Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion

Michael S. Ip, Justin L. Gottlieb, Alon Kahana, Ingrid U. Scott, Michael M. Altaweel, Barbara A. Blodi, Ronald E. Gangnon, Carmen A. Puliafito

Research output: Contribution to journalReview article

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Abstract

Objective: To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edema associated with central retinalvein occlusion (CRVO). Methods: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. Each intravitreal injection was delivered through 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 (inter-quartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n=5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificant visual acuity improvement. No patient had a decrease in visual acuity. Mean baseline 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-up examination in 12 patients was 212 μm (retinal thickening=38 μm). At the 3-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 193 μm (retinal thickening=19 μm). Between the 3- and 6-month follow-up examinations, 4 patients developed a recurrence of macular edema. Three of the 4 patients were retreated with a second injection of triamcinolone. Two of these 3 patients experienced an improvement in visual acuity following retreatment. At the 6-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 281 μm (retinal thickening=107 μm). No adverse effects such as retinal detachment or endophthalmitis occurred. One patient experienced an increase in intraocular pressure that was controlled with 2 aqueous suppressants. Conclusions: Intravitreal injection of triamcinolone appears to be a possibly effective treatment in some patients with macular edema associated with CRVO. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO, and retreatment may be necessary in some patients. In this case series, severe complications were not noted.

Original languageEnglish (US)
Pages (from-to)1131-1136
Number of pages6
JournalArchives of Ophthalmology
Volume122
Issue number8
DOIs
StatePublished - Aug 1 2004

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Retinal Vein
Triamcinolone
Retinal Vein Occlusion
Macular Edema
Visual Acuity
Optical Coherence Tomography
Therapeutics
Intravitreal Injections
Triamcinolone Acetonide
Retreatment
Injections
Endophthalmitis
Temazepam
Retinal Detachment
Intraocular Pressure

All Science Journal Classification (ASJC) codes

  • Ophthalmology

Cite this

Ip, Michael S. ; Gottlieb, Justin L. ; Kahana, Alon ; Scott, Ingrid U. ; Altaweel, Michael M. ; Blodi, Barbara A. ; Gangnon, Ronald E. ; Puliafito, Carmen A. / Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion. In: Archives of Ophthalmology. 2004 ; Vol. 122, No. 8. pp. 1131-1136.
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title = "Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion",
abstract = "Objective: To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edema associated with central retinalvein occlusion (CRVO). Methods: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. Each intravitreal injection was delivered through 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 (inter-quartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n=5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificant visual acuity improvement. No patient had a decrease in visual acuity. Mean baseline 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-up examination in 12 patients was 212 μm (retinal thickening=38 μm). At the 3-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 193 μm (retinal thickening=19 μm). Between the 3- and 6-month follow-up examinations, 4 patients developed a recurrence of macular edema. Three of the 4 patients were retreated with a second injection of triamcinolone. Two of these 3 patients experienced an improvement in visual acuity following retreatment. At the 6-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 281 μm (retinal thickening=107 μm). No adverse effects such as retinal detachment or endophthalmitis occurred. One patient experienced an increase in intraocular pressure that was controlled with 2 aqueous suppressants. Conclusions: Intravitreal injection of triamcinolone appears to be a possibly effective treatment in some patients with macular edema associated with CRVO. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO, and retreatment may be necessary in some patients. In this case series, severe complications were not noted.",
author = "Ip, {Michael S.} and Gottlieb, {Justin L.} and Alon Kahana and Scott, {Ingrid U.} and Altaweel, {Michael M.} and Blodi, {Barbara A.} and Gangnon, {Ronald E.} and Puliafito, {Carmen A.}",
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Ip, MS, Gottlieb, JL, Kahana, A, Scott, IU, Altaweel, MM, Blodi, BA, Gangnon, RE & Puliafito, CA 2004, 'Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion', Archives of Ophthalmology, vol. 122, no. 8, pp. 1131-1136. https://doi.org/10.1001/archopht.122.8.1131

Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion. / Ip, Michael S.; Gottlieb, Justin L.; Kahana, Alon; Scott, Ingrid U.; Altaweel, Michael M.; Blodi, Barbara A.; Gangnon, Ronald E.; Puliafito, Carmen A.

In: Archives of Ophthalmology, Vol. 122, No. 8, 01.08.2004, p. 1131-1136.

Research output: Contribution to journalReview article

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T1 - Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion

AU - Ip, Michael S.

AU - Gottlieb, Justin L.

AU - Kahana, Alon

AU - Scott, Ingrid U.

AU - Altaweel, Michael M.

AU - Blodi, Barbara A.

AU - Gangnon, Ronald E.

AU - Puliafito, Carmen A.

PY - 2004/8/1

Y1 - 2004/8/1

N2 - Objective: To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edema associated with central retinalvein occlusion (CRVO). Methods: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. Each intravitreal injection was delivered through 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 (inter-quartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n=5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificant visual acuity improvement. No patient had a decrease in visual acuity. Mean baseline 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-up examination in 12 patients was 212 μm (retinal thickening=38 μm). At the 3-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 193 μm (retinal thickening=19 μm). Between the 3- and 6-month follow-up examinations, 4 patients developed a recurrence of macular edema. Three of the 4 patients were retreated with a second injection of triamcinolone. Two of these 3 patients experienced an improvement in visual acuity following retreatment. At the 6-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 281 μm (retinal thickening=107 μm). No adverse effects such as retinal detachment or endophthalmitis occurred. One patient experienced an increase in intraocular pressure that was controlled with 2 aqueous suppressants. Conclusions: Intravitreal injection of triamcinolone appears to be a possibly effective treatment in some patients with macular edema associated with CRVO. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO, and retreatment may be necessary in some patients. In this case series, severe complications were not noted.

AB - Objective: To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edema associated with central retinalvein occlusion (CRVO). Methods: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. Each intravitreal injection was delivered through 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 (inter-quartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n=5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificant visual acuity improvement. No patient had a decrease in visual acuity. Mean baseline 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-up examination in 12 patients was 212 μm (retinal thickening=38 μm). At the 3-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 193 μm (retinal thickening=19 μm). Between the 3- and 6-month follow-up examinations, 4 patients developed a recurrence of macular edema. Three of the 4 patients were retreated with a second injection of triamcinolone. Two of these 3 patients experienced an improvement in visual acuity following retreatment. At the 6-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 281 μm (retinal thickening=107 μm). No adverse effects such as retinal detachment or endophthalmitis occurred. One patient experienced an increase in intraocular pressure that was controlled with 2 aqueous suppressants. Conclusions: Intravitreal injection of triamcinolone appears to be a possibly effective treatment in some patients with macular edema associated with CRVO. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO, and retreatment may be necessary in some patients. In this case series, severe complications were not noted.

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