Rebound Phenomenon after Intravitreal Injection of Triamcinolone Acetonide for Macular Edema

2020 ◽  
Vol 243 (6) ◽  
pp. 420-425
Author(s):  
Ozlem Dikmetas ◽  
Laura Kuehlewein ◽  
Faik Gelisken
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Retinal Thickness ◽  
Vascular Endothelial ◽  
Intravitreal Triamcinolone ◽  
Vein Occlusion ◽  
Factor Inhibitor ◽  
Rebound Phenomenon ◽  
The Mean ◽  
Endothelial Growth Factor

<b><i>Introduction:</i></b> The aim of this article was to report on a rebound phenomenon after intravitreal triamcinolone acetonide (IVTA) injection for macular edema secondary to diabetic retinopathy (DR) and central or branch retinal vein occlusion (CRVO/BRVO). <b><i>Methods:</i></b> The data were analyzed retrospectively. Complete ophthalmic examinations, including spectral domain optical coherence tomography, were performed before and 2 months after IVTA injection. The incidence of a rebound phenomenon was defined as an increase in central retinal thickness of &#x3e;10% from baseline at 2 months after IVTA injection. <b><i>Results:</i></b> This retrospective study included 211 consecutive patients (268 eyes). One hundred ninety (71.2%), 39 (14.6%), and 39 (14.6%) eyes had macular edema (ME) due to DR, CRVO, and BRVO. In total, 9.7% of the eyes showed a rebound phenomenon (DR: 9.5%, CRVO: 5.2%, BRVO: 15.4%). The mean number of prior injections of vascular endothelial growth factor inhibitor or corticosteroid agent was statistically significantly higher in the rebound group (6.8 vs. 5.3) than in the nonrebound group (<i>p</i> = 0.01). <b><i>Conclusion:</i></b> Our study shows that 9.7% of the eyes with ME secondary to DR and RVO developed a rebound phenomenon following IVTA injection, limiting its therapeutic effect. We found an increased number of prior intravitreal pharmacotherapy to be a risk factor for a rebound phenomenon.

scholarly journals Effects of Switching from Anti-VEGF Treatment to Triamcinolone Acetonide in Eyes with Refractory Macular Edema Associated with Diabetic Retinopathy or Retinal Vein Occlusion

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Tomoaki Tatsumi ◽  
Toshiyuki Oshitari ◽  
Takayuki Baba ◽  
Yoko Takatsuna ◽  
Shuichi Yamamoto
Keyword(s):  
Macular Edema ◽  
Triamcinolone Acetonide ◽  
Retinal Vein Occlusion ◽  
Medical Records ◽  
Retinal Thickness ◽  
Vein Occlusion ◽  
Corrected Visual Acuity ◽  
Anti Vegf ◽  
The Mean ◽  
Endothelial Growth Factor

Purpose. To evaluate the efficacy of switching from intravitreal antivascular endothelial growth factor (VEGF) agents to triamcinolone acetonide (TA) in eyes with diabetic macular edema (DME) or with retinal vein occlusion-associated macular edema (RVO-ME) on the resolution of the macular edema (ME). Methods. The medical records of 11 eyes of 11 patients with DME and 9 eyes of 9 patients with RVO-ME whose MEs were refractory to anti-VEGF treatment were reviewed. The central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and the mean interval of the recurrences were measured during the anti-VEGF treatment and after switching to the TA injections. Results. Switching to TA injections significantly increased the mean interval for recurrences from 9.2 ± 2.7 weeks to 22.3 ± 12.9 weeks in eyes with DME ( P = 0.006 ). In eyes with RVO-ME, the mean period of recurrence was 12.3 ± 5.6 weeks before and 11.6 ± 4.4 weeks after the switch ( P = 0.44 ). The mean interval for recurrence was extended to more than 8 weeks in 7 of 11 eyes with DME, but none of the eyes with RVO-ME had a prolongation of more than 4 weeks. An elevation of the IOP was observed in 3 of the 20 eyes after the TA injection. Conclusions. These findings indicate that switching to TA injections can be a good option for DME eyes refractory to anti-VEGF injections but not for the RVO-ME eyes.

scholarly journals Efficacy of Intravitreal Triamcinolone Acetonide in the Treatment of Macular Oedema in Retinal Vein Occlusion Refractory to Anti-VEGF Therapy - A Prospective Interventional Study from a Tertiary Care Centre in Eastern India

2021 ◽  
Vol 8 (24) ◽  
pp. 2083-2088
Author(s):  
Pradeep Kumar Panigrahi ◽  
Suprava Das ◽  
Suchismita Mishra
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Triamcinolone Acetonide ◽  
Retinal Vein Occlusion ◽  
Macular Oedema ◽  
Study Group ◽  
Vascular Endothelial ◽  
Intravitreal Triamcinolone ◽  
Intravitreal Triamcinolone Acetonide ◽  
Vein Occlusion ◽  
Endothelial Growth Factor

