Posterior Sub-Tenon Triamcinolone Injection for Chronic Macular Oedema Associated With Non-Ischemic Branch or Central Retinal Vein Occlusion

Authors

  • Hoai Viet Tran Jules Gonin University Eye Hospital, Lausanne, VD, Switzerland
  • Aude Ambresin Jules Gonin University Eye Hospital, Lausanne, VD, Switzerland
  • Jean-Antoine Pournaras Jules Gonin University Eye Hospital, Lausanne, VD, Switzerland
  • Thomas J. Wolfensberger Jules Gonin University Eye Hospital, Lausanne, VD, Switzerland

DOI:

https://doi.org/10.17140/OOJ-1-103

Keywords:

Branch/Central retinal vein occlusion; Chronic macular oedema; Triamcinolone; Posterior sub-Tenon injection

Abstract

Aims: To evaluate the effectiveness and safety of Posterior Sub-Tenon (PST) Triamcinolone
Acetonide (TA) injection for persistent macular oedema associated with non-ischemic Central
Retinal Vein Occlusion (CRVO) or Branch Retinal Vein Occlusion (BRVO) in non-vitrectomized eye.
Methods: Fourteen consecutive eyes of 14 patients characterized by macular oedema lasting
more than 3 months and with a visual acuity of less than 20/40 were enrolled. Six eyes presented with BRVO, 8 eyes with CRVO. PST injection of 40 mg TA was performed in topical
anaesthesia. All patients were phakic, and followed for at least 6 months. Snellen visual acuity
converted to LogMAR units and anatomic responses were evaluated before, and at 1, 3, 6, and
12 (if required) months after injections and re-injection considered.
Results: In the BRVO group, mean foveal thickness was 548.2±49.50 µm preoperatively,
and 452.8±56.2 µm and 280.8±62.5 µm at 1 and 12 month follow-up, respectively. Statistical
analysis showed significant differences between preoperative and postoperative measurements
(p<.05, paired t test) 3 months after injections. Improvement of visual acuity by at least 0.2
LogMAR was seen in 3(50%) of the 6 eyes. No re-injection was needed. In the CRVO group,
mean foveal thickness was 543.7±34.4 µm preoperatively, and 283.0±29.0 µm and 234.8±23.6
µm at 1 and 12 month follow-up, respectively. Statistical analysis showed significant differences between preoperative and postoperative measurements (p<.05, paired t test). Improvement
of visual acuity by at least 0.2 LogMAR was seen in 7 eyes (88%). Mean number of re-injection
was of 2.1±0.3. Intraocular pressure elevation of 22 mm Hg or higher was found in 2/14 eyes
(14%). Cataract progression was noted in 5/14 eyes (36%).
Conclusions: PST injection of TA appears to be as safe and effective treatment for chronic
macular oedema associated due to both non-ischemic BRVO or CRVO, with a better efficacy
in BRVO.

References

The Central Vein Occlusion Study Group. Evaluation of grid pattern photocoagulation for macular edema in central vein oc-clusion. The CVOS Group M Report. Ophthalmology. 1995; 102: 1425-1433. doi: 10.1016/S0161-6420(95)30849-4

Branch Vein Occlusion Study Group. Argon laser photoco-agulation for macular edema in branch vein occlusion. Am J Ophthalmol. 1984; 98: 271-282.

Yepremyan M, Wertz FD, Tivnan T, et al. Early treatment of cystoid macular edema secondary to branch retinal vein occlu-sion with intravitreal triamcinolone acetonide. Ophthalmic Surg Lasers Imaging. 2005; 36: 30-36.

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. Ophthalmology. 2011; 118: 1594-1602. doi: 10.1016/j.oph-tha.2011.02.022

Brown DM, Campochiaro PA, Singh RP, et al. Ranibizumab for macular edema following central retinal vein occlusion: six month primary end point results of a phase III study. Ophthalmol-ogy. 2010; 117: 1124-1133. doi: 10.1016/j.ophtha.2010.02.022

Shima C, Sakaguchi H, Gomi F, et al. Complications in pa-tients after intravitreal injection of bevacizumab. Acta Ophthal-mol. 2008; 86: 372-376. doi: 10.1111/j.1600-0420.2007.01067.x

Greenberg PB, Martidis A, Rogers AH, et al. Intravitreal tri-amcinolone acetonide for macular oedema due to central retinal vein occlusion. Br J Ophthalmol. 2002; 86: 247-248.

Ip MS, Gottlieb JL, Kahana A, et al. Intravitreal triamcino-lone for the treatment of macular edema associated with central retinal vein occlusion. Arch Ophthalmol. 2004; 122: 1131-1136. doi: 10.1001/archopht.122.8.1131

Wakabayashi T, Okada AA, Morimura Y, et al. Trans-tenon retrobulbar triamcinolone infusion for chronic macular edema in central and branch retinal vein occlusion. Retina. 2004; 24: 964-967.

