Abstract
Background: To assess the safety and efficacy of post-scleral injection of triamcinolone acetonide (TA) in macular region to treat macular edema secondary to branch retinal vein occlusion (BRVO), and compare it with intravitreal injection of TA and Ranibizumab. Methods: This is a prospective, double masked and single-center study. Thirty-six eyes, one from each participant who was diagnosed with macular edema secondary to BRVO between July 2011 and December 2014, were randomised into three groups to receive post-sclera injection of 20mg/0.05ml TA (PS-TA), intravitreal injection of 2mg TA (IV-TA) and intravitreal injection of 0.5mg Ranibuzmab (IV-Ranibizumab), respectively. Changes of retinal thickness in optical coherence tomography (OCT) in foveal (zone 1) and average macular area (1-9 zones) at month 1 and 3 from baseline were the primary outcomes. The secondary study outcomes include changes of best corrected visual acuity (BCVA) and intraocular pressure (IOP) at month 1 and 3 from baseline and profile of adverse events. Results: The mean thickness changes from the baseline in macular fovea (zone 1) were statistically significant at month 1 in IV-TA and PS-TA groups, respectively (P-value < 0.0005 and P-value = 0.032), but not in Ranibizumab group (P-value = 0.083). At month 3, the mean thickness change from the baseline in macular fovea (zone 1) was statistically significant only in IV-TA group (P-value = 0.001). There was no significant difference in the mean thickness changes in macular region (zone 1-9) from baseline to month 1 or 3 in any group. No statistically significant differences were detected across the three treatment groups in mean thickness changes in macular fovea (zone 1) nor macular region (zone 1-9), over 1 and 3 months from baseline (P-values > 0.05). No Serious Adverse Event was detected in any treatment group during the study period. Two eyes in the IV-TA group had mild elevated IOP after the injection. Conclusion: PS-TA injection near macular region is safe and effective in treating macular edema secondary to BRVO. PS-TA could reduce the incidence of intraocular hypertension significantly, and thus has the advantages of safety compared to IVTA.
Macular sensitivity and morphology after intravitreal injection of triamcinolone acetonide for macular edema secondary to central retinal vein occlusion