Elsevier

American Journal of Ophthalmology

Volume 140, Issue 4, October 2005, Pages 695.e1-695.e10
American Journal of Ophthalmology

Original article
Intravitreal Triamcinolone Compared With Macular Laser Grid Photocoagulation for the Treatment of Cystoid Macular Edema

https://doi.org/10.1016/j.ajo.2005.05.021Get rights and content

Purpose

To evaluate the outcome of cystoid macular edema (CME) treated with intravitreal injections of triamcinolone acetonide (TA), macular laser grid photocoagulation (MLG), or both (TA+MLG).

Design

Prospective, randomized, interventional, parallel, three-arm clinical trial.

Methods

setting: Institutional clinical study. patients: Fifty-six patients (63 eyes) affected by diabetic or retinal vein occlusion CME. procedures: Twenty-two eyes received intravitreal injections of 4 mg TA; 21 eyes underwent MLG; and 20 eyes received intravitreal injection of 4 mg TA, and after 3 months, MLG. main outcome measures: Best-corrected visual acuity (VA), central macular thickness (CMT) (by optical coherence tomography), and postoperative complications.

Results

Mean follow-up was 9 ± 2 months (range 6 to 12 months). Baseline VA (logarithm of minimal angle of resolution [logMAR]) and CMT were, respectively, 0.82 ± 0.19 and 556 ± 139 μm microns for the TA group, 0.84 ± 0.15 and 601 ± 102 μm microns for the MLG group, and 0.83 ± 0.22 and 573 ± 106 μm microns for the TA+MLG group (no statistically significant difference among the groups). After the treatment, at 45 days, 3, 6, and 9 months in the TA group, VA had improved (P = .004) by 0.26, 0.25, 0.22, and 0.23 logMAR and CMT had decreased by 37%, 33%, 29%, and 31% (P = < .001). In the MLG group, VA was unchanged although CMT had decreased by 5%, 13%, 14%, and 16% (P = .021). In the TA+MLG group, VA had improved (P = .003) by 0.26, 0.24, 0.19, and 0.20 logMAR, and CMT had decreased by 36%, 34%, 28%, and 29% (P = < .001). The groups receiving triamcinolone had better VA and lower CMT values at all time points (P < .05). A reinjection was performed in eight eyes; intraocular pressure increased in nine eyes (treated with medical therapy), and cataract progressed in one eye. No injection-related complications occurred.

Conclusions

TA intravitreal injection improves VA and reduces CMT more than MLG, which in triamcinolone-treated eyes does not offer further advantages. Intravitreal TA injection could be used as primary treatment in patients with CME.

Section snippets

Methods

The study was a prospective, randomized, interventional, parallel, three-arm clinical trial at the Retina Center of the Institute of Ophthalmology of the University of Catania, Catania, Italy. The study, following the tenets of Declaration of Helsinki, was approved by the Institutional Review Board. All patients provided informed consent after the aim of the study and the possible risks had been fully explained. From September 2003 to March 2004, 63 eyes of 56 patients affected with CME

Results

Sixty-three eyes of 56 patients (27 men, 29 women), aged between 55 and 72 years (mean 64 ± 5 years), were included in the study. CME was caused in 48 eyes by DR, in nine eyes by CRVO, and in six eyes by BRVO. Macular edema had been present for 6 to 12 months (mean 9 ± 2 months). Twenty-two eyes received intravitreal TA injection, 21 eyes MLG, and 20 eyes both. There were no differences among the three groups in baseline VA or baseline macular thickness (ANOVA; NS) (TABLE 1, TABLE 2). All

Discussion

CME is a common pathologic sequel of several ocular disorders, where it is often the main cause of vision loss. The treatments advocated often do not modify the course of the edema, which leads to severe vision impairment. For example, in eyes with macular edema and VA <20/40, VA improved (as assessed by ETDRS) in 16% of laser-treated eyes and 11% of unlasered eyes.3 After MLG, a VA improvement (2 or 3 lines) in 12% to 17% of eyes has been reported.14, 15, 16 The Central Vein Occlusion Study

Teresio Avitabile, MD, is Associate Professor of Ophthalmology and head of Retina Center of the Institute of Ophthalmology of the University of Catania, Italy. Relator at many international congress, co-author of a book, author of more than 200 publications, his main fields of interest are echography, retinal detachment, cataract surgery, glaucoma, and vitreo-retinal surgery.

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    • Cited by (0)

    Teresio Avitabile, MD, is Associate Professor of Ophthalmology and head of Retina Center of the Institute of Ophthalmology of the University of Catania, Italy. Relator at many international congress, co-author of a book, author of more than 200 publications, his main fields of interest are echography, retinal detachment, cataract surgery, glaucoma, and vitreo-retinal surgery.

    Alfredo Reibaldi, MD, PhD, is Ordinary Professor of Ophthalmology and Director of the Institute of Ophthalmology of the University of Catania. Chairman at many international congress and author of a book and of more than 600 publications, his main fields of interest are glaucoma, echography, retinal detachment, ROP, vitreo-retinal surgery, and ocular oncology.

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