Bernd A. Kamppeter

Branch retinal vein occlusion treated by intravitreal triamcinolone acetonide.

AbstractPurposeTo evaluate the effect of intravitreal triamcinolone acetonide on visual acuity in branch retinal vein occlusion.MethodsThe prospective comparative nonrandomized clinical interventional study included 28 patients (28 eyes) with branch retinal vein occlusion. The study group consisting of 10 consecutive patients received an intravitreal injection of 20–25 mg of triamcinolone acetonide. The control group including 18 patients did not receive an intravitreal injection. The mean follow-up was 8.7±4.4 months.ResultsIn the study group, mean visual acuity increased significantly (P=0.02) from 0.27±0.11 preoperatively to a best postoperative visual acuity of 0.45±0.27. Visual acuity measurements determined 1 month after the injection were significantly (P=0.027) higher than baseline values. Nine (90%) eyes gained in visual acuity, with six (60%) eyes showing an increase in visual acuity of at least two Snellen lines. In the ischaemic subgroup, visual acuity did not change significantly (0.18±0.18 to 0.13±0.04; P=0.66), while, in the nonischaemic subgroup, visual acuity increased significantly (P=0.012) from the baseline value to the best postoperative measurement (0.29±0.09 to 0.53±0.24). In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (P=0.27). Comparing the study and control groups with each other, the gain in visual acuity was significantly higher in the study group at 1 month (P=0.016) and 2 months (P=0.012) after baseline.ConclusionsIntravitreal injection of triamcinolone acetonide can increase visual acuity in patients with branch retinal vein occlusion.

Frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide

Purpose To evaluate the frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide in elderly patients. Methods This clinical interventional case series study included 144 phakic eyes that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide for diffuse diabetic macular edema (n=42 eyes), exudative age-related macular degeneration (n=98), and branch retinal vein occlusion (n=4). Mean age was 72.3±8.9 years. Mean follow-up was 11.0±6.8 months (median, 8.8 months; range, 3 to 35.5 months). Reinjections were carried out in 12 (8.3%) eyes. Results Cataract surgery was performed in 20 (13.9%) eyes 17.4±9.1 months (median, 12.7 months; range, 8.0 to 35.5 months) after the first intravitreal injection. Out of the 20 eyes undergoing cataract surgery, 19 (95%) eyes had received one intravitreal injection, and 1 (5%) eye had received two previous injections. Conclusions In the elderly population of patients with exudative age-related macular degeneration, diffuse diabetic macular edema, or branch retinal vein occlusion, intravitreal high-dosage injection of triamcinolone acetonide leads to clinically significant cataract with eventual cataract surgery in about 15% to 20% of eyes within about 1 year after the intravitreal injection.

Intravitreal triamcinolone acetonide for treatment of central retinal vein occlusion.

Purpose To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and intraocular pressure in patients with central retinal vein occlusion. Methods This prospective comparative non-randomized clinical interventional study included 32 patients (33 eyes) with central retinal vein occlusion. The study group (12 patients; 13 eyes) received an intravitreal injection of about 20 mg of triamcinolone acetonide. The control group (20 patients) did not receive any treatment. Mean follow-up was 10.1±8.6 months in the study group and 6.0±5.2 months in the control group. Results In the study group, mean visual acuity increased significantly (p=0.018) from 0.11±0.11 preoperatively to a best visual acuity during follow-up of 0.18±0.15. An improvement in visual acuity by at least 2 Snellen lines and 3 Snellen lines, respectively was found for 8 (62%) eyes and 5 (38) eyes. Visual acuity measurements determined 1 month (p=0.038) and 3 months (p=0.046) after the injection were significantly higher than the baseline values. Increase in visual acuity was higher in the non-ischemic subgroup than in the ischemic subgroup. In the control group, baseline visual acuity and best visual acuity during the follow-up did not vary significantly (p=0.33). Visual acuity decreased significantly (p=0.007) towards the end of the follow-up. Comparing study group and control group, gain in visual acuity was significantly (p=0.01) higher in the study group. In the study group, intraocular pressure increased significantly (p=0.018) from 14.4±3.9 mmHg to a mean maximal value of 21.6±9.2 mmHg (range, 10–44 mmHg), and re-decreased (p=0.012) towards the end of follow-up to 15.3±5.1 mmHg (range, 10–21 mmHg). Conclusions Intravitreal triamcinolone acetonide temporarily increases visual acuity in central retinal vein occlusion. It is accompanied by an increase in intraocular pressure.

