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| |  Steroid Injections Improves Vision in Some Patients With Retinal Vein Occlusion CHICAGO -- September 14, 2009 -- Injecting the eye with the corticosteroid triamcinolone appears effective in improving the vision of some patients with retinal vein occlusion, an important cause of vision loss that results from blockages in the blood vessels in the retina, according to 2 studies published in the September issue of Archives of Ophthalmology. One dose of triamcinolone 1 mg may be a treatment option for certain patients with blockages in the main portion of the retinal vein, whereas existing laser therapies appear superior for those with blockages in smaller branches of the vein. Grid photocoagulation, or a laser treatment of the retina, has shown a benefit in improving the vision of patients with branch retinal vein occlusion. However, there is presently no proven, effective therapy for vision loss associated with macular oedema after central retinal vein occlusion. In the first paper, the Standard Care versus Corticosteroid for Retinal Vein Occlusion (SCORE) study research group reported the results of a randomised clinical trial involving 271 participants with macular oedema from central retinal vein occlusion. Of these, 92 were assigned to receive 1 mg of intravitreal triamcinolone, 91 received a 4 mg dose and 88 were assigned to an observation group that did not receive treatment. Participants were evaluated every 4 months for 12 months, and those in the triamcinolone group received additional injections at each follow-up visit unless there was a specific reason not to re-treat them (adverse events or apparent success of the treatment). Additional follow-up data were collected annually through 36 months, although complete 24- and 36-month outcome assessments were not available for analysis. After 1 year, vision improved significantly in 7% of those in the observation group, 27% of those who received triamcinolone 1 mg, and 26% of those who received triamcinolone 4 mg. The odds of reaching a predetermined level of visual improvement were 5 times greater among individuals receiving either dose of triamcinolone than those not receiving treatment. Cataracts and elevated intraocular pressure, potential adverse events associated with corticosteroid treatment, were similar for the observation and for patients in the 1 mg group, but higher for the 4 mg group. “The superior safety profile of the 1 mg dose compared with the 4 mg dose, particularly with respect to glaucoma and cataract, renders it the preferred dose,” the authors wrote. Based on the results, “intravitreal triamcinolone in a 1 mg dose and following the retreatment criteria used in this study should be considered for up to 1 year, and possibly 2 years, in patients with vision loss associated with macular oedema secondary to central retinal vein occlusion who have characteristics similar to the participants studied in this trial,” they concluded. In a second study, the same research group compared the safety and efficacy of triamcinolone with standard care (grid photocoagulation in eyes without haemorrhage, or deferring photocoagulation until haemorrhage clears) for 411 patients with macular oedema from branch retinal vein occlusion. A group of 137 was assigned to receive standard care, 136 to receive a 1 mg dose of intravitreal triamcinolone and 138 to receive a 4 mg dose. Similar to the central retinal occlusion trial, participants were evaluated and re-treated as indicated every 4 months. After 1 year, 29% of participants in the standard care group, 26% in the 1 mg triamcinolone group and 27% in the 4 mg group experienced improved vision. “The rates of adverse events with respect to cataract surgery and elevated intraocular pressure were similar between the standard care and 1 mg groups, but the potential for added risks of procedure-related complications in the 1 mg group (as exemplified by the one case of endophthalmitis reported in the 4 mg group) suggests a superior safety profile for the standard care group,” the authors wrote. Adverse event rates were higher in the 4 mg group. “Thus, current study results support grid photocoagulation as the continued standard of care for patients with decreased visual acuity associated with macular oedema secondary to branch retinal vein occlusion who have similar characteristics to the cohort in this clinical trial,” the authors concluded. “The results of this trial also support the idea that grid photocoagulation, as applied in the current study, should be the benchmark against which other treatments for vision loss associated with macular oedema secondary to branch retinal vein occlusion are compared in clinical trials.”
SOURCE: Archives of Ophthalmology
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