scholarly journals Spectral Domain OCT Documented Resolution of Pseudophakic Cystoid Macular Edema after Intravitreal Triamcinolone

2010 ◽  
Vol 2 ◽  
pp. OED.S3671
Author(s):  
Ravi K Murthy ◽  
Kakarla V. Chalam
Keyword(s):  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Spectral Domain ◽  
Vascular Endothelial ◽  
Intravitreal Triamcinolone ◽  
Cross Sectional ◽  
Spectral Domain Oct ◽  
Endothelial Growth Factor ◽  
Stratus Oct ◽  
Sd Oct

Cystoid macular edema (CME) is an important cause of visual loss after cataract surgery. Treatment is usually with topical anti-inflammatory agents, with anti-vascular endothelial growth factor agents and steroids used intravitreally in resistant cases. Even though time-domain Stratus OCT can quantify the macular thickness, it cannot prognosticate visual outcomes due to the poor resolution of images, especially the outer segment-inner segment junction. Spectral-domain OCT (SD-OCT) by its ability to acquire large number of images in a short span of time provides high resolution cross-sectional images of the retina, which not only highlights the underlying pathological changes, but in addition can prognosticate visual recovery. We describe pre and post SD-OCT features of a case of refractory CME who was treated with intravitreal triamcinolone actetonide.

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.

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.

The Role of Steroids and NSAIDs in Prevention and Treatment of Postsurgical Cystoid Macular Edema

2019 ◽  
Vol 24 (41) ◽  
pp. 4896-4902 ◽  
Author(s):  
Andrzej Grzybowski ◽  
Piotr Kanclerz
Keyword(s):  
At Risk ◽  
Vascular Endothelial Growth Factor ◽  
Growth Factor ◽  
Cataract Surgery ◽  
Macular Edema ◽  
Cystoid Macular Edema ◽  
Topical Steroids ◽  
Subconjunctival Injection ◽  
Vascular Endothelial ◽  
Endothelial Growth Factor

Background: Pseudophakic cystoid macular edema (PCME) remains one of the most common visionthreatening complication of phacoemulsification cataract surgery (PCS). Pharmacological therapy is the current mainstay of both prophylaxis, and treatment of PCME in patients undergoing PCS. We aimed to review pharmacological treatment options for PCME, which primarily include topical steroids, topical nonsteroidal antiinflammatory drugs (NSAIDS), periocular and intravitreal steroids, as well as anti-vascular endothelial growth factor therapy. Methods: The PubMed and Web Of Science web platforms were used to find relevant studies using the following keywords: cataract surgery, phacoemulsification, cystoid macular edema, and pseudophakic cystoid macular edema. Of articles retrieved by this method, all publications in English and abstracts of non-English publications were reviewed. Other studies were also considered as a potential source of information when referenced in relevant articles. The search revealed 193 publications. Finally 82 articles dated from 1974 to 2018 were assessed as significant and analyzed. Results: Based on the current literature, we found that corticosteroids remain the mainstay of PCME prophylaxis in uncomplicated cataract surgery, while it is still unclear if NSAID can offer additional benefits. In patients at risk for PCME development, periocular subconjunctival injection of triamcinolone acetonide may prevent PCME development. For PCME treatment the authors recommend a stepwise therapy: initial topical steroids and adjuvant NSAIDs, followed by additional posterior sub-Tenon or retrobulbar corticosteroids in moderate PCME, and intravitreal corticosteroids in recalcitrant PCME. Intravitreal anti-vascular endothelial growth factor agents may be considered in patients unresponsive to steroid therapy at risk of elevated intraocular pressure, and with comorbid macular disease. Conclusion: Therapy with topical corticosteroids and NSAIDs is the mainstay of PCME prophylaxis and treatment, however, periocular and intravitreal steroids should be considered in refractory cases.

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.)

Analysis of anatomical biomarkers in subtypes of diabetic macular edema refractory to anti-vascular endothelial growth factor treated with dexamethasone implant

2019 ◽  
Vol 30 (4) ◽  
pp. 764-769 ◽  
Author(s):  
Verónica Castro-Navarro ◽  
Enrique Cervera-Taulet ◽  
Catalina Navarro-Palop ◽  
Laura Hernández-Bel ◽  
Clara Monferrer-Adsuara ◽  
...  
Keyword(s):  
Vascular Endothelial Growth Factor ◽  
Retinal Detachment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Cystoid Macular Edema ◽  
Serous Retinal Detachment ◽  
Vascular Endothelial ◽  
Dexamethasone Implant ◽  
Endothelial Growth Factor ◽  
Best Corrected Visual Acuity

Introduction: To analyze functional and anatomical outcomes in subtypes of diabetic macular edema treated with a single dexamethasone implant and to assess the usefulness of a pro-re-nata treatment among subtypes. Methods: Retrospective study in morphologic patterns of diabetic macular edema (diffuse retinal thickening n = 15; cystoid macular edema n = 38, and serous retinal detachment n = 17) recalcitrant to anti-vascular endothelial growth factor, treated with dexamethasone implant. Examinations included timing to recidive of diabetic macular edema, best-corrected visual acuity, and central subfield macular thickness at 2, 4, and 6 months. Results: In previously treated patients with a mean of 6.64 ± 3.69 anti-vascular endothelial growth factor injections, the best-corrected visual acuity improved from 61.64 ± 13.71 to 65.71 ± 14.65 as per the Early Treatment Diabetic Retinopathy Study protocol (p = 0.009) and central subfield macular thickness change from 447.46 ± 110.82 to 354.39 ± 80.46 µm (p < 0.005). The best-corrected visual acuity improvement was better in the diffuse retinal thickening group (68.67 ± 13.81 vs 65.26 ± 14.04 in cystoid macular edema and vs 64.12 ± 17.06 in serous retinal detachment), whereas higher central subfield macular thickness thinning was observed in serous retinal detachment group (368.47 ± 29.96 to 310.27 ± 67.47 in diffuse retinal thickening, vs 445.92 ± 105.06 to 364.39 ± 80.28 and 520.59 ± 122.96 to 370.94 ± 81.73 in cystoid macular edema and serous retinal detachment, respectively). Cystoid macular edema group was the group with more recurrences after 6 months (86.8% vs 66.7% in diffuse retinal thickening and 70.6% in serous retinal detachment). Conclusion: Dexamethasone implant is effective for all persistent diabetic macular edema subtypes with sustained functional and morphologic gains in the first 6 months.

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