Short-term efficacy of sub-Tenon's injection of triamcinolone acetonide for cystoid macular edema after cataract surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Huang Ying , Sun Zuhua , Li Yingzi , Liu Xiaoling ,  Lin Bing

Department of Retina, The Affiliated Eye Hospital of Wenzhou Medical University, Wenzhou 325027, China;

Corresponding author：

Lin Bing, Email: lbing124@126.com

Keywords：

Tenon capsule; Triamcinolone acetonide; Macular edema/drug therapy; Phacoemulsification

DOI：

10.3760/cma.j.cn511434-20190421-00152

Video：

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Objective To observe the short-term efficacy of sub-Tenon’s triamcinolone acetonide (TA) in the treatment of cystoid macular edema (CME) after cataract surgery.Methods A retrospective study. From October 1, 2013 to October 1, 2018, 21 patients (21 eyes) with CME after cataract surgery diagnosed at The Affiliated Eye Hospital of Wenzhou Medical University were included in this study. All eyes underwent BCVA, intraocular pressure, frequency domain OCT examination. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logMAR visual acuity when recorded. A frequency domain OCT instrument was used to measure the foveal retinal thickness (CRT). Among 21 eyes of 21 patients, 9 eyes were male and 12 eyes were female; the average age was 66.38±10.88 years. The average logMAR BCVA was 0.46±0.23; the average CRT was 519.90±131.59 μm; the average intraocular pressure was 11.01±3.97 mmHg (1 mmHg=0.133 kPa). All eyes underwent a single treatment of 100 mg/ml TA suspension 0.4 ml (containing TA 40 mg) under Tenon's capsule. The average follow-up time after treatment was 32.86±20.2 days. The changes of BCVA, CRT and intraocular pressure were observed 1 month after treatment. The BCVA, CRT and intraocular pressure before and after treatment were compared by paired t test.Results One month after treatment, the average logMAR BCVA, CRT, and intraocular pressure of the CME eyes were 0.29±0.22, 307.71±35.82 μm and 14.19±6.30 mmHg, respectively. Compared with those before treatment, the differences were statistically significant (t=5.252, 8.166, 4.128; P=0.000, 0.000, 0.001). Among 21 eyes, 13 eyes (61.90%) of the retinal cysts in the macular area completely disappeared; 8 eyes (38.1%) were still visible between the retinal layers. Three eyes with intraocular pressure over than 21 mmHg were treated with lowering intraocular pressure and returned to normal.Conclusion Sub-Tenon’s capsular injection of TA to treat CME after cataract surgery can reduce CRT and improve vision in a short time.

Citation： Huang Ying, Sun Zuhua, Li Yingzi, Liu Xiaoling, Lin Bing. Short-term efficacy of sub-Tenon's injection of triamcinolone acetonide for cystoid macular edema after cataract surgery. Chinese Journal of Ocular Fundus Diseases, 2020, 36(8): 616-619. doi: 10.3760/cma.j.cn511434-20190421-00152 Copy

