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Purpose: To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA)., Methods: Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation., Results: Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively)., Conclusion: Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery., (© 2021 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare the efficacy, safety and tolerability of a single perioperative subconjunctival injection of triamcinolone acetonide (TA) with steroid drops for the prevention of macular oedema and ocular inflammation after cataract surgery., Methods: This prospective non-randomized controlled clinical trial analysed 101 eyes of 101 patients having an elective cataract surgery at Kymenlaakso Central Hospital, Kotka, Finland. Fifty eyes received conventional postoperative care with dexamethasone 1 mg/ml eye drops (DEX), and 51 eyes received a perioperative 20 mg subconjunctival injection of TA. None of the eyes received postoperative topical antibiotic prophylaxis. The main outcome measures were aqueous flare, central retinal thickness (CRT), corrected distance visual acuity (CDVA) and intraocular pressure (IOP) measured at 7, 28 and 90 days after surgery., Results: Central retinal thickness (CRT) increased in DEX but not in TA-treated eyes at 7 days (+1.2 ± 20.1 μm and -9.2 ± 24.8 μm, p = 0.031), at 28 days (+23.8 ± 62.6 μm and -3.3 ± 27.7 μm, p = 0.008) and at 90 days (+8.5 ± 24.4 μm and -5.5 ± 33.4 μm, p = 0.026). Aqueous flare increased from baseline in both groups but remained higher in DEX eyes at 90 days (+3.3 ± 9.9 photons/ms and -0.2 ± 6.6 photons/ms, p = 0.021). Corrected distance visual acuity (CDVA) and IOP changes were similar, and ocular tolerance was good in both groups. No serious adverse events were observed., Conclusions: Perioperative subconjunctival TA was effective in preventing ocular inflammation and macular oedema after cataract surgery. Subconjunctival TA combined with intracameral cefuroxime provides a noteworthy option for dropless postoperative care in modern cataract surgery., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To evaluate the effects of repeated intravitreal injections of bevacizumab (IVB) versus triamcinolone acetonide (IVT) in the treatment of acute central retinal vein occlusion (CRVO)., Methods: In this randomized clinical trial, 86 eyes with recent onset (<12 weeks) CRVO were assigned to two groups: IVB group (43 eyes) that received three monthly injections of 1.25 mg of IVB, and IVT group (43 eyes) that received two injections of 2 mg IVT 2 months apart. Outcomes were best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) changes., Results: Mean BCVA improved significantly at 6 months in both groups; from 0.87 ± 0.49 to 0.41 ± 0.35 logMAR in IVB group, and from 0.81 ± 0.45 to 0.62 ± 0.48 logMAR in IVT group (p < 0.001). However, between-group differences reach a significant level at months 4 (p = 0.003) and 6 (p < 0.001) in favour of the IVB group. In terms of CMT reduction, the difference between the groups was statistically significant (p = 0.002) at month 6. Significant differences were noted more in the ischaemic cases in favour of the IVB group. Mean IOP rise was significantly higher in the IVT group at all visits., Conclusions: Both 3-times monthly IVB injections and 2-times IVT injections could be effective in cases with recent onset CRVO up to 6 months. However, considering the better outcomes after IVB injections and the potential complications of IVT injections, we would recommend prescheduled repeated IVB injections for such cases. The observed favourable responses were more pronounced in the ischaemic types; nevertheless, this should be confirmed in larger studies., (© 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To investigate the changes in the aqueous levels of various cytokines after intravitreal triamcinolone or bevacizumab for branch retinal vein occlusion (BRVO)., Methods: Twenty-four eyes with macular oedema associated with BRVO and six eyes of six patients undergoing cataract surgery participated in this study. Each patient with BRVO randomly received an intravitreal injection of either 4 mg triamcinolone or 1.25 mg bevacizumab. Aqueous samples were obtained before and 4 weeks after the intravitreal injection in the BRVO group and before surgery in the control group. Aqueous concentrations of 16 cytokines were measured via multiplex bead assay., Results: Prior to the administration of the drugs, aqueous levels of interleukin (IL)-6, IL-8, IL-17 and vascular endothelial growth factor (VEGF) were significantly higher in the BRVO group than in the control group (p=0.044, p=0.013, p<0.001, and p=0.008, respectively). Between the control group and the BRVO group, no significant differences were noted between pre- and postinjection best-corrected visual acuity (p=0.60, p=0.54) and central foveal thickness (p=0.47, p=0.82). In the triamcinolone group, levels of IL-6, IL-17, IP-10, platelet-derived growth factor (PDGF)-AA and VEGF were reduced significantly (p=0.012, p<0.001, p<0.001, p=0.015, and p<0.001, respectively). But in bevacizumab group, only VEGF was significantly reduced (p<0.001). Between the IVTA group and the IVBe group, no significant differences in the changes in VEGF levels were noted (p=0.06)., Conclusion: Triamcinolone injection reduces plural inflammatory cytokines in BRVO, while bevacizumab has no influence on other cytokines as selective anti-VEGF therapy. No differences in the therapeutic effect were noted between an inhibition of plural inflammatory cytokines and an inhibition of VEGF only., (© 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

