Jb Jonas

Intraocular pressure after intravitreal injection of triamcinolone acetonide

Aim: To investigate the intraocular pressure (IOP) response after intravitreal injections of triamcinolone acetonide as treatment of intraocular neovascular or oedematous diseases. Methods: The prospective consecutive non-comparative interventional case series study included 71 patients (75 eyes) with progressive exudative age related macular degeneration (n = 64 eyes) or diffuse diabetic macular oedema (n = 11 eyes), who received an intravitreal injection of 25 mg triamcinolone acetonide. Mean follow up time was 6.86 (SD 2.52) months (range 3.1–14.47 months). Results: IOP increased significantly (p<0.001) from 15.43 (3.26) mm Hg preoperatively to a mean maximum of 23.38 (8.37) mm Hg (range 13–64 mm Hg) postoperatively. An IOP rise to values higher than 21 mm Hg was observed in 39 (52%) eyes. Elevation of IOP occurred about 2 months after the injection. Preoperative predictive factor for the rise in IOP was younger age (p=0.013). It was statistically independent of refractive error, presence of diabetes mellitus, and indication for the injection. In all but one eye, IOP could be lowered to the normal range with topical medication, without development of glaucomatous optic nerve head changes. In the eyes with an elevation of IOP, IOP normalised about 6 months after the injection, without further medication. Eyes undergoing repeatedly intravitreal injections of triamcinolone acetonide showed only an elevation of IOP, if after the first injection a rise of IOP had occurred. Conclusions: After intravitreal injections of 25 mg of triamcinolone acetonide, an IOP elevation can develop in about 50% of eyes, starting about 1–2 months after the injection. In the vast majority, IOP can be normalised by topical medication, and returns to normal values without further medication about 6 months after the injection.

Intravitreal triamcinolone acetonide for exudative age related macular degeneration.

Aim: To evaluate the effect of intravitreal triamcinolone acetonide on the visual acuity of patients with exudative age related macular degeneration, to assess the duration of a possible effect, and to evaluate clinical side effects of the treatment. Methods: The study included 67 patients (71 eyes) who presented with exudative age related macular degeneration of predominantly or total occult type (n = 68) or classic type (n = 3), and who received once, or repeatedly, an intravitreal injection of 25 mg of crystalline triamcinolone acetonide. Mean follow up time was 7.46 (SD 3.54) months (range 3.1–19.57 months). Results: Visual acuity increased significantly (p <0.001) from 0.16 (0.11) to a mean maximum of 0.23 (0.17). Postoperative visual acuity was highest 1–3 months after the injection. 47 (66.2%) eyes gained in maximal visual acuity and 11 (15.5%) eyes lost in visual acuity. Intraocular pressure increased significantly (p <0.001) from 15.1 (3.1) mm Hg at baseline to a maximal value of 23.0 (8.25) mm Hg. At the end of follow up, intraocular pressure again decreased significantly (p<0.001) to 16.8 (4.9) mm Hg. No cases of postoperative infectious endophthalmitis, rhegmatogenous retinal detachment, or proliferative vitreoretinopathy occurred. Owing to a decrease in visual acuity after an initial increase, six patients received a second intravitreal triamcinolone acetonide injection after which visual acuity increased again in three eyes. Conclusions: Intravitreal injection of 25 mg of crystalline triamcinolone acetonide merits further study for the treatment of exudative age related macular degeneration.

Prevalence of dry eye among adult Chinese in the Beijing Eye Study.

