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| |  Low-Dose Triamcinolone Safer, Equally as Effective as High-Dose in Treating Central Retinal Vein Occlusion: Presented at RC2009 By Cameron Johnston NEW YORK -- October 7, 2009 -- There is little appreciable difference between high-dose and low-dose triamcinolone in treating central retinal vein occlusion (CRVO), according to a study presented here at the Retina Congress (RC) 2009. Both are better than placebo, or observation only, but the safety profile of the lower dose makes it the preferred treatment for this condition. The study included 271 patients who had vision loss stemming from macular oedema secondary to CRVO. Patients were randomised to receive either observation or intravitreal triamcinolone 1 or 4 mg. Patients were re-examined and offered re-treatment every 4 months for a total of 3 years. Michael Ip, MD, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin, discussed the data on October 4. According to Dr. Ip, in the first year, patients in the low-dose arm received a mean of 2.2 injections compared with 2.0 injections in the high-dose arm, and 0.1 injections in the observation group. As for primary outcomes, at 12 months follow-up, 27% of patients in the low-dose arm and 26% in the high-dose arm had achieved an improvement in vision of at least 15 ETDRS letters. This compared with 7% of those in the observation arm. Approximately half of patients who gained 15 or more letters showed significant improvements as early as 4 months into the study. There were significant changes in centre-point retinal thickness in all 3 arms over 24 months follow-up, but the greatest improvements were seen among patients in the low-dose triamcinolone arm. Their CRT resolved to a mean of approximately 225 microns. Adverse ocular events were common and included neovascularisation of the iris or neovascular glaucoma, and retinal neovascularisation. Four patients in each of the low-dose arm and in the observation arm experienced vitreous haemorrhages. Elevated intraocular pressure (IOP) was seen in both groups of patients receiving triamcinolone, with 26% of those in the high-dose arm having an increase of >10 mm Hg, and 35% of them having to be initiated on ocular hypotensive drugs. Two patients had to have tube shunts implanted to help lower their IOP and 9% of patients in the high-dose arm reached an IOP of >35 mm Hg. Cataracts were also a serious concern, which was not unexpected. One-third of patients in the high-dose arm developed lens opacities and/or significant progression of cataracts; 4 required surgery within the first year, and the remainder required surgery between months 12 and 24. Dr. Ip concluded his presentation noting that the visual benefit seen here was greater than what one might have expected based on the changes in central retinal thickness alone. This could suggest that triamcinolone has other benefits -- perhaps it works as an anti-inflammatory, or it may have neuroprotective benefits. Either way, the low-dose drug has a superior safety profile to the higher dose, but offers more or less the same outcomes. For that reason, he said, low-dose triamcinolone, delivered in 1 mg injections should be considered the treatment of choice for patients who match the criteria established here. Such treatment has been proven beneficial for 1 year, and the evidence suggests it may be useful for as much as 2 years as well. The 2009 Retina Congress is a combined meeting of the American Society of Retina Specialists, the Macula Society, and the Retina Society. Funding for this study was provided by the National Institutes of Health and the National Eye Institute. [Presentation title: The SCORE Study CRVO Trial: A Randomized Trial to Compare the Efficacy and Safety of Intravitreal Triamcinolone With Standard Care to Treat CRVO]
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