Short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide in macular edema due to ischemic retinal vein occlusions_Chinese Journal of Ocular Fundus Diseases

Authors：

ChuMengqi , MaoJianbo , ZhuSha , ChenYiqi , WuSulan , ZhangYun , TaoJiwei , ZhaoShixin ,  ShenLijun

The Affiliated Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou 310020, China;

Corresponding author：

ShenLijun, Email: 13868302929@139.com

Keywords：

Retinal vein occlusion/drug therapy; Macular edema/drug therapy; Triamcinolone acetonide/therapeutic use

DOI：

10.3760/cma.j.issn.1005-1015.2016.05.015

Video：

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Objective To observe the short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide (PSTA) in the treatment of macular edema due to ischemic retinal vein occlusions (RVO). Methods A retrospective clinical study. A total of 53 eyes of 53 patients with RVO macular edema diagnosed by fundus color photography, fundus fluorescein angiography and optical coherence tomography (OCT) were included in the study. The best corrected visual acuity (BCVA) was detected by the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The central macular thickness (CMT) was measured by OCT. Among 53 eyes, there were 27 eyes with ischemic RVO macular edema (ischemic group) and 26 eyes with non-ischemic RVO macular edema (non-ischemic group). The mean logMAR BCVA was 0.82±0.37, mean CMT was (662.1±216.7) μm in ischemic group. The mean logMAR BCVA was 0.41±0.23, mean CMT was (548.0±161.9) μm. The differences of logMAR BCVA and CMT between the two groups were both statistically significant (t=4.745, 2.258; P<0.05). All eyes were treated with a single sub-Tenon injection of 0.4 ml triamcinolone acetonide suspension (100 mg/ml).The mean logMAR BCVA, CMT before and 1, 3 months after the treatment between the two groups were observed and compared. Results On 1 and 3 months after treatment, the mean logMAR BCVA in the non-ischemic group (0.32±0.25 and 0.27±0.29) were improved compared with ischemic group (0.76±0.37 and 0.41±0.79), the difference was statistically significant (t=5.052, 5.240; P<0.05). The mean logMAR BCVA before and after treatment had no statistically significant difference in ischemic group (F=0.516, P>0.05), but had a statistically significant difference in non-ischemic group (F=7.685, P<0.05). On 1 and 3 months after treatment, the mean CMT in the ischemic group were (534.7±223.4), (470.8±234.7) μm, which were lower (127.4±28.28), (191.4±34.55) μm before treatment. In the non-ischemic group, the average CMT was (426.2±188.8), (371.3±200.6) μm, which were lower (103.1±33.1), (164.9±49.6) μm. There were statistically significant differences in the mean CMT between the ischemic group and the non-ischemic group (F=17.040, 10.360; P<0.05). In non-ischemic group, CMT had a bigger reduction compared to the the ischemic group (t=2.056, 2.103; P<0.05). The difference of CMT decrease value between two groups was not statistically significant (t=0.560, 0.441; P>0.05). On 1 month after the treatment, there were 3 and 5 eyes had a higher intraocular pressure than 21 mmHg (1 mmHg=0.133 kPa) in ischemic and non-ischemic group, respectively; but all of them returned to normal after drug treatment. There were no drugs and ocular injection related complications. Conclusion PSTA of ischemic RVO macular edema can lower the CMT in the short term, but can't significant improve the visual acuity.