BACKGROUND Macular oedema due to retinal vein occlusion can be refractory to treatment with anti-vascular endothelial growth factor agents in some patients. We wanted to evaluate the efficacy of single dose of intravitreal triamcinolone acetonide in the treatment of macular oedema due to retinal vein occlusion, which is refractory to anti-vascular endothelial growth factor agents. METHODS 32 patients with refractory macular oedema were included in this prospective, interventional, comparative study. 20 patients were included in the study group and received 4 mg / 0.1 ml of intravitreal triamcinolone acetonide. 12 patients in control group did not receive any treatment. Best corrected visual acuity (BCVA) and central foveal thickness (CFT) were assessed in each group at 1 week, 1 month, 2 months and 3 months following injection. RESULTS Mean BCVA in study group improved from 1.36 ± 0.33 logarithm of minimum angle of resolution (LogMAR) at baseline to 0.94 ± 0.49 LogMAR at the end of 3 months. Mean CFT at baseline and 3 months was 498.65 ± 90.64 and 331 ± 100.57 microns respectively in the study group. The mean baseline BCVA and CFT in the control group was 1.19 ± 0.43 LogMAR and 428.33 ± 101.75 microns respectively. Mean BCVA and CFT at the end of 3 months was 1.16 ± 0.45 LogMAR and 424.75 ± 98.75 microns respectively. Change in mean BCVA and CFT at baseline and at the end of 3 months was found to be statistically significant (P = 0.000) between the 2 groups. There was increase in macular oedema in the study patients after the 2nd month following injection leading to slight worsening of visual acuity. CONCLUSIONS Intravitreal triamcinolone acetonide is an option in the treatment of macular oedema due to retinal vein occlusion refractory to anti-vascular endothelial growth factor agents. However, the efficacy of a single injection is short lived. Multiple injections might be needed to maintain the visual gains. KEYWORDS Retinal Vein Occlusion, Macular Oedema, Refractory, Triamcinolone, Intravitreal

scholarly journals Outcome of Switching Anti-VEGF Agents at Fixed Intervals to Treat Eyes With Macular Edema Secondary to Branch Retinal Vein Occlusion

2021 ◽  
Author(s):  
Tsuyoshi Mito ◽  
Takeshi Kobayashi ◽  
Atsushi Shiraishi
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Retinal Thickness ◽  
Vascular Endothelial ◽  
Vein Occlusion ◽  
Injection Interval ◽  
One Year ◽  
The One ◽  
Endothelial Growth Factor

Abstract ObjectiveTo determine whether switching intravitreal injections of ranibizumab or aflibercept to the other will affect the interval of subsequent injections in patients with macular edema secondary to branch retinal vein occlusion (BRVO).ResultsThe medical charts of 16 eyes of 16 patients were reviewed. After injections of ranibizumab or aflibercept for >3 times/year, the type of anti-vascular endothelial growth factor agent was switched. A comparison was made of the average injection interval for the one year before switching and the interval of the first two injections post-switching. In the group that switched from ranibizumab to aflibercept (R to A group, n=8), the interval before was 85.4±6.6 days which was significantly increased to 125.9±23.2 days post-switching (P=0.0013). In the A to R group (n=8), a significant shortening from 103.9±11.8 days before to 85.9±12.6 days was observed (P=0.007). In the R to A group, the central retinal thickness at a recurrence was 522.1±79.6 µm which decreased significantly to 419.3±64.5 µm post-switching (P=0.005). The results suggest that the intervals can be different between ranibizumab and aflibercept in patients with macular edema secondary to BRVO who required repeat injections.

Steroids in the Treatment of Central Retinal Vein Occlusion

2020 ◽  
pp. 139-144
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Vision Loss ◽  
Standard Of Care ◽  
Vascular Endothelial ◽  
Intravitreal Triamcinolone ◽  
Vein Occlusion ◽  
Endothelial Growth Factor ◽  
Central Retinal Vein

The Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE-CRVO) Study was a randomized clinical trial comparing intravitreal triamcinolone to observation in eyes with vision loss associated with macular edema due to perfused (nonischemic) central retinal vein occlusion (CRVO). The results suggested that intravitreal triamcinolone in a 1-mg dose should be considered for up to 1 year, and possibly 2 years, in patients with vision loss associated with macular edema secondary to CRVO. The study was the first to establish an effective treatment for perfused CRVO. (Treatment with intravitreal anti–vascular endothelial growth factor [VEGF] agents has been shown to produce greater improvement in visual acuity and is now the standard of care.)