PurposeTo study the prevalence and associations of dry eye symptoms in adult Chinese.MethodsThe Beijing Eye Study is a population-based study in northern China, which included 4439 of 5324 subjects invited to participate with an age of 40+ years (response rate: 83.4%). For the present study, a random sample was taken consisting of 1957(44.1%) subjects (1112 women; 56.9%). Dry eye symptoms were evaluated with (1) an interviewer-assisted questionnaire; (2) measurement of the tear-film break-up time; (3) assessment of the fluorescein staining of the cornea; (4) slit-lamp-based examination of a meibomian gland dysfunction; and (5) Schirmers test.ResultsSymptoms of a dry eye felt ‘often’ or ‘at all times’ were present in 411 subjects (21.0%). In a multivariate analysis, dry eye symptoms were significantly associated with age (P<0.001), female gender (P<0.001; odds ratio (OR): 1.56; 95% confidence intervals (CI): 1.23, 1.98), urban region (P<0.001;OR: 1.89; 95% CI: 1.46, 2.48), low degree of nuclear cataract (P=0.02), and undercorrection of refractive error (P=0.005; OR: 1.42; 95% CI: 1.11, 1.82). All tests for dry eye did not vary significantly between the dry eye group and the normal group.ConclusionsThe dry eye symptoms as evaluated subjectively in a questionnaire occurred in about 21% of the adult population in China, with associations to age, female gender, urban region, and undercorrection of a refractive error. Measurement of the tear-film break-up time, assessment of the corneal fluorescein staining, slit-lamp-based examination of a meibomian gland dysfunction, and Schirmers test were not significantly associated with dry eye symptoms.

Optic disc size in a population based study in northern China: the Beijing Eye Study

Aim: To determine the optic disc size in the adult Chinese population in an urban and a rural region of Beijing. Methods: The population based, cross sectional cohort study included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%). It was divided into a rural part (1973 (44.4%) subjects) and an urban part (2466 (55.6%) subjects). Mean age was 56.2 (SD 10.6) years (range 40–101 years). Colour optic disc photographs were morphometrically examined. Main outcome measure was optic disc area. Results: Optic disc photographs were available for 4027 (90.7%) subjects. Mean optic disc area measured 2.65 (0.57) mm2 (range 1.03 mm2–7.75 mm2). Optic disc area was significantly (p<0.001) correlated with myopic refractive error, with a steep decrease in optic disc area from high myopia to the mid-range of refractive error, a slightly horizontal course in the refractive error range between −8 dioptres and +4 dioptres, and a further decrease in optic disc area towards higher hyperopia. Optic disc area was not related to age (p = 0.14) or sex (p = 0.93) (optic disc area, males: 2.65 (0.56) mm2 versus females: 2.65 (0.57) mm2). “Microdiscs” may be defined as smaller than 1.51 mm2, and “macrodiscs” as larger than 3.79 mm2. Conclusions: Compared with data of preceding studies, mean optic disc size is larger in Chinese people than in white people. In Chinese people highly hyperopic eyes have significantly smaller optic discs, and highly myopic eyes have significantly larger optic discs than emmetropic eyes.

Diffuse diabetic macular oedema treated by intravitreal triamcinolone acetonide: a comparative, non-randomised study

Aim: To report on visual outcome of patients receiving an intravitreal injection of triamcinolone acetonide for treatment of diffuse diabetic macular oedema. Methods: Prospective, comparative, non-randomised clinical interventional study included 136 patients with diffuse diabetic macular oedema. Patients of the study group (97 eyes) received an intravitreal injection of 20–25 mg of triamcinolone acetonide and no other retinal treatment. Patients of the control group (69 eyes) received focal or panretinal laser treatment if indicated. Mean (standard deviation) follow up was 8.4 (SD 6.0) months (range 1.03–25.2 months). Results: Visual acuity (VA) increased significantly (p<0.001) in the study group with 66 (68%) eyes gaining in VA by at least two Snellen lines. In the control group, VA did not change significantly during the first 4 months of follow up, and decreased significantly (p<0.001) towards the end of the follow up. Difference in change of best VA was significant (p<0.001) between both groups. Correspondingly, the number of patients with VA improvement of two or more Snellen lines and visual loss of two or more Snellen lines, respectively, was significantly (p<0.001) higher and lower, respectively, in the study group. Conclusions: Intravitreal triamcinolone acetonide can temporarily increase VA in some patients with diffuse diabetic macular oedema.