Intraocular Concentration of Triamcinolone Acetonide after Intravitreal Injection in the Rabbit Eye

PURPOSE To examine the decrease in the intraocular concentration of intravitreally injected triamcinolone acetonide over an 8-month period in a rabbit model. DESIGN Experimental study. PARTICIPANTS The study included 18 white New Zealand rabbits. METHODS The animals received an intravitreal injection of 6 mg triamcinolone acetonide. Vitreous and aqueous humor samples of the anterior and posterior chamber were taken at the first and third day, at 1 and 2 weeks, and at 1, 1.5, 2, 3, 6, and 8 months. The concentrations of triamcinolone were analyzed using a high-phase liquid chromatography assay. MAIN OUTCOME MEASURES Intraocular concentration of triamcinolone during follow-up. RESULTS Over the entire study period, triamcinolone concentrations were significantly higher in the vitreous samples than in the anterior chamber samples (day 1, 14 434+/-10 768 microg/l vs. 21.0+/-18.9 microg/l; day 30, 571.3+/-329.6 microg/l vs. 6.1+/-1.6 microg/l; month 8, 70.7+/-37.0 microg/l vs. 3.3+/-1.6 microg/l). In the anterior chamber, the triamcinolone concentrations were highest at 3 days after the injection (28.9+/-24.5 microg/l), and in the vitreous, the concentrations were highest at the first day (14,434.0+/-10,768 microg/l). Triamcinolone levels in the vitreous and in the anterior chamber followed a 2-compartment model, with an exponential decrease in the concentration within the first 4 weeks, followed by a steady decline over the following months. At 8 months, the triamcinolone concentrations were 70.7+/-37.0 microg/l in the vitreous samples and 3.3+/-1.6 microg/l in the anterior chamber samples. CONCLUSIONS The decrease in the concentration of triamcinolone after an intravitreal injection of 6 mg in rabbits follows a 2-compartment model, with an exponential decrease in the first 4 weeks followed by a more linear decrease. During the entire study period, the triamcinolone concentration was significantly higher in the vitreous than in the anterior chamber. After a single intravitreal triamcinolone injection of 6 mg in rabbits, triamcinolone is detectable for at least 8 months after the injection.

Repeated intravitreal injection of triamcinolone acetonide for diffuse diabetic macular oedema

Recent studies have suggested that intravitreal triamcinolone acetonide may be a treatment option for diffuse diabetic macular oedema.1 Since the duration of the effect of an intravitreal application of triamcinolone acetonide lasts between 4 weeks and up to 9 months,2,3 the purpose of this study was to evaluate the effect of a repeated intravitreal injection of triamcinolone acetonide. The clinical interventional case series study included four patients with diffuse diabetic macular oedema who consecutively received a second intravitreal injection of about 20 mg triamcinolone acetonide 7.6 (SD 3.9) …

Follow-up after intravitreal triamcinolone acetonide for diabetic macular edema.

Purpose To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema. Methods The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 ± 6.2 months. Results Visual acuity improved significantly (p<0.001) from 0.89 ± 0.33 logMAR to a best minimum of 0.65 ± 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, espectively Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p<0.001), 2 months (p<0.001), 3 months (p<0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure >21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected. Conclusions The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.

Potential of the 1 CU accommodative intraocular lens.

Aim: To assess the accommodative power of a new foldable monofocal intraocular lens. Method: A prospective randomised non-masked clinical interventional study. The study included 40 patients attending the hospital for cataract surgery and who were randomly distributed into a study group receiving a new foldable monofocal intraocular lens with flexible haptics, and a control group receiving a standard foldable intraocular lens. Mean follow up period was 8.51 (SD 1.34) months (range 4–11 months) Standard cataract surgery consisted of clear cornea incision, capsulorrhexis, phacoemulsification, and intraocular lens implantation, with topical anaesthesia. The main outcome measures were preoperative and postoperative visual acuity for near and distance; range of accommodation; change in anterior chamber depth. Results: In the study group compared with the control group, range of accommodation was significantly (p = 0.01) higher (1.01 (SD 0.4) dioptres versus 0.50 (0.11) dioptres) and change in anterior chamber depth was significantly more pronounced (0.82 (0.30) versus 0.40 (0.32), p = 0.01). Both groups did not vary significantly in best corrected vision (0.94 (0.12) versus 0.93 (0.18); p = 0.74). Conclusion: During a mean follow up period of 8 months after implantation, the new foldable monofocal intraocular lens with flexible haptics showed an accommodative power of about 1 dioptre, which was significantly higher than the accommodative power of a conventional monofocal flexible intraocular lens. The difference in the accommodative power between the two intraocular lenses was paralleled by a difference in the change of the anterior chamber depth.