scholarly journals Evaluation of Contrast Sensitivity after Single Intravitreal Triamcinolone Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Tulin Aras Ogreden ◽  
Zeynep Alkin ◽  
Abdullah Ozkaya ◽  
Halil Ibrahim Demirkale ◽  
Irfan Perente ◽  
...  
Keyword(s):  
Macular Edema ◽  
Contrast Sensitivity ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Retinal Thickness ◽  
Intravitreal Triamcinolone ◽  
Intravitreal Triamcinolone Acetonide ◽  
Vein Occlusion ◽  
Intravitreal Triamcinolone Injection ◽  
The Mean

Purpose. To evaluate visual acuity (VA), contrast sensitivity (CS), and central retinal thickness (CRT) after intravitreal triamcinolone acetonide (IVT) injection for macular edema secondary to branch retinal vein occlusion (BRVO). Methods. In this prospective study, a total of 21 eyes of 21 patients were included. VA, CS, and CRT were assessed at baseline and at 1, 3, and 6 months after a single IVT injection. Results. Mean age was 64.57 ± 8.34 years. The mean baseline VA (LogMAR) increased from 1.11 ± 0.63 to 0.55 ± 0.39 (P<0.001), 0.60 ± 0.40 (P<0.001), and 0.78 ± 0.39 (P=0.07) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 1 meter improved from 0.66 ± 0.49 to 1.11 ± 0.32 (P<0.001), 0.99 ± 0.38 (P<0.001), and 0.72 ± 0.37 (P=0.8) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 3 meters improved from 0.34 ± 0.41 to 0.74 ± 0.41 (P<0.001), 0.64 ± 0.44 (P=0.036), and 0.46 ± 0.49 (P=0.8) at 1, 3, and 6 months, respectively. The mean baseline CRT decreased from 511 ± 146 μm to 242 ± 119 μm, 277 ± 131 μm, and 402 ± 166 μm at 1, 3, and 6 months after IVT (P<0.001 for each). Conclusion. Single IVT injection improved VA and CS and reduced CRT at 1 and 3 months of treatment. VA and CS returned to baseline levels at 6 months.

scholarly journals Topographic patterns of retinal edema in eyes with branch retinal vein occlusion and their association with macular edema recurrence

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hae Min Park ◽  
Young Hwan Kim ◽  
Byung Ro Lee ◽  
Seong Joon Ahn
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Optical Coherence Tomography ◽  
Growth Factor ◽  
Macular Edema ◽  
Branch Retinal Vein Occlusion ◽  
Retinal Thickness ◽  
Vascular Endothelial ◽  
Retinal Edema ◽  
Vein Occlusion ◽  
Endothelial Growth Factor

AbstractIn this study, we evaluated the topographic pattern of retinal edema in eyes with macular edema (ME) secondary to branch retinal vein occlusion (BRVO) using a widefield retinal thickness map of optical coherence tomography and its association with ME recurrence. In 87 eyes with ME secondary to BRVO who were treated with anti-vascular endothelial growth factor (VEGF) injections and followed up for ≥ 1 years, 12 × 9 mm macular volume scans of swept-source optical coherence tomography (DRI-OCT Triton; Topcon Inc, Japan) were performed and retinal thickness maps were automatically generated at baseline and follow-up visits. Topographic patterns of retinal edema on the maps at baseline and 1 month after the first anti-vascular endothelial growth factor (VEGF) treatment were classified as extramacular (outside the ETDRS grid), macular (within the grid), and combined pattern and correlated with ME recurrences. Seventy-five of 87 (86.2%) eyes with BRVO ME showed combined edema at baseline. There were 4 topographic patterns of edema at 1 month following anti-VEGF injection as follows: no residual edema, extramacular only, macular only, and combined edema. In contrast to the baseline pattern, the pattern of retinal edema 1 month following anti-VEGF therapy showed significant association with 6-month recurrence, number of ME recurrences during a 1-year period, and time to first recurrence. (all P < 0.05) An automatically generated widefield retinal thickness map could be used to effectively visualize the topographic patterns of retinal edema in eyes with BRVO. The map can be used as a valuable tool for detection of retinal edema on widefield retinal areas and prediction of ME recurrence in eyes with BRVO.

scholarly journals Evaluation of the Response to Ranibizumab Therapy following Bevacizumab Treatment Failure in Eyes with Diabetic Macular Edema

2015 ◽  
Vol 6 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Joel Hanhart ◽  
Itay Chowers
Keyword(s):  
Treatment Failure ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Median Number ◽  
Vascular Endothelial ◽  
Spectral Domain Oct ◽  
Bevacizumab Treatment ◽  
Central Subfield Thickness ◽  
The Mean ◽  
Endothelial Growth Factor

