Effectiveness of Intravitreal Preservative-free Triamcinolone Injection for Refractory Macular Edema Secondary to Retinal Vein Occlusion

Chang Hwan Lee; Moo Hwan Jang; Young Seung Seo

doi:10.3341/jkos.2018.59.8.730

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Lee, Jang, and Seo: Effectiveness of Intravitreal Preservative-free Triamcinolone Injection for Refractory Macular Edema Secondary to Retinal Vein Occlusion

Original Article

J Korean Ophthalmol Soc 2018;59(8):730-737.

Published online: 25 September 2018

DOI: https://doi.org/10.3341/jkos.2018.59.8.730

Effectiveness of Intravitreal Preservative-free Triamcinolone Injection for Refractory Macular Edema Secondary to Retinal Vein Occlusion

Chang Hwan Lee, MD, Moo Hwan Jang, MD, PhD, Young Seung Seo, MD, PhD

Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea

Address reprint requests to Young Seung Seo, MD, PhD Department of Ophthalmology, Dankook University Hospital, #201 Manghyang-ro, Dongnam-gu, Cheonan 31116, Korea Tel: 82-41-550-6497, Fax: 82-41-550-7050 E-mail: mailcarr@naver.com

Received 29 March 2018 Revised 17 May 2018 Accepted 19 July 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of intravitreal preservative-free triamcinolone acetonide (Maqaid^®) injection for the treatment of macular edema secondary to retinal vein occlusion (RVO) refractory to intravitreal bevacizumab injections.

Methods

This retrospective, observational study included 17 eyes of 17 patients with refractory macular edema secondary to RVO. The patients with macular edema unresponsive to intravitreal bevacizumab injections were treated with intravitreal preser-vative-free triamcinolone acetonide (Maqaid^®) injection. Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) based on optical coherence tomography were evaluated before intravitreal triamcinolone injection (IVTA), 1 month and 3 months after IVTA injection. intraocular pressure (IOP) changes were analyzed up to 6 months.

Results

The logarithm of the minimal angle of resolution (logMAR) BCVA was decreased from 0.56 ± 0.32 to 0.41 ± 0.32 after 1 month with statistical significance (p = 0.006) and to 0.47 ± 0.36 after 3 months of IVTA without statistical significance (p = 0.204). CFT was significantly improved from 474.82 ± 91.91 μ m to 262.58 ± 60.11 μ m after 1 month and to 339.58 ± 152.48 μ m after 3 months of IVTA injection (p ≤ 0.001 and 0.005, respectively). IOP was significantly increased from 13.11 ± 2.66 mmHg to 16.64 ± 5.66 mmHg after 1 month and to 17.05 ± 7.21 μ m after 3 months of IVTA injection (p = 0.024 and 0.026, respectively). Treatment-associated IOP elevation was manageable with antiglaucoma medications. IOP was 15.13 ± 3.90 mmHg after 6 months of IVTA injection (p = 0.023).

Conclusions

Intravitreal preservative-free triamcinolone (Maqaid^®) Injection improves BCVA and reduces CFT in some patients with macular edema secondary to RVO refractory to intravitreal bevacizumab therapy. There were no serious vision-threatening complications associated with intravitreal preservative-free triamcinolone (Maqaid^®) therapy during the study period. Intravitreal preservative-free triamcinolone (Maqaid^®) could be considered as a treatment option for refractory macular edema associated with RVO.

Keywords: Intraocular pressure, Intravitreal injection, Macular edema, Preservative-free triamcinolone, Retinal vein occlusion

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Figure 1.

Changes in logarithm of the minimal angle of resolution best-corrected visual acuity and central foveal thickness in eyes with macular edema secondary to retinal vein occlusion. Measurements were made at diagnosis (baseline), before intravitreal triamcinolone injection (IVTA) which is after intravitreal bevacizumab injections, 1 month after IVTA, and 3 months after IVTA. (A) Although the visual acuity was significantly improved 1 month after IVTA, no statistical significance was found 3 months after IVTA. (B) The central foveal thickness was significantly improved after IVTA (Wilcoxon signed-rank test).

Figure 2.

Changes in intraocular pressure in eyes with macular edema secondary to retinal vein occlusion. Measurements were made at diagnosis (baseline), before intravitreal triamcinolone injection (IVTA) which is after intravitreal bevacizumab injections, 1 month after IVTA, 3 months after IVTA, and 6 months after IVTA. The intraocular pressure was significantly increased after IVTA (Wilcoxon signed-rank test).

Figure 3.

Optical coherence tomography (OCT) images of an eye diagnosed with refractory macular edema secondary to central retinal vein occlusion. (A) Compared to baseline. (B) Macular edema remained after 2 consecutive intravitreal bevacizumab injections. (C) A marked decrease in macular edema was noted 1 month after an intravitreal injection of triamcinolone. (D) OCT showed a flat macula without macular edema 3 month after an intravitreal injection of triamcinolone.

Table 1.

Baseline characteristics of patients with macular edema secondary to retinal vein occlusion that was refractory to intravitreal bevacizumab therapy (n = 17 eyes)

	Data
Age (years)	64.9 ± 11.9
Gender (male:female)	10:7
Classification
Branch RVO (n, %)	13 (76.4)
Central RVO (n, %)	4 (23.6)
Type
Non-ischemic type	10
Ischemic type	7
Baseline BCVA (logMAR)	0.57 ± 0.38
Mean baseline CFT (μ m)^*	585.64 ± 154.69
Baseline IOP (mmHg)	12.88 ± 3.68
BCVA (logMAR) before IVTA	0.56 ± 0.32
Mean CFT (μ m) before IVTA^†	474.82 ± 91.91
IOP before IVTA	13.11 ± 2.66
Phakic (n, %)	12 (70.5)
Number of bevacizumab injections before IVTA (N)	1.82 ± 1.07
Time from IVBI to IVTA (week)	16.58 ± 9.10

Values are presented as mean ± standard deviation (SD) or n (%) unless otherwise indicated.

RVO = retinal vein occlusion; BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; CFT = central foveal thickness; IOP = intraocular pressure; IVTA = intravitreal triamcinolone injection; IVBI = intravitreal bevacizumab injection.

^* Mean baseline CFT ± SD (μ m) before intravitreal bevacizumab injection

^† Mean CFT ± SD (μ m) just before IVTA.

Table 2.

Changes in logarithm of central foveal thickness and the minimal angle of resolution best-corrected visual acuity and intraocular pressure in eyes with macular edema secondary to branch retinal vein occlusion (n = 13 eyes)

	BCVA (logMAR)	p-value^*	CFT (μ m)	p-value^*	IOP (mmHg)	p-value^*
Baseline	0.61 ± 0.38		597.07 ± 169.15		11.69 ± 2.81
Before IVTA	0.50 ± 0.29		474.92 ± 95.20		12.69 ± 2.52
1 M after IVTA	0.37 ± 0.28	0.010	263.61 ± 66.50	0.001	16.69 ± 5.83	0.039
3 M after IVTA	0.42 ± 0.33	0.197	371.46 ± 160.84	0.023	15.23 ± 6.15	0.178
6 M after IVTA					15.00 ± 3.83	0.021

BCVA = best corrected visual acuity; logMAR = logarithm of the minimum angle of resolution; CFT = central foveal thickness; IOP = intraocular pressure; M = month; IVTA = intravitreal triamcinolone injection.

^* Wilcoxon signed-rank test.

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