H Kwon Kang
To evaluate safety and efficacy of subtenontriamcinolone injection as an adjunct to intravitrealanti-VEGF therapy for refractory macular oedema.
Sixteen consecutive eyes (fifteen patients)with chronic macular oedema unresponsive to at least6 months of intravitreal anti-VEGF therapy were pro-spectively recruited. The case series included 7 diabeticmacular oedema, 2 retinal vein occlusion, 4 age-related macular degeneration and 3 of other causes (2post-cataract surgery, 1 idiopathic). Posterior subtenoninjection of triamcinolone 30 mg was administeredalong with the existing intravitreal therapy. Patientswere followed for a minimum of 12 weeks with assess-ment of visual acuity, intraocular pressure, spectral-domain OCT and fundal examination. Central macularoedema was measured as central macular thicknessminus 250 microns.
Twelve eyes received intravitreal avastin and4 eyes aflibercept every four weeks, along with a singledose of subtenon triamcinolone 30 mg. Four (25 %)eyes showed reduction of central macular oedema bymore than 50 %, 5 (31 %) showed reduction of 25 to50 %, and 7 (44 %) eyes showed less than 25 % ofreduction. Macular oedema did not worsen in anyeye. No eye achieved improvement of vision of morethan Snellen 2 lines. In all eyes, intraocular pressureremained less than 25 mmHg. One patient sufferedmarked subconjunctival haemorrhage. There were noother injection-related adverse events.
Adjunctive subtenon triamcinolone issafe and may reduce macular oedema in eyes forwhich intravitreal anti-VEGF therapy alone hasproven ineffective.