Background/Aims: Bevacizumab and ranibizumab are routinely used to treat diabetic macular edema (DME). We aim to evaluate the usefulness of switching to ranibizumab therapy following bevacizumab treatment failure in eyes with DME. Methods: We performed a retrospective analysis of a consecutive group of patients with DME who received ranibizumab injections following the failure of bevacizumab injections. The injections were delivered following a pro re nata protocol every 4-6 weeks. The data collected included demographics, systemic and ophthalmic findings, as well as the central subfield thickness according to spectral-domain OCT. Results: Eight eyes (5 patients) were included in the study. The median number of bevacizumab injections prior to the switch to ranibizumab was 4, and the median number of ranibizumab injections during the study was 2. The mean follow-up period was 541 ± 258 days. The mean central retinal thickness (CRT) (±SEM) was 539 ± 75 μm before the initiation of bevacizumab treatment, and 524 ± 43 μm after the last bevacizumab injection (p = 0.7). It reduced to 325 ± 26 μm following the ranibizumab injections (p = 0.0063). The best-corrected visual acuity (BCVA) improved in 4 eyes and remained stable in 4 eyes following the ranibizumab injections. Conclusion: A ranibizumab therapy was effective in reducing the CRT in eyes that failed bevacizumab therapy. A BCVA improvement can also occur in these eyes. Switching between anti-vascular endothelial growth factor compounds may be beneficial in eyes with DME.

scholarly journals Association between Retinal Thickness Variability and Visual Acuity Outcome during Maintenance Therapy Using Intravitreal Anti-Vascular Endothelial Growth Factor Agents for Neovascular Age-Related Macular Degeneration

2021 ◽  
Vol 11 (10) ◽  
pp. 1024
Author(s):  
Timothy Y. Y. Lai ◽  
Ricky Y. K. Lai
Keyword(s):  
Visual Acuity ◽  
Retinal Thickness ◽  
Age Related Macular Degeneration ◽  
Vascular Endothelial ◽  
Anti Vegf ◽  
Age Related ◽  
Thickness Variability ◽  
The Mean ◽  
Endothelial Growth Factor

Previous studies based on clinical trial data have demonstrated that greater fluctuations in retinal thickness during the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy for neovascular age-related macular degeneration (nAMD) is associated with poorer visual acuity outcomes. However, it was unclear whether similar findings would be observed in real-world clinical settings. This study aimed to evaluate the association between retinal thickness variability and visual outcomes in eyes receiving anti-VEGF therapy for nAMD using pro re nata treatment regimen. A total of 64 eyes which received intravitreal anti-VEGF therapy (bevacizumab, ranibizumab or aflibercept) for the treatment of nAMD were evaluated. Variability in spectral-domain optical coherence tomography (OCT) central subfield thickness (CST) was calculated from the standard deviation (SD) values of all follow-up visits after three loading doses from month 3 to month 24. Eyes were divided into quartiles based on the OCT CST variability values and the mean best-corrected visual acuity values at 2 years were compared. At baseline, the mean ± SD logMAR visual acuity and CST were 0.59 ± 0.39 and 364 ± 113 µm, respectively. A significant correlation was found between CST variability and visual acuity at 2 years (Spearman’s ρ = 0.54, p < 0.0001), indicating that eyes with lower CST variability had better visual acuity at 2 years. Eyes with the least CST variability were associated with the highest mean visual acuity improvement at 2 years (quartile 1: +9.7 letters, quartile 2: +1.1 letters, quartile 3: −2.5 letters, quartile 4: −9.5 letters; p = 0.018). No significant difference in the number of anti-VEGF injections was found between the four CST variability quartile groups (p = 0.21). These findings showed that eyes undergoing anti-VEGF therapy for nAMD with more stable OCT CST variability during the follow-up period were associated with better visual outcomes. Clinicians should consider adopting treatment strategies to reduce CST variability during the treatment course for nAMD.

scholarly journals Bevacizumab Treatment and Treatment Regimes in Branch Retinal Vein Occlusion and Macular Edema

2019 ◽  
pp. 99-103
Keyword(s):  
Macular Edema ◽  
Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Vascular Endothelial ◽  
Steroid Injections ◽  
Treatment Regimes ◽  
Vein Occlusion ◽  
Bevacizumab Treatment ◽  
Endothelial Growth Factor ◽  
Retinal Vein Occlusions

Macular edema secondary to retinal vein occlusions is a significant complication affecting the vision. Medical treatment of retinal vein occlusions first started with intraocular steroid injections and then enriched with intraocular Anti-VEGF (Vascular Endothelial Growth Factor) injections. But till now the length and frequency of therapy have not been defined clearly. In this review, the use of bevacizumab in the treatment of branch retinal vein occlusion and macular edema will be summarized in light of the current literature.

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