1.	Wielders LH, Lambermont VA, Schouten JS, et al. Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: a systematic review and meta-analysis[J]. Am J Ophthalmol, 2015, 160(5): 968-981. DOI: 10.1016/j.ajo.2015.07.032.
2.	Henderson BA, Kim JY, Ament CS, et al. Clinical pseudophakic cystoid macular edema: risk factors for development and duration after treatment[J]. Cataract Refract Surg, 2007, 33(9): 1550-1558. DOI: 10.1016/j.jcrs.2007.05.013.
3.	Bradford JD, Wilkinson CP, Bradford RH Jr. Cystoid macular edema following extracapsular cataract extraction and posterior chamber intraocular lens implantation[J]. Retina, 1988, 8(3): 161-164. DOI: 10.1097/00006982-198808030-00001.
4.	Rothova A. Inflammatory cystoid macular edema[J]. Curr Opin Ophthalmol, 2007, 18(6): 487-492. DOI: 10.1097/ICU.0b013e3282f03d2e.
5.	Conway MD, Canakis C, Livir-Rallatos C, et al. Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema[J]. Cataract Refract Surg, 2003, 29(1): 27-33. DOI: 10.1016/s0886-3350(02)01441-4.
6.	Benhamou N, Massin P, Haouchine B, et al. Intravitreal riamcinolone for refractory pseudophakic macular edema[J]. Am J Ophthalmol, 2003, 135(2): 246-249. DOI: 10.1016/s0002-9394(02)01938-4.
7.	Veritti D, Di Giulio A, Sarao V, et al. Drug safety evaluation of intravitreal triamcinolone acetonide[J]. Expert Opin Drug Saf, 2012, 11(2): 331-340. DOI: 10.1517/14740338.2012.635141.
8.	Matsuura K, Sasaki S, Uotani R. Successful treatment of prostaglandin-induced cystoid macular edema with subtenon triamcinolone[J]. Clin Ophthalmol, 2012, 6: 2105-2018. DOI: 10.2147/OPTH.S39542.
9.	Venkatesh P, Kumar CS, Abbas Z, et al. Comparison of the efficacy and safety of different methods of posterior subtenon injection[J]. Ocul Immunol Inflamm, 2008, 16(5): 217-223. DOI: 10.1080/09273940802209153.
10.	Smith RT, Campbell CJ, Koester CJ, et al. The barrier function in extracapsular cataract surgery[J]. Ophthalmology, 1990, 97(1): 90-95. DOI: 10.1016/s0161-6420(13)31411-0.
11.	Chu CJ, Johnston R, Buscombe C, et al. Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes[J]. Ophthalmology, 2016, 123(2): 316-323. DOI: 10.1016/j.ophtha.2015.10.001.
12.	Schmier JK, Halpern MT, Covert DW, er al. Evaluation of costs for cystoid macular edema among patients after cataract surgery[J]. Retina, 2007, 27(5): 621-628. DOI: 10.1097/01.iae.0000249577.92800.c0.
13.	Bélair ML, Kim SJ, Thorne JE, et al. Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography[J]. Am J Ophthalmol, 2009, 148(1): 128-135. DOI: 10.1080/15569527.2020.1734817.
14.	Thach AB, Dugel PU, Flindall RJ, et al. A comparison of retrobulbar versus sub-Tenon's corticosteroid therapy for cystoid macular edema refractory to topical medications[J]. Ophthalmology, 1997, 104(12): 2003-2008. DOI: 10.1016/s0161-6420(97)30065-7.
15.	Jonas JB, Söfker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema[J]. Am J Ophthalmol, 2001, 132(3): 425-427. DOI: 10.1016/s0002-9394(01)01010-8.
16.	Dang Y, Mu Y, Li L, et al. Comparison of dexamethasone intravitreal implant and intravitreal triamcinolone acetonide for the treatment of pseudophakic cystoid macular edema in diabetic patients[J]. Drug Des Devel Ther, 2014, 8: 1441-1449. DOI: 10.2147/DDDT.S66611.
17.	Liu X, Li Y, Zhang Y, et al. Comparison of intraocular pressure elevation after anterior versus posterior subtenon triamcinolone acetonide acetate injection: a retrospective study[J]. Retina, 2012, 32(9): 1838-1843. DOI: 10.1097/IAE.0b013e31824fd384.
18.	Bellocq D, Korobelnik JF, Burillon C, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study[J]. Br J Ophthalmol, 2015, 99(7): 979-983. DOI: 10.1136/bjophthalmol-2014-306159.
19.	Spitzer MS, Ziemssen F, Yoeruek E, et al. Efficacy of intravitreal bevacizumab in treating postoperative pseudophakic cystoid macular edema[J]. J Cataract Refract Surg, 2008, 34(1): 70-75. DOI: 10.1016/j.jcrs.2007.08.021.
20.	Barone A, Russo V, Prascina F, et al. Short-term safety and efficacy of intravitreal bevacizumab for pseudophakic cystoid macular edema[J]. Retina, 2009, 29(1): 33-37. DOI: 10.1097/IAE.0b013e31818a1fbc.
21.	Marmor MF, Maack T. Enhancement of retinal adhesion and subretinal fluid resorption by acetazolamide[J]. Invest Ophthalmol Vis Sci, 1982, 23(1): 121-124.
22.	Catier A, Tadayoni R, Massin P, et al. Advantages of acetazolamide associated with anti-inflammatory medications in postoperative treatment of macular edema[J]. J Fr Ophtalmol, 2005, 28(10): 1027-1031. DOI: 10.1016/s0181-5512(05)81134-9.
23.	Schalnus R. Topical nonsteroidal anti-inflammatory therapy in ophthalmology[J]. Ophthalmologica, 2003, 217(2): 89-98. DOI: 10.1159/000068563.
24.	Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology[J]. Surv Ophthalmol, 2010, 55(2): 108-133. DOI: 10.1016/j.survophthal.2009.07.005.
25.	Miyake K, Ota I, Ibaraki N, et al. Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia[J]. Arch Ophthalmol, 2001, 119(3): 387-394. DOI: 10.1001/archopht.119.3.387.
26.	Miyake K, Ota I, Maekubo K, et al. Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias[J]. Arch Ophthalmol, 1999, 117(1): 34-40. DOI: 10.1001/archopht.117.1.34.
27.	Miyanaga M, Miyai T, Nejima R, et al. Effect of bromfenac ophthalmic solution on ocular inflammation following cataract surgery[J]. Acta Ophthalmol, 2009, 87(3): 300-305. DOI: 10.1111/j.1755-3768.2008.01433.x.
28.	Sivaprasad S, Bunce C, Crosby-Nwaobi R. Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery[CD]. Cochrane Database Syst Rev, 2012(2): CD004239. DOI: 10.1002/14651858.CD004239.pub3.