Citation： ChuMengqi, MaoJianbo, ZhuSha, ChenYiqi, WuSulan, ZhangYun, TaoJiwei, ZhaoShixin, ShenLijun. Short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide in macular edema due to ischemic retinal vein occlusions. Chinese Journal of Ocular Fundus Diseases, 2016, 32(5): 522-526. doi: 10.3760/cma.j.issn.1005-1015.2016.05.015 Copy

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17.	毛剑波, 褚梦琪, 陈亦棋, 等. 玻璃体腔注射康柏西普治疗视网膜静脉阻塞黄斑水肿短期疗效观察[J]. 中华眼底病杂志, 2016, 32(4):372-376. DOI:10.3760/cma.j.issn.1005-1015.2016.04. Mao JB,Chu MQ,Chen YQ, et al.The efficacy of intravitreal conbercept for macular edema secondary to retinal vein occlusion[J]. Chin J Ocul Fundus Dis, 2016, 32(4):372-376. DOI:10.3760/cma.j.issn.1005-1015.2016.04.
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19.	Byun YS, Park YH.Complications and safety profile of posterior subtenon injection of triamcinolone acetonide[J].J Ocul Pharmacol Ther, 2009,25(2):159-162. DOI:10.1089/jop.2008.0087.
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1. The Central Vein Occlusion Study Group. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion[J].Ophthalmology,1995,102(10):1425-1433.
2. Brown DM, Campochiaro PA, Bhisitkul RB,et al.Sustained benefits from ranibizumab for macular edema following branch retinal vein occlusion:12-month outcomes of a phase Ⅲ study[J].Ophthalmology, 2011,118(8):1594-1602.DOI:10.1016/j.ophtha.2011.02.022.
3. Brown D, Heier JS, ClARK JL,et al. Intravitreal aflibercept injection for macular edema secondary to central retinal vein occlusion:1-year results from the phase 3 copernicus study[J].Am J Ophthalmol, 2013,155(3):429-437. DOI:10.1016/j.ajo.2012.09.026.
4. Campochiaro PA, Clark WL, Boyer DS, et al. Intravitreal aflibercept for macular edema following branch retinal vein occlusion:the 24-week results of the VIBRANT Study[J]. Ophthalmology, 2015,122(3):538-544. DOI:10.1016/j.ophtha.2014.08.031.
5. 王雯秋, 王泓,姜媛,等. 玻璃体腔内注射Bevacizumab联合眼底激光治疗视网膜静脉阻塞继发黄斑水肿的临床观察[J]. 中华眼视光学与视觉科学杂志, 2012, 14(2):90-94. DOI:10.3760/cma.issn.1674-845X.2012.02.007. Wang WQ, Wang H, Jiang Y, et al. Clinical observation of intravitreal Bevacizumab combined with laser photocoagulation for treatment of macular edema secondary to retinal vein occlusion[J]. Chin J Optom Ophthalmol Vis Sci, 2012,14(2):90-94. DOI:10.3760/cma.issn.1674-845X.2012.02.007.
6. Scott IU, Ip MS, VanVeldhuisen PC, et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with standard care to treat vision loss associated with macular Edema secondary to branch retinal vein occlusion:the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 6[J].Arch Ophthalmol, 2009,127(9):1115-1128. DOI:10.1001/archophthalmol.2009.233.
7. Ip MS,Scott IU,VanVeldhuisen PC,et al. A randomized trial comparing the efficacy and safety of intravitreal triamcinolone with observation to treat vision loss associated with macular edema secondary to central retinal vein occlusion:the Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study report 5[J].Arch Ophthalmol, 2009,127(9):1101-1114. DOI:10.1001/archophthalmol.2009,234.
8. Haller JA, Bandello F, Belfort R Jr,et al.Randomized,sham-controlled trial of dexamethasone intravitreal implant in patients with macular edema due to retinal vein occlusion[J]. Ophthalmology, 2010,117(6):1134-1146.DOI:10.1016/j.ophtha.2010.03.032.
