Effect of posterior sub-tenon triamcinolone in macular edema due to non-ischemic vein occlusions.

PURPOSE: To study the efficacy and safety of Posterior Sub-Tenon Triamcinolone acetonide (PSTT) in the treatment of macular edema in retinal vein occlusions. The efficacy is studied by anatomical and visual improvements.

BACKGROUND

Macular edema is the most common cause of visual loss in retinal vein occlusions. Many treatments have been advocated including laser, PSTT etc. The most recent trend is the usage of intravitreal Anti-VEGF (Vascular Endothelial Growth Factor) agents and steroids. Intravitreal injections have more complications.

METHODS

This study was a prospective interventional case series. 24 eyes of 24 patients (13 male and 11 female) with recent onset non-ischemic RVO (Retinal Vein Occlusion) underwent Posterior Sub-Tenon Triamcinolone (PSTT). Of the 24 eyes treated, 18 eyes were of BRVO (Branch Retinal Vein Occlusion) and 6 were CRVO (Central Retinal Vein Occlusion). All the eyes received 40 mg of Triamcinolone Acetonide (TA) in 1ml through posterior sub-tenon route. All the eyes were examined at baseline and after four weeks of being injected with TA. Changes in the best corrected visual acuity {letters of ETDRS (Early Treatment Diabetic Retinopathy Study) chart} and Central Macular Thickness (CMT) were studied. A gain of more than 5 letters was considered as effective. The eyes were examined for raised IOP (Intra-Ocular Pressure) and other complications.

RESULTS

Out of the 24 eyes 19 (79%) showed an improvement of more than 5 letters after a month of treatment. All the patients exhibited a certain degree of decrease in CMT. The mean BCVA increased from 30.08±10.16 to 40.21±8.93 (p<0.05). The mean CMT decreased from 575.08±131.55 to 282.08±163.99 (p<0.05). Out of them 3 eyes developed raised IOP of more than >21mmHg, which was controlled with medication. There were no other complications observed in any of the patients.

CONCLUSION

PSTT is an effective modality of treatment with minimal complications for macular edema associated with Non-Ischemic RVO with minimal complications. In view of the more severe complications associated with intravitreal injections, PSTT can be used as the first line of treatment before contemplating intravitreal injections. Multicenter randomised trials with longer periods of follow-up are needed to evaluate the long term safety and efficacy of this treatment. Furthermore, comparative studies are required to compare it with intravitreal Anti-VEGF or TA.