Intravitreal injection of triamcinolone acetonide for the treatment of macular edema

Purpose: To study the efficacy and safety of intravitreal injection of triamcinolone acetonide for the treatment of macular edema (ME). Methods: Thirty-five eyes of 33 patients with ME were studied. The causes of ME included diabetes (24 eyes), postoperative ME (four eyes), intraocular inflammation (three eyes), retinal vein occlusion (three eyes), and Coats disease (one eye). All patients underwent a complete ophthalmic examination and fluorescein angiography before and after treatment. Treatment consisted of a single intravitreal injection of 2 or 4 mg of triamcinolone acetonide under subconjunctival anaesthesia. Mean follow-up time was 4 months (range, 1-10 months). Results: Mean visual acuity before treatment was 20/200 (range, 20/400-20/70). Visual acuity improved by one line or more on the Snellen visual acuity chart in seven eyes (20%) and remained unchanged in nine eyes (25.7%). In the 19 remaining eyes, visual acuity improved slightly and remained less than 20/200. ME diminished or resolved completely in 32 eyes (91%). This improvement was seen in all eyes with diabetic ME, pseudophakic ME, or inflammatory ME. ME recurred in three eyes 3 months after injection of triamcinolone and in one eye 9 months after injection of triamcinolone. In one diabetic patient, retinal neovascularization associated with ME resolved as a consequence of intravitreal triamcinolone injection. Reversible ocular hypertension occurred in ten eyes (28.6%). No case of endophthalmitis was seen. Conclusion: Intravitreal injection of triamcinolone acetonide is an effective treatment of ME. Its best indications seem to be diabetic, pseudophakic and inflammatory ME. Randomized clinical trials are warranted to assess long-term efficacy and safety of this treatment modality of M E.