Exudative age-related macular degeneration treated by intravitreal triamcinolone acetonide. A prospective comparative nonrandomized study.

AbstractPurposeTo report on visual outcome of patients receiving an intravitreal injection of triamcinolone acetonide as treatment of progressive exudative age-related macular degeneration.MethodsThe prospective comparative nonrandomized clinical interventional study included 187 consecutive patients with progressive exudative age-related macular degeneration, divided into a study group of 115 patients receiving an intravitreal injection of 25 mg triamcinolone acetonide, and a control group of 72 patients without treatment. The mean follow-up was 6.0±4.2 months.ResultsVisual acuity increased significantly (P=0.03) in the study group, and decreased significantly (P=0.01) in the control group, at 1 month and 3 months after start of the study. Between the study group and control group, the differences in change of visual acuity were significant (P=0.001). In the study group, the number of patients with an increase in visual acuity of 2 or more Snellen lines was significantly (P=0.001) larger than in the control group. Correspondingly, the number of patients with a decrease of 2 or more Snellen lines was significantly (P=0.007) smaller in the study group. In all, 43 (37.4%) patients of the study group experienced an increase in best visual acuity by 2 or more Snellen lines.ConclusionsVisual acuity increased in patients with exudative age-related macular degeneration at 1 month and 3 months after an intravitreal injection of 25 mg triamcinolone acetonide.

Short-term complications of intravitreal injections of triamcinolone and bevacizumab

AimsTo evaluate the rate of complications after intravitreal injection of bevacizumab and triamcinolone.MethodsThe clinical interventional case-series study included 5403 intravitreal injections of about 20 mg triamcinolone acetonide (n=1588) or 1.5 mg bevacizumab (n=3818) consecutively performed in the period from 2000 to 2007 by three surgeons for treatment of various intraocular edematous or neovascular diseases. Follow-up after each injection was at least 4 weeks.ResultsAn infectious endophthalmitis which necessitated pars plana vitrectomy was detected in two eyes (2/5403 or 0.04±0.03%) from the bevacizumab group. Two eyes (2/5403 or 0.04±0.03%) from the bevacizumab group showed a painless vitreous clouding which subsided after intensified topical antibiotic therapy; one eye (1/5403 or 0.02±0.02%) developed a retinal detachment; and three eyes (3/5403 or 0.06±0.03%) (two eyes from the bevacizumab group) showed a rapidly progressive cataract. The total rate of these complications was 8/5403 (0.15±0.05%). It was statistically independent of the surgeon (P=0.18), the drug injected (P=0.45), and the age of the patients (P=0.87).ConclusionsInjection-related complications such as infectious endophthalmitis, retinal detachment, and traumatic cataract may occur with a frequency of about 0.15±0.05% after intravitreal injections of bevacizumab or triamcinolone, independently of the drug injected.

Visual acuity in northern China in an urban and rural population: the Beijing Eye Study

Aim: To evaluate prevalence and demographic associations of visual impairment in an urban and rural population in northern China. Methods: In the Beijing Eye Study, a population based cohort study in northern China, visual acuity was assessed for 8876 eyes (4438 subjects) according to a response rate of 83.4%. The study was divided into a rural part (1972 subjects) and an urban part (n = 2466). Mean age was 56.20 (SD 10.59) years (median 56 years; range 40–101 years). Results: Mean uncorrected visual acuity measured 0.72 (0.32) (median, 0.80), and mean best corrected visual acuity measured 0.91 (0.21) (median, 1.0). In a multiple regression analysis, best corrected visual acuity was significantly correlated with age (p<0.001), degree of nuclear cataract (p<0.001), amount of cortical cataract (p = 0.014), amount of subcapsular cataract (p<0.001), educational background (p<0.001), and refractive error (p<0.001). Rural region versus urban region (p = 0.34) and sex (p = 0.053) were not statistically significantly associated with best corrected visual acuity. Conclusions: In northern China, determinants of a low degree of best corrected visual acuity are age, cataract, low educational background, and myopia. Despite marked differences in educational background and family income, sex, and rural area versus urban area are not markedly associated with best corrected visual acuity.

