Chinmay, Nakhwa (2010) Clinical study on the safety and efficacy of intravitreal triamcinolone for recalcitrant acular edema in south Indian population. Masters thesis, Madras Medical College, Chennai.
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Abstract
Edema of the retina is an extremely common condition occurring to some degree in most circulatory disturbances and all inflammatory conditions. Broadly defined macular edema is an abnormal thickening of the macula with accumulation of excess fluid in the extracellular space of the neurosensory retina. The term cystoids macular edema applies when there is accumulation of fluid in cyst like spaces within the macula as evidenced by clinical examination, fluorescein angiography or OCT. Macular edema in its various forms can be considered the leading cause of central vision loss in the world and is therefore of enormous medical and socio-economic importance. SUMMARY • This is a six month prospective , non randomized clinical study to evaluate the efficacy and safety of intravitreal triamcinolone in the treatment of macular edema due to causes like diabetes, post surgical and post venous obstruction, which was refractory to conventional treatment. • The main aim was to evaluate the improvement in visual acuity and decrease in macular thickness in the above said conditions after intravitreal injection. • The occurrence of adverse effects known to intraocular steroids like increase in the intraocular pressure and progression of cataract were also noted. • Of the 32 patients who were enrolled for this study 19 were female (59%) and 13 were male (41%) • The indications for treatment were diabetic macular edema (56%), post surgical macular edema (28%) and edema secondary to retinal venous occlusions(16%). Visual acuity: • The VA in diabetic maculopathy showed a definite increase with 44% patients showing an increase in VA better than 6/24. There was an increase by 3 lines in about 50% of the patients • In post surgical macular edema 2 patients showed an improvement of 2 lines. 56% patients had a VA ranging from 6/60 to 6/24 whereas pre treatment 45% patients had VA in the same range. • In the treatment of edema secondary to retinal venous occlusion , the visual acuity showed an improvement by one line(50%) on an average. 2 patients had about 3 lines of improvement. • In summary, this study shows that the vast majority of patients demonstrated stability or improvement of the VA. Of those few patients with a visual decline, the change was felt to be due to disease progression rather than drug toxicity. Macular thickness: • The reduction in macular thickness in DME after administration of triamcinolone was substantial. Pre treatment the macular thickness varied from 200 to 1200μ. After treatment most of the patients (89%) had a reduction within the range of 180 to 300μ.Patients also had a corresponding increase in their visual acuity. • In post surgery CME, the macular thickness was within the range of 200 to 1100 μ. The mean baseline macular thickness was 400μ. Post injection all the patients had macular thickness less than 400μ with 11 % having thickness less than 180μ. • In cases of macular edema secondary to venous occlusion, the results were encouraging. Prior to treatment 40% patients had thicknesses of > 400μ. After treatment all the patients had thickness within 400 μ, with 2 patients having reduction to < 200μ. However, again this drastic reduction did not correspond to improved visual acuity most likely due to long standing macular edema with associated photoreceptor loss. Intra ocular pressure measurements: • The IOP for most patients remained within the normal physiological range. The mean IOP noted for all patients was 16±2mm Hg. However 2 patients showed a rise in IOP occurring around 10 weeks of followup. These patients were started on topical aqueous suppressants (0.5 % timolol maleate) and were seen to be maintaining their IOP within the physiological limits on subsequent visits. None of the patients with increased IOP needed multiple drugs or trabeculectomy. Conclusions Intravitreal Triamcinolone (4 mg) treatment is well tolerated over 6 months with significant safety and efficacy. Nevertheless, this is a small interventional study, with no comparison arm to quantify the actual magnitude of benefit of this treatment modality compared with other therapies. This would have to be studied subsequently in larger studies and also needs to be compared with other VEGF inhibitiors regarding safety and efficacy.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | intravitreal triamcinolone; recalcitrant macular edema; retina |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Devi S |
| Date Deposited: | 20 Jul 2017 07:56 |
| Last Modified: | 20 Jul 2017 07:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1978 |
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