9. DeCroos FC, Shuler RK Jr, Stinnett S,et al. Pars plana vitrectomy, internal limiting membrane peeling, and panretinal endophotocoagulation for macular edema secondary to central retinal vein occlusion[J].Am J Ophthalmol, 2009,147(4):627-633. DOI:10.1016/j.ajo.2008.10.024.
10. Noma H, Funatsu H, Mimura T, et al. Macular sensitivity and morphology after intravitreal injection of triamcinolone acetonide for macular edema with branch retinal vein occlusion[J].Retina,2012,32(9):1844-1852. DOI:10.1097/IAE.0b013e318259569f.
11. Mehmet D,Burcu D,Zeynep A,et al.Comparison of the effects of intravitreal bevacizumab and triamcinolone acetonide in the treatment of macular edema secondary to central retinal vein occlusion[J]. Indian J Ophthalmol, 2014,62(3):279-283.DOI:10.4103/0301-4738.105769.
12. Gurram MM. Effect of posterior sub-tenon triamcinolone in macular edema due to non-ischemic vein occlusions[J].J Clin Diagn Res, 2013,7(12):2821-2824. DOI:10.7860/JCDR/2013/6473.3766.
13. Timothy L, Jackson M. Manual of ophthalmology[M].Elsevier Science Health Science div,2011:471-474.
14. Brown DM,Wykoff CC,Wong TP,et al.Ranibizumab in preproliferative (ischemic) central retinal vein occlusion:the rubeosis anti-VEGF (RAVE) trial[J].Retina, 2014,34(9):1728-1735. DOI:10.1097/IAE.0000000000000191.
15. 王彬, 贾淑琴,霍建新.视网膜静脉阻塞的诊断与治疗研究进展[J].国际眼科杂志,2014,7(14):1227-1230. DOI:10.3980/j.issn.1672-5123.2014.07.13. Wang B, Jia SQ, Huo JX. Research progress of the diagnosis and treatment for retinal vein occlusion[J]. Int Eye Sci, 2014,7(14):1227-1230.DOI:10.3980/j.issn.1672-5123.2014.07.13.
16. 胡恩海, 刘庆淮.TA不同给药方式治疗黄斑水肿的临床疗效观察[J].中国眼耳鼻喉科杂志,2011,11(2):92-94.DOI:10.3969/j.issn.1671-2420.2011.02.010. Hu EH, Liu QH. Clinical effects of intravitreal injection and posterior sub-tenon injection of triamcinolone acetonide on the treatment of macular edema[J]. Chin J Ophthalmol and Otorhinolaryngol,2011,11(2):92-94. DOI:10.3969/j.issn.1671-2420.2011.02.010.
17. 毛剑波, 褚梦琪, 陈亦棋, 等. 玻璃体腔注射康柏西普治疗视网膜静脉阻塞黄斑水肿短期疗效观察[J]. 中华眼底病杂志, 2016, 32(4):372-376. DOI:10.3760/cma.j.issn.1005-1015.2016.04. Mao JB,Chu MQ,Chen YQ, et al.The efficacy of intravitreal conbercept for macular edema secondary to retinal vein occlusion[J]. Chin J Ocul Fundus Dis, 2016, 32(4):372-376. DOI:10.3760/cma.j.issn.1005-1015.2016.04.
18. Lin JM, Chiu YT, Hung PT,et al. Early treatment of severe cystoid macular edema in central retinal vein occlusion with posterior sub-tenon triamcinolone acetonide[J].Retina, 2007,27(2):180-189. DOI:10.1097/01.iae.0000237584.56552.1c.
19. Byun YS, Park YH.Complications and safety profile of posterior subtenon injection of triamcinolone acetonide[J].J Ocul Pharmacol Ther, 2009,25(2):159-162. DOI:10.1089/jop.2008.0087.
20. Iwao K, Inatani M, Kawaji T,et al. Frequency and risk factors for intraocular pressure elevation after posterior sub-Tenon capsule triamcinolone acetonide injection[J].J Glaucoma, 2007, 16(2):251-256.DOI:10.1097/IJG.0b013e31802d696f.

Chinese Journal of Ocular Fundus Diseases

Short-term efficacy of posterior sub-tenon injection of triamcinolone acetonide in macular edema due to ischemic retinal vein occlusions

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