Optical coherence tomography of the optic nerve head: interindividual reproducibility.

PurposeOptical coherence tomography may be a new technique for quantitative 3-dimensional assessment of the optic nerve head for diagnosis of optic nerve anomalies and diseases such as the glaucomas. The purpose of the present study was to examine its reproducibility. Patients and MethodsThe clinical noninterventional study included 10 randomly chosen eyes of 10 healthy individuals who underwent 24 optical coherence tomographic examinations with the high-resolution and fast scan program, interactively corrected or uncorrected. The pupils were not dilated. All examinations were performed by 3 examiners independently of one another. The coefficient of variation was calculated as the ratio of the mean of the standard deviations divided by the mean of the means. ResultsThe coefficients of variation for redetermination of optic disc area, ranging between 0.047 and 0.119, were lowest for the manually corrected fast scan mode and highest for the uncorrected fast scan mode. For remeasurements of the neuroretinal rim area, the best mean coefficient of variation was 0.073±0.026 (corrected fast scan mode). ConclusionsIn healthy eyes, the morphometric measurements of the optic nerve head by optical coherence tomography show a relatively high reproducibility with mean coefficients of variation lower than 10% for remeasurements of the optic disc and neuroretinal rim area. With undilated pupils, reproducibility is better with the fast scan mode with interactive correction of the outlining of the optic disc border than it is with the high-resolution mode.

Intravitreal triamcinolone acetonide for persisting cystoid macular edema after penetrating keratoplasty

Purpose: The intravitreal application of triamcinolone acetonide as treatment of long-standing, therapy-resistant cystoid macular edema after penetrating keratoplasty is reported. Methods: A 44-year-old patient showed therapy-resistant cystoid macular edema for 2 years after repeated penetrating keratoplasty was performed as treatment of keratoconus. The crystalline lens was clear. The patient received an intravitreal injection of approximately 20 mg of triamcinolone acetonide. Preinjection visual acuity measured 20/80. Results: Within the first 4 weeks after the injection, dense cataract developed necessitating cataract surgery. After phakoemulsification, visual acuity improved to 20/50. Optical coherent tomography and fluorescein angiography showed an almost complete resolution of cystoid macular edema. Ten months after the injection, visual acuity remained at 20/50, and intraocular pressure measured 15 mm Hg without antiglaucomatous therapy taken. Conclusions: Intravitreal injection of triamcinolone acetonide may be an additional tool in the treatment of therapy-resistant cystoid macular edema after penetrating keratoplasty. After intravitreal injection of triamcinolone acetonide, cataract may rapidly develop in eyes that have been intensively treated, topically and systemically, by corticosteroids for several years.

Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration

PurposeTo report on the follow-up of patients who received an intravitreal triamcinolone acetonide injection (IVTA) as treatment of exudative age-related macular degeneration.MethodsThe clinical interventional case-series study included 205 patients (222 eyes) with progressive exudative age-related macular degeneration with subfoveal neovascularization who consecutively received an IVTA of about 20 mg as only therapeutic procedure and for whom follow-up was at least 3 months. Mean follow-up was 10.4±7.1 months (range, 3–35.7 months).ResultsVisual acuity improved significantly (P<0.001) from baseline (0.90±0.45 logarithm of the minimum angle of resolution (LogMar)) to a mean minimum of 0.79±0.42 LogMar during follow-up. In 86 (38.7%) eyes and in 55 (24.8%) eyes, best visual acuity increased by at least two and three Snellen lines, respectively. Comparing the measurements at specific postinjection examination dates showed that visual acuity measurements taken at 1, 2, and 3 months after injection were not significantly different from the baseline value. Measurements taken at 6, 9, and 12 months after the injection were significantly (P<0.001) lower than the measurements at baseline. Mean loss at 6 months was 1.4±3.8 Snellen lines, at 9 months, 2.5±4.6 lines, and at 12 months after the injection, 2.6±4.0 lines. Intraocular pressure increased significantly (P<0.001) during the first 6 months, and returned to baseline at 9 months after injection.ConclusionsSingle injection high-dosage IVTA did not show an apparent benefit at 12 months after injection in patients with neovascular age-related macular degeneration.