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Kim and Moon: Prognostic Factors after Intravitreal Triamcinolone Injection for Macular Edema due to Branch Retinal Vein Occlusion
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(1): 49-58.

Published online: 16 January 2012

DOI: https://doi.org/10.3341/jkos.2012.53.1.49

Prognostic Factors after Intravitreal Triamcinolone Injection for Macular Edema due to Branch Retinal Vein Occlusion

Suk Jin Kim, MD, Yeon Sung Moon, MD, PhD

Department of Ophthalmology, Inha University School of Medicine, Incheon, Korea.

Address reprint requests to Yeon Sung Moon, MD, PhD. Department of Ophthalmology, Inha University Hospital, #7-206 Sinheung-dong 3-ga, Jung-gu, Incheon 400-711, Korea. Tel: 82-32-890-2408, Fax: 82-32-890-2403, drmys@inha.ac.kr

Received 8 June 2011       Accepted 17 November 2011

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To evaluate prognostic factors for improvement of visual acuity after intravitreal triamcinolone acetonide injection (IVTA) for treatment of macular edema (ME) secondary to branch retinal vein occlusion (BRVO).

Methods

Sixty-eight eyes of 68 consecutive patients treated with IVTA for ME due to BRVO were retrospectively reviewed. Patients were categorized into 2 groups according to the final visual acuity. The 'gainer group' consisted of eyes with a gain of 2 or more Snellen chart lines and the 'non-gainer group' consisted of eyes with less than 2 lines improvement or which had worsened at the last follow-up visit. Comparative clinical characteristics and ophthalmoscopic examinations were analyzed between the 2 groups.

Results

Out of the 68 eyes, 38 (56%) showed improved vision and were categorized as the gainer group; 30 eyes (44%) were categorized as the non-gainer group. The duration of symptoms in the non-gainer group was longer than the gainer group. Additionally, patients with a better baseline vision were expected to show greater improvement. The number of early visual acuity gainers who showed visual improvement at 1 month after IVTA was significantly higher in the gainer group. The number of eyes with angiographically documented macular ischemia was significantly higher in the non-gainer group. Existence of subretinal fluid has been identified as a positive factor for visual improvement.

Conclusions

The cases with early treatment, good baseline visual acuity, case of favorable response to the initial IVTA, absence of macular ischemia, and baseline subretinal fluid are favorable prognostic factors for the outcome of visual acuity after IVTA for ME due to BRVO.

Keywords: Branch retinal vein occlusion, Grid photocoagulation, Intravitreal triamcinolone acetonide injection, Macular edema

Figures and Tables

Figure 1
Parameters evaluated in baseline OCT scans. (A) Height of Subretinal fluid (SRF). (B)Maximum horizontal diameter of intraretinal cystoid spaces (ICS).
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Figure 2
Changes in logMAR visual acuity after treatment. Within each treatment group, pairwise comparisons revealed significant improvement in visual acuity at each follow-up visit in gainer group (all p < 0.001), whereas a significant change in visual acuity was observed only at post-treatment 2 months in the non-gainer group (p = 0.001). In both groups, the average visual acuity showed improvement at 2 weeks; however, at one month, the tendency toward improved was maintained in the gainer group, and visual acuity showed a slight worsening in the non-gainer group. The asterisk (*) indicates a statistically significant difference within groups (*p < 0.05).
jkos-53-49-g002
Figure 3
Changes in central macular thickness after treatment. The baseline central macular thickness (mean ± SD) was 480.3 ± 181.0 µm in the gainer group and 519.4 ± 138.3 µm in the non-gainer group (p = 0.332). Within each treatment group, pairwise comparisons revealed significant reductions in central macular thicknesses at all time points in both treatment groups (p < 0.05). In both groups, the average central macular thickness showed a gradual decrease afterward at all time points and the mean changes were 247.4 ± 29.5 µm in the gainer group and 165.0 ± 187.2 µm in the non-gainer group at the last follow-up visit.
jkos-53-49-g003
Table 1
Patients' baseline characteristics
jkos-53-49-i001

Values are mean ± SD or number (%).

SD = standard deviation; HTN = hypertension; V/A = visual acuity; CMT = central macular thickness; IOP = intraocular pressure; IVTA = intravitreal triamcinolone acetonide.

*Student's t-test, †Chi-square test, ‡Fischer's exact test; §from onset of symptoms to the date of first IVTA; ∥from the date after the first IVTA, #Statistically significant result (p < 0.05).

Table 2
Changes of visual acuity (log MAR) and central macular thickness after treatment
jkos-53-49-i002

SD = standard deviation.

*Baseline vs. follow up measures within a group; paired t-test, significance level 0.05; †Gainer group vs. non-gainer group comparing change vs. baseline values; Student t-test, significance level 0.05, ‡Statistically significant result (p < 0.05).

Table 3
Evaluation of prognostic factors for visual outcome between the 2 groups
jkos-53-49-i003

Values are number (%) or mean ± SD.

SD = standard deviation; IOP = intraocular pressure; OCT = optical coherence tomography; SRF = subretinal fluid; ICS=intraretinal cystoids spaces. *Fischer's exact test; †Chi-square test; ‡Student's t-test, §Statistically significant result (p<0.05).

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