Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

Abstract

Background: The influence of serous retinal detachment (SRD) on visual acuity, macular sensitivity, and macular thickness is unclear after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema with branch retinal vein occlusion (BRVO).

Methods: Twenty-one eyes of 21 BRVO patients with macular edema received IVTA. Patients were divided into two groups by optical coherence tomography findings: 11 patients who had cystoid macular edema (CME) with SRD (SRD (+) group) and 10 patients who had CME without SRD (SRD (-) group). Microperimetry was performed with a Micro Perimeter 1 before and at 3 and 6 months after IVTA. Macular thickness was measured by optical coherence tomography. We exchanged the superior and inferior regions to separate the regions into those with and without occlusion. As a result, the superior region was always the occluded region and the inferior region was non-occluded.

Results: In both the SRD (-) group and the SRD (+) group, the mean macular thickness within the central 4° field and the 10° and 20° fields of the occluded region decreased significantly from baseline to 3 and 6 months after IVTA (all P <0.01). Visual acuity also improved significantly in both groups from baseline to 3 and 6 months after IVTA (both P <0.05). In both groups, the mean macular sensitivity (measured with by microperimetry) within the central 4° field and the 10° and 20° fields of the occluded region showed a significant increase from baseline to 3 and 6 months after IVTA (all P <0.05). The trend profiles of macular thickness within the 10° and 20° fields of the occluded region showed significant differences, but there were no significant differences with respect to the trend profiles of visual acuity and macular sensitivity within the central 4° field and the 10° and 20° fields of the occluded region.

Conclusions: These results suggest that IVTA may achieve more marked improvement of macular morphology in BRVO patients with SRD than in those without SRD, while this therapy may have a similar effect on macular function in BRVO patients with or without SRD.

Figure 1

Trend profiles of the mean macular thickness after intravitreal injection of triamcinolone acetonide (IVTA) in BRVO patients with macular edema. (a) Central 4° field (SRD (+), P<0.001; SRD (-), P<0.001; SRD (+) vs. SRD (-), P=0.227). (b) 10° field of the occluded region (SRD (+), P<0.001; SRD (-), P<0.001; SRD (+) vs. SRD (-), P=0.019). (c) 10° field of the non-occluded region (SRD (+), P=0.001; SRD (-), P=0.165; SRD (+) vs. SRD (-), P=0.372). (d) 20° field of the occluded region (SRD (+), P<0.001; SRD (-), P=0.001; SRD (+) vs. SRD (-), P=0.020). (e) 20° field of the non-occluded region (SRD (+), P=0.085; SRD (-), P=0.058; SRD (+) vs. SRD (-), P=0.839).

Figure 2

Trend profile of the mean visual acuity after intravitreal injection of triamcinolone acetonide (IVTA) in BRVO patients with macular edema. SRD (+), P=0.005; SRD (-), P=0.007; SRD (+) vs. SRD (-), P=0.910.

Figure 3

Trend profiles of the mean macular sensitivity after intravitreal injection of triamcinolone acetonide (IVTA) in BRVO patients with macular edema. (a) Central 4° field (SRD (+), P=0.006; SRD (-), P=0.016; SRD (+) vs. SRD (-), P=0.518). (b) 10° field of the occluded region (SRD (+), P=0.007; SRD (-), P=0.018; SRD (+) vs. SRD (-), P=0.581). (c) 10° field of the non-occluded region (SRD (+), P=0.130; SRD (-), P=0.168; SRD (+) vs. SRD (-), P=0.468). (d) 20° field of the occluded region (SRD (+), P=0.022; SRD (-), P=0.049; SRD (+) vs. SRD (-), P=0.526). (e) 20° field of the non-occluded region (SRD (+), P=0.230; SRD (-), P=0.145; SRD (+) vs. SRD (-), P=0.782).