1. Wielders LH, Lambermont VA, Schouten JS, et al. Prevention of cystoid macular edema after cataract surgery in nondiabetic and diabetic patients: a systematic review and meta-analysis[J]. Am J Ophthalmol, 2015, 160(5): 968-981. DOI: 10.1016/j.ajo.2015.07.032.
2. Henderson BA, Kim JY, Ament CS, et al. Clinical pseudophakic cystoid macular edema: risk factors for development and duration after treatment[J]. Cataract Refract Surg, 2007, 33(9): 1550-1558. DOI: 10.1016/j.jcrs.2007.05.013.
3. Bradford JD, Wilkinson CP, Bradford RH Jr. Cystoid macular edema following extracapsular cataract extraction and posterior chamber intraocular lens implantation[J]. Retina, 1988, 8(3): 161-164. DOI: 10.1097/00006982-198808030-00001.
4. Rothova A. Inflammatory cystoid macular edema[J]. Curr Opin Ophthalmol, 2007, 18(6): 487-492. DOI: 10.1097/ICU.0b013e3282f03d2e.
5. Conway MD, Canakis C, Livir-Rallatos C, et al. Intravitreal triamcinolone acetonide for refractory chronic pseudophakic cystoid macular edema[J]. Cataract Refract Surg, 2003, 29(1): 27-33. DOI: 10.1016/s0886-3350(02)01441-4.
6. Benhamou N, Massin P, Haouchine B, et al. Intravitreal riamcinolone for refractory pseudophakic macular edema[J]. Am J Ophthalmol, 2003, 135(2): 246-249. DOI: 10.1016/s0002-9394(02)01938-4.
7. Veritti D, Di Giulio A, Sarao V, et al. Drug safety evaluation of intravitreal triamcinolone acetonide[J]. Expert Opin Drug Saf, 2012, 11(2): 331-340. DOI: 10.1517/14740338.2012.635141.
8. Matsuura K, Sasaki S, Uotani R. Successful treatment of prostaglandin-induced cystoid macular edema with subtenon triamcinolone[J]. Clin Ophthalmol, 2012, 6: 2105-2018. DOI: 10.2147/OPTH.S39542.
9. Venkatesh P, Kumar CS, Abbas Z, et al. Comparison of the efficacy and safety of different methods of posterior subtenon injection[J]. Ocul Immunol Inflamm, 2008, 16(5): 217-223. DOI: 10.1080/09273940802209153.
10. Smith RT, Campbell CJ, Koester CJ, et al. The barrier function in extracapsular cataract surgery[J]. Ophthalmology, 1990, 97(1): 90-95. DOI: 10.1016/s0161-6420(13)31411-0.
11. Chu CJ, Johnston R, Buscombe C, et al. Risk factors and incidence of macular edema after cataract surgery: a database study of 81984 eyes[J]. Ophthalmology, 2016, 123(2): 316-323. DOI: 10.1016/j.ophtha.2015.10.001.
12. Schmier JK, Halpern MT, Covert DW, er al. Evaluation of costs for cystoid macular edema among patients after cataract surgery[J]. Retina, 2007, 27(5): 621-628. DOI: 10.1097/01.iae.0000249577.92800.c0.
13. Bélair ML, Kim SJ, Thorne JE, et al. Incidence of cystoid macular edema after cataract surgery in patients with and without uveitis using optical coherence tomography[J]. Am J Ophthalmol, 2009, 148(1): 128-135. DOI: 10.1080/15569527.2020.1734817.
14. Thach AB, Dugel PU, Flindall RJ, et al. A comparison of retrobulbar versus sub-Tenon's corticosteroid therapy for cystoid macular edema refractory to topical medications[J]. Ophthalmology, 1997, 104(12): 2003-2008. DOI: 10.1016/s0161-6420(97)30065-7.