Purpose: To compare the efficacy of intravitreal injections of triamcinolone acetonide (TA) and that of bevacizumab for macular oedema because of branch retinal vein occlusion (BRVO)., Design: Prospective, comparative, randomized, interventional clinical trial., Methods: Forty-three eyes of 43 patients with macular oedema because of BRVO were randomly assigned to 4-mg intravitreal injections of TA (IVTA)(21 patients, IVTA group) or 1.25-mg intravitreal injections of bevacizumab (IVB) (22 patients, IVB group) and followed for 12 months. No additional treatments were administered for 3 months after the initial injection; additional injections were administered when macular oedema recurred between 3 and 12 months after the initial injection. The best-corrected visual acuity (BCVA) and the central retinal thickness (CRT) were measured at baseline and monthly. The main outcome measures were changes in the logarithm of the minimal angle of resolution BCVA and CRT from baseline to 12 months., Results: Eighteen eyes of 18 patients in the IVTA group and 18 eyes of 18 patients in the IVB group completed follow-up at 12 months. The mean improvements in BCVA from baseline to 12 months were 0.12 in the IVTA group and 0.33 in the IVB group, which was significantly (p = 0.032) higher than in the IVTA group. There was no significant difference between the two groups in the mean reduction in CRT from baseline to 12 months after the initial injection. Two eyes in the IVTA group required intraocular pressure-lowering medications., Conclusion: Intravitreal injection of bevacizumab may be of greater benefit than that of TA for macular oedema because of BRVO., (© 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To determine the aqueous humour levels of chemokines before and after an intravitreal injection of triamcinolone acetonide (IVTA) in eyes with macular oedema associated with a branch retinal vein occlusion (ME-BRVO)., Design:   Single-centre, prospective, consecutive interventional case series., Participants: Seventeen eyes of 17 consecutive patients with ME-BRVO who underwent IVTA were studied. Seven eyes without retinal vascular disease served as control., Intervention: All patients with ME-BRVO underwent IVTA., Main Outcome Measures: The optical coherence tomographically determined foveal thickness (FT) and the aqueous humour levels of inflammatory chemokines of the C-C subfamily, including eotaxin, monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), β (MIP-1β), and RANTES was determined before the IVTA (baseline) and at 1 week after the IVTA., Results: At the baseline, only MCP-1 and MIP-1β were detected in the aqueous, and MIP-1β was significantly higher in eyes with a ME-BRVO than in controls (p = 0.004). The level of both of these chemokines was not correlated with the FT (p = 0.654 and p = 0.608, respectively). One week after IVTA, the FT was significantly decreased (p < 0.001), and the levels of MCP-1 and MIP-1β were also significantly reduced (p < 0.001 and p = 0.044, respectively). The decrease in the FT was correlated with the decrease in only MIP-1β (r = 0.58, p = 0.020)., Conclusions: Alterations of the aqueous level of MIP-1β reflect the improvement of the macular oedema after IVTA in eyes with ME-BRVO. This indicates that the steroid-dependent ME-BRVO was closely related with the level of MIP-1β., (© 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To compare the effect of a single intravitreal injection of triamcinolone acetonide and bevacizumab in reducing macular thickness, which was measured by optical coherence tomography (OCT) in patients with diabetic macular oedema (DMO)., Methods:   The patients received a single intravitreal injection of 1.25 mg bevacizumab in one randomly selected eye and 4.0 mg triamcinolone acetonide in the contralateral eye. Central foveal thickness measurement (CFT) with OCT was taken at the initial visit and at the 4-week, 12-week and 24-week visits., Results: Eleven patients (22 eyes) were enrolled and statistically analysed. CFT reduced in the eyes treated with triamcinolone and those treated with bevacizumab in weeks 4 and 12 (p < 0.05). At the 24-week follow-up, no significant difference was noted, relative to the initial visit. Comparing the two groups treated with different drugs, a statistically significant difference in CFT in weeks 4 and 12 was noted, with a more significant reduction in triamcinolone-treated eyes (p < 0.05). Regarding visual acuity (VA), patients treated with triamcinolone had improvement in VA at 4-week (p = 0.02) and 12-week follow-up (p = 0.01), while the group treated with bevacizumab had VA improvement at 4 -week follow-up (p = 0.02). Among the eyes treated with triamcinolone, intraocular pressure (IOP) measurement of more than 21 mmHg was found in three eyes (27.3%)., Conclusions: Intravitreal triamcinolone proved to be more efficient in reducing DMO, providing longer lasting visual improvement, relative to bevacizumab. Eyes treated with triamcinolone had the highest percentage increase in IOP. Further studies are needed to corroborate these findings., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)

