| Objective: Central retinal vein occlusion is a common retinal vascular disorder, Macular edema is a primary complication and a frequent cause of visual loss in patients with CRVO. At present , there is no proven effective treatment. The Central Vein Occlusion Study showed that gridpattern photocoagulation significantly reduced macular edema but did not result in visual improvement. Triamcinolone Acetonide(TA )is a long acting glucocorticoid, it has been used for the management of macular edema due to various retinal vascular disorder at present depending on the theory foundation of cutting down the endothelial cell permeability and steadying the blood-retinal barrier. TA administered intravitreally bypass the blood-ocular barrier to achieve therapeutic levels in the eye while minimizing systemic side effects. But there are many different therapeutic efficacy, so we have done this experiment in the random pair manner to evaluate the efficacy and safety of intravitreal TA in the management of persistent macular edema secondary to nonischemic central retinal vein occlusion.Methods: Thirty patients with history of nonischemic CRVO and persistent macular edema were random separated into 2 groups. Treated group(15patients) received a single intravitreal injection of 4mg TA. Contrast group(15patients) was managed with general medication. 4 mg (0.1ml) TA were injected into the vitreous cavity using a sharp 27 G needle through the inferior pars plana(3.25 mm from the limbus in phakic eyes and 3.00 mm in pseudophakic eyes). Post- operatively , patients must keep sitting position for 3 hours at once and keep lateral position for 1 week to avoid TA depositing on the macula area. In orded to reduce the retinaltoxicity, we prior removal of the vehicle from the TA suspension . Lavofloxacin Lactate drops were applied three times daily for 3 days. Best corrected visual acuity, slitlamp and fundus examination, intraocular pressure, fundus fluorescein angiography were performed on the two groups patients before and after treatment. Complications were observed. The follow-up period was 6 months.Results: In the treated group, the visual acuity was(0.2193±0.10983),(0.3067±0.1374),(0.2852±0.13632)and(0.2500±0.1244)respectively 1week ,1,3,6 months after operation , while visual acuity was 0.0933±0.08989 before the operation. The difference was statistically significant(T =-6.298,-8.255,-7.473,-6.078 , P=0.000). Macular thickness was ( 187.2667±13.96151μm ),( 195.6667±49.28005μm ),( 247.2000±152.5536μm)respectively 1,3,6months after operation. Comparing with the macular thickness before the operation (589.2667±65.5215), the difference was statistically significant (T=23.202, 20.760, 8.329, P=0.000). Intraocular pressure turned higher at 1,3,6 months after the operation than preoperation,with significant difference. In the contrast group , the complaints of visual acuity,macular thick ness,intraocular pressure unchanged at 1week 1,3,6 month after treatment with no statistic difference. At 6 month follow-up, 13 patients of treated group had complete resolution of macular edema vs only 2 patients of contrast group. Two of the treated group had recurrence of macular edema, and 5 patients experienced an increase in intraocular pressure. 4 patients was controlled to normal level with topitcal medication after the operation, only 1 patient had to accept the trabeculectomy. None of the treated group developed ischemic CRVO while 2 patients of the contrast group needed panretinal photocoagulation for large-scale non-perfusion area. No adverse effects such as cataract, retinal detachment or endophthalmitis occurred.Conclusion: Intravitreous injection with TA led to significant improvement in visual acuity and resolution of macular edema in patients with ME due to ischemic CRVO. However recurrence of macular edema or increase of intraocular pressure may occur in some patients. |
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