Introduction

Following Robert Machemer, Gholam Peyman, and others,1, 2, 3, 4, 5, 6 intravitreal triamcinolone acetonide has increasingly been used in recent studies as treatment for other intraocular proliferative, oedematous, and neovascular diseases, such as diffuse diabetic macular oedema,7, 8, 9, 10, 11, 12, 13 central retinal vein occlusion,14, 15, 16, 17 branch retinal vein occlusion,18, 19, 20 chronic uveitis,21, 22, 23, 24, 25 persistent pseudophakic cystoid macular oedema,26, 27, 28, 29 exudative age-related macular degeneration,30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44 and other diseases.6 It has remained unclear so far, whether the various ocular disorders differ in their response to intravitreal triamcinolone acetonide in terms of an increase in visual acuity and a rise in intraocular pressure. It was, therefore, the purpose of the present review to compare groups of patients with selected ocular diseases with respect to the effect of intravitreal triamcinolone on visual acuity and intraocular pressure.

In the review, 359 eyes with diffuse diabetic macular oedema (n=102), progressive exudative age-related macular degeneration with non-classic subfoveal neovascularization (n=216), uveitis (n=10), branch retinal vein occlusion (n=12), central retinal vein occlusion (n=12), and pseudophakic cystoid macular oedema (n=7) were included (Table 1). All patients received an intravitreal high-dose injection of triamcinolone acetonide of about 20 mg as single and only procedure and had been evaluated in previous single-disease studies.6, 7, 14, 18, 21, 26, 30, 45, 46, 8 Age was significantly lowest in the uveitis group than in the other groups.

Table 1 Visual acuity and intraocular pressure after intravitreal injection of triamcinolone acetonide for various diseases
Full size table

Comparing the different patient groups with each other revealed that the maximal increase in visual acuity during follow-up was significantly lower in the AMD group (−0.10±0.30 logMar units) than in the diabetic macular oedema group (−0.24±0.22 logMar units) (P<0.001), the branch retinal vein occlusion group (−0.22±0.23 logMar units) (P=0.032), the central retinal vein occlusion group (−0.26±0.26 logMAR units) (P=0.032), the uveitis group (−0.29±0.19 logMar units), and the pseudophakic cystoid macular oedema (−0.30±0.22 logMar units) (P=0.042). The other study groups did not vary statistically and significantly in the maximal gain in visual acuity although the gain in visual acuity was slightly higher in the uveitis group and the pseudophakic cystoid macular oedema group than in the diabetic macular oedema group.

The intraocular pressure rise was significantly higher in the uveitis group (11.3±7.0 mm Hg) than in the age-related macular degeneration group (6.4±6.9 mm Hg) (P=0.007), the diabetic macular oedema group (5.9±5.8 mm Hg) (P=0.007), the branch retinal vein occlusion group (5.4±4.2 mm Hg) (P=0.021), and the pseudophakic cystoid macular oedema group (5.5±6.1 mm Hg) (P=0.033). The non-uveitis study groups did not vary significantly in the amount of an increase in intraocular pressure (P=0.91). Correspondingly, the frequency of an increase in intraocular pressure by more than 10 mm Hg was significantly higher in the uveitis group than in the age-related macular degeneration group (P=0.001) and the diabetic macular oedema group (P=0.001). The other study groups, except the uveitis group did not vary significantly (P>0.10) in the frequency of a rise in the intraocular pressure.

The results of the present review suggest that the best response in terms of gain in visual acuity after the intravitreal injection of triamcinolone acetonide can be found in eyes with intraretinal oedematous diseases without marked ischaemia such as pseudophakic cystoid macular oedema and uveitic cystoid macular oedema. A moderate increase was detected in eyes with intraretinal oedema and variable macular ischemia such as in diffuse diabetic macular oedema, branch retinal vein occlusion, and central retinal vein occlusion. The visual acuity was lowest in patients with an unhealthy chorioretinal interface, as in exudative age-related degeneration. The results of the present study additionally suggest that the rise in the intraocular pressure was significantly the highest and occurred most frequently in the uveitis group. Simultaneously, the patients of the uveitis study group were significantly younger than the remaining patients. It agrees with a recent study in which the rise in intraocular pressure reaction after an intravitreal injection of triamcinolone acetonide was significantly associated with younger age of the patients.47 Regarding the uveitis associated pathophysiologic changes such as an increased viscosity of the aqueous humour and inflammatory changes in the trabecular meshwork, one may take into account that besides younger age the uveitic disease by itself might have been the reason or an additional reason for the higher intraocular pressure response in the uveitis group compared with the other study groups.

In conclusion, the increase in visual acuity after intravitreal triamcinolone acetonide may be highest in non-ischaemic diseases with an intraretinal macular oedema such as pseudophakic cystoid macular oedema and uveitis; the increase in visual acuity may be moderate in partially ischaemic diseases with intraretinal macular oedema, such as diabetic macular oedema; and the increase in visual acuity may be lowest in diseases with a primarily subretinal location of the disease such as exudative age-related macular degeneration. The rise in intraocular pressure as complication of intravitreal triamcinolone acetonide may be higher in relatively young patients with uveitis than in elderly patients with other reasons for macular oedema.