Kawaji T, Hirata A, Awai N, et al. Trans-tenon retrobulbar tri-amcinolone injection for macular edema associated with branch retinal vein occlusion remaining after vitrectomy. Am J Ophthal-mol. 2005; 140: 540-542. doi: 10.1016/j.ajo.2005.02.056

Chylack LT Jr, Leske MC, McCarthy D, et al. Lens opacities classification system II (LOCS II). Arch Ophthalmol. 1989; 107: 991-997. doi: 10.1001/archopht.1989.01070020053028

Murakami T, Takagi H, Kita M, et al. Intravitreal tissue plas-minogen activator to treat macular edema associated with branch retinal vein occlusion. Am J Ophthalmol. 2006; 142: 318-320. doi: 10.1016/j.ajo.2006.02.039

Lahey JM, Fong DS, Kearney J. Intravitreal tissue plasmino-gen activator for acute central retinal vein occlusion. Ophthal-mic Surg Lasers. 1999; 30: 427-434. doi: 10.3928/1542-8877- 19990601-04

Opremcak EM, Bruce RA, Lomeo MD, et al. Radial optic neurotomy for central retinal vein occlusion: a retrospective pi-lot study of 11 consecutive cases. Retina. 2001; 21: 408-415.

Opremcak EM, Bruce RA. Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy: a prospective review of 15 cases. Retina. 1999; 19: 1-5.

Mandelcorn MS, Mandelcorn E, Guan K, et al. Surgical macular decompression for macular edema in retinal vein oc-clusion. Can J Ophthalmol. 2007; 42: 116-122. doi: 10.3129/ can.j.ophthalmol.06-091

McAllister IL, Douglas JP, Constable IJ, et al. Laser-induced chorioretinal venous anastomosis for nonischemic central retinal vein occlusion: evaluation of the complications and their risk factors. Am J Ophthalmol. 1998; 126: 219-229. doi: 10.1016/ S0002-9394(98)00156-1

Lee H, Shah GK. Intravitreal triamcinolone as primary treat-ment of cystoid macular edema secondary to branch retinal vein occlusion. Retina. 2005; 25: 551-555.

Moshfeghi DM, Kaiser PK, Scott IU, et al. Acute endo-phthalmitis following intravitreal triamcinolone acetonide in-jection. Am J Ophthalmol. 2003; 136: 791-796. doi: 10.1016/ S0002-9394(03)00483-5

Roth DB, Chieh J, Spirn MJ, et al. Noninfectious endo-phthalmitis associated with intravitreal triamcinolone injec-tion. Arch Ophthalmol. 2003; 121: 1279-1282. doi: 10.1001/ archopht.121.9.1279

Ozdek S, Deren YT, Gurelik G, et al. Posterior sub-tenon triamcinolone, intravitreal triamcinolone and grid laser pho-tocoagulation for the treatment of macular edema in branch retinal vein occlusion. Ophthalmic Res. 2008; 40: 26-31. doi: 10.1159/000111155

Thomas ER, Wang J, Ege E, et al. Intravitreal triamcinolone acetonide concentration after sub-tenon injection. Am J Oph-thalmol. 2006; 142: 860-861. doi: 10.1016/j.ajo.2006.05.023

Thach AB, Dugel PU, Flindall RJ, et al. A comparison of ret-robulbar versus sub-Tenon’s corticosteroid therapy for cystoid macular edema refractory to topical medications. Ophthalmolo-gy. 1997; 104: 2003-2008. doi: 10.1016/S0161-6420(97)30065-7

Bakri SJ, Beer PM. Intravitreal triamcinolone injection for diabetic macular edema: a clinical and fluorescein angiographic case series. Can J Ophthalmol. 2004; 39: 755-760.

Jennings T, Rusin MM, Tessler HH, et al. Posterior sub-ten-on’s injections of corticosteroids in uveitis patients with cystoid macular edema. Jpn J Ophthalmol. 1988; 32: 385-391.

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. Retina. 2007; 27: 180-189.

Kola M, Hacioglu D, Turk A, Erdol H. The effectiveness and reliability of posterior sub-Tenon triamcinolone acetonide injec-tion in branch retinal vein occlusion-relatedmacular edema.Cutan Ocul Toxicol. 2015; 1-5. doi: 10.3109/15569527.2015.1074586

Gurram MM. Effect of posterior sub-tenon triamcinolone in macular edema due to non-ischemic vein occlusions. J Clin Diagn Res. 2013; 7: 2821-2824. doi: 10.7860/JCDR/2013/6473.3766

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Published

2015-12-04

How to Cite

Hoai Viet Tran, Aude Ambresin, Jean-Antoine Pournaras, & Thomas J. Wolfensberger. (2015). Posterior Sub-Tenon Triamcinolone Injection for Chronic Macular Oedema Associated With Non-Ischemic Branch or Central Retinal Vein Occlusion. The Ophthalmology, 9–14. https://doi.org/10.17140/OOJ-1-103

Issue

Volume 1 Issue 1 2015

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