15. Jonas JB, Söfker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema[J]. Am J Ophthalmol, 2001, 132(3): 425-427. DOI: 10.1016/s0002-9394(01)01010-8.
16. Dang Y, Mu Y, Li L, et al. Comparison of dexamethasone intravitreal implant and intravitreal triamcinolone acetonide for the treatment of pseudophakic cystoid macular edema in diabetic patients[J]. Drug Des Devel Ther, 2014, 8: 1441-1449. DOI: 10.2147/DDDT.S66611.
17. Liu X, Li Y, Zhang Y, et al. Comparison of intraocular pressure elevation after anterior versus posterior subtenon triamcinolone acetonide acetate injection: a retrospective study[J]. Retina, 2012, 32(9): 1838-1843. DOI: 10.1097/IAE.0b013e31824fd384.
18. Bellocq D, Korobelnik JF, Burillon C, et al. Effectiveness and safety of dexamethasone implants for post-surgical macular oedema including Irvine-Gass syndrome: the EPISODIC study[J]. Br J Ophthalmol, 2015, 99(7): 979-983. DOI: 10.1136/bjophthalmol-2014-306159.
19. Spitzer MS, Ziemssen F, Yoeruek E, et al. Efficacy of intravitreal bevacizumab in treating postoperative pseudophakic cystoid macular edema[J]. J Cataract Refract Surg, 2008, 34(1): 70-75. DOI: 10.1016/j.jcrs.2007.08.021.
20. Barone A, Russo V, Prascina F, et al. Short-term safety and efficacy of intravitreal bevacizumab for pseudophakic cystoid macular edema[J]. Retina, 2009, 29(1): 33-37. DOI: 10.1097/IAE.0b013e31818a1fbc.
21. Marmor MF, Maack T. Enhancement of retinal adhesion and subretinal fluid resorption by acetazolamide[J]. Invest Ophthalmol Vis Sci, 1982, 23(1): 121-124.
22. Catier A, Tadayoni R, Massin P, et al. Advantages of acetazolamide associated with anti-inflammatory medications in postoperative treatment of macular edema[J]. J Fr Ophtalmol, 2005, 28(10): 1027-1031. DOI: 10.1016/s0181-5512(05)81134-9.
23. Schalnus R. Topical nonsteroidal anti-inflammatory therapy in ophthalmology[J]. Ophthalmologica, 2003, 217(2): 89-98. DOI: 10.1159/000068563.
24. Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology[J]. Surv Ophthalmol, 2010, 55(2): 108-133. DOI: 10.1016/j.survophthal.2009.07.005.
25. Miyake K, Ota I, Ibaraki N, et al. Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia[J]. Arch Ophthalmol, 2001, 119(3): 387-394. DOI: 10.1001/archopht.119.3.387.
26. Miyake K, Ota I, Maekubo K, et al. Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias[J]. Arch Ophthalmol, 1999, 117(1): 34-40. DOI: 10.1001/archopht.117.1.34.
27. Miyanaga M, Miyai T, Nejima R, et al. Effect of bromfenac ophthalmic solution on ocular inflammation following cataract surgery[J]. Acta Ophthalmol, 2009, 87(3): 300-305. DOI: 10.1111/j.1755-3768.2008.01433.x.
28. Sivaprasad S, Bunce C, Crosby-Nwaobi R. Non-steroidal anti-inflammatory agents for treating cystoid macular oedema following cataract surgery[CD]. Cochrane Database Syst Rev, 2012(2): CD004239. DOI: 10.1002/14651858.CD004239.pub3.

Chinese Journal of Ocular Fundus Diseases

Short-term efficacy of sub-Tenon's injection of triamcinolone acetonide for cystoid macular edema after cataract surgery

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