Cataract surgery after intravitreal injection of triamcinolone acetonide

AbstractPurpose To report the clinical outcome of patients undergoing cataract surgery after one or repeated intravitreal injections of triamcinolone acetonide as treatment of intraocular neovascular or oedematous diseases.Methods The interventional clinical case series study included all patients (n=22) who presented with cataract which had progressed after a single or repeated intravitreal injection of 25 mg of triamcinolone acetonide as treatment of exudative age-related macular degeneration (n=18) or diffuse diabetic macular oedema (n=4). Duration of the follow-up period was 3.76±4.99 months. With topical anaesthesia, the patients underwent standard cataract surgery including clear cornea incision, phakoemulsification and aspiration of the lens nucleus and cortex, and implantation of a foldable posterior chamber lens. The main outcome measures were frequencies of capsular rupture, vitreous loss, postoperative infectious endophthalmitis, secondary cataract, and decentration of the intraocular lens, visual acuity and intraocular pressure.Results Intraoperative dialysis of the lens zonules occurred in one (4.5%) eye and resulted in a loss of vitreous. Secondary cataract leading to Nd : YAG laser capsulotomy was observed in one (4.5%) eye. An optically significant decentration of the IOL or infectious endophthalmitis was not encountered in any patient. Visual acuity increased from 0.11±0.10 to 0.13±0.94 during the follow-up. Within 1 week after surgery, intraocular pressure was in the normal range in all the eyes.Conclusions Cataract surgery after single or repeated intravitreal injection of 25 mg of triamcinolone acetonide does not harbour a markedly elevated frequency or a markedly changed profile of surgical complications.

Factors influencing visual acuity after intravitreal triamcinolone acetonide as treatment of exudative age related macular degeneration

Aim: To evaluate factors influencing change in visual acuity (VA) after intravitreal injection of triamcinolone acetonide as treatment of exudative age related macular degeneration (AMD). Methods: This prospective, interventional, comparative non-randomised clinical case series study included 94 patients (99 eyes) showing progressive exudative AMD with occult (n = 61 eyes), minimally classic (n = 18), predominantly classic (n = 1), or totally classic (n = 8) subfoveal neovascularisation. Mean follow up was 8.5 (SD 4.7) months (median, 7.3 months; range 3.1–24.5 months). All patients received an intravitreal injection of 20–25 mg of triamcinolone acetonide. Results: An increase in best VA of at least one line on the Snellen charts was found in 63 (63.1%) eyes. Correspondingly, mean VA increased significantly (p<0.001) from 0.17 (SD 0.13) to 0.22 (SD 0.17) after the injection. Postoperative increase in VA was significantly (p<0.001) and negatively correlated with preoperative VA (correlation coefficient, −0.49). Gain in visual acuity was significantly (p = 0.009) higher if preoperative visual acuity was less than 0.08 (gain: 3.2 (SD 2.9) Snellen lines) than if preoperative VA ranged between 0.08 and 0.20 (gain: 1.2 (SD 2.2) Snellen lines). Change in VA was significantly (p = 0.016) less if preoperative VA was higher than 0.20 (change: −0.8 (SD 3.4) Snellen lines). Maximal gain in VA was significantly (p = 0.035) larger in eyes with retinal pigment epithelium detachment than in eyes with minimally classic subfoveal neovascularisation. This was statistically independent of age (p = 0.99), refractive error (p = 0.88), sex (p = 0.92), and duration of follow up (p = 0.46). Conclusions: Gain in VA after intravitreal injection of 20–25 mg of triamcinolone acetonide is significantly and negatively correlated with preoperative VA. It is significantly larger in eyes with retinal pigment epithelium detachment than in eyes with minimally classic subfoveal neovascularisation.