
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  2. Vlassis Loukopoulos
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  3. Cornelia Meier
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  4. Melanie Timmermann
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  5. Heinrich Gerding
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Correspondence to Heinrich Gerding.

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Riese, J., Loukopoulos, V., Meier, C. et al. Combined intravitreal triamcinolone injection and laser photocoagulation in eyes with persistent macular edema after branch retinal vein occlusion. Graefes Arch Clin Exp Ophthalmol 246, 1671–1676 (2008). https://doi.org/10.1007/s00417-008-0898-0

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  • DOI: https://doi.org/10.1007/s00417-008-0898-0

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