Objective: To compare efficacy of intravitreal bevacizumab versus triamcinolone in the treatment of diffuse diabetic macular oedema (DME)., Methods: This retrospective nonrandomized study includes 60 patients with diffuse DME treated with at least one intravitreal triamcinolone injection (ITA) or intravitreal bevacizumab injection (IBe). Regression analysis was performed for pretreatment, glycosylated haemoglobin level, visual acuity (VA) at baseline and central macular thickness (CMT) at baseline., Results: After 1-, 3-, 6- and 9-month follow-up, there was no significant change in either VA or CMT treatment in the ITA and IBe groups. There was no statistically significant difference between the two treatment groups. Changes in CMT and VA in the subgroups were not significant. Only predictive factor independent of HbA1c level and VA was CMT at baseline in both treatment groups. The thicker CMT at baseline, the higher was reduction in CMT. After 1 month, the IBe group had a significantly higher decrement than the ITA group., Conclusion: In our study collective, neither IBe nor ITA treatment was able to improve VA during follow-up, significantly. CMT was reduced in both treatment groups, however not significantly. Our data demonstrates that reduction in CMT with either IBe or ITA treatment was significantly influenced by degree of CMT at baseline., (© 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.)

Purpose: To compare intravitreal bevacizumab (IVB) injection versus macular photocoagulation (MPC) or a combination of intravitreal bevacizumab and intravitreal triamcinolone acetonide (IVB/IVTA) injection in improving visual acuity (VA) of patients with primary diabetic macular oedema (DMO)., Methods: The following databases were searched: Medline (1950 - December week 3, 2009), The Cochrane Library (Issue 4, 2009), EMBASE (up to 24 December 2009), and the TRIP database (up to 23 December 2009), using no language or other limits. Randomized controlled trials were included that consisted of patients with primary DMO (not with refractory DMO), those comparing IVB injection with MPC or IVB/IVTA injection, those reporting VA outcomes, and those having a minimum follow-up of 6 weeks., Results: In the four randomized clinical trials comparing IVB injection with MPC, IVB injection demonstrated significantly greater improvement in VA at 6 weeks, but not at 12 weeks. In the three randomized clinical trials comparing IVB injection with IVB/IVTA, IVB injection demonstrated greater improvement in VA at 6 weeks but the benefit was again no longer significant at 12 weeks. No adjunctive effect of IVTA was demonstrated., Conclusions: Intravitreal bevacizumab injection is effective in improving VA in patients with primary DMO for 6 weeks, but the benefits are no longer present 12 weeks following the injection., (© 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.)

Purpose: This study aimed to observe changes in anterior chamber parameters and the course of intraocular pressure (IOP) after injection of 0.1 ml intravitreal triamcinolone acetonide (TA) and to determine differences between phakic and pseudophakic eyes without vitreous reflux., Methods: A prospective observational clinical trial was conducted with 89 patients who received an intravitreal injection of TA and did not display vitreous reflux. Intraocular pressure measurements were made before injection and at 3, 10, 20, 30 and 40 mins after injection. Pentacam measurements were made before injection and at 5, 15, 30 and 45 mins after injection., Results: Anterior chamber depth (ACD) and anterior chamber volume (ACV) were significantly greater in pseudophakic eyes than in phakic eyes at all measurement time-points (p < 0.001). There was a decrease in both ACD and ACV at 5 mins after injection, and a gradual increase to normal values was observed at 15, 30 and 45 mins after injection in all study eyes. Compared with pre-injection measurements, changes in ACD and ACV were statistically significant at each time-point in both phakic and pseudophakic eyes (p < 0.001). A significant increase in IOP within 3 mins of injection was observed in both groups and a more rapid decrease 10 mins after injection was observed in pseudophakic eyes. The differences in IOP between phakic and pseudophakic eyes at all measurement time-points, except baseline and 3 mins after injection, were statistically significant (p < 0.001). Intraocular pressure < 30 mmHg and < 24 mmHg was recorded in all pseudophakic eyes at 10 and 20 mins after intravitreal injection, respectively., Conclusions: Following intravitreal injection of 0.1 ml TA, without vitreous reflux, IOP decreased to safe levels more quickly in pseudophakic eyes than in phakic eyes. Although there were more pronounced changes in anterior chamber parameters in pseudophakic eyes, these changes were reversible without any residual clinical significance., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)

Purpose: This study aimed to evaluate the course of macular sensitivity (MS) following treatment with reduced fluence photodynamic therapy (RPDT) versus standard photodynamic therapy (SPDT) in combination with intravitreal triamcinolone acetonide (IVTA) in patients with neovascular age-related macular degeneration, and to investigate the correlation between MS and angiographic outcomes., Methods: Forty eyes in 40 patients were included in this prospective, randomized clinical study. Group 1 patients received RPDT (n = 20, light dose of 25 J/cm(2) at 300 mW/cm(2)); group 2 patients received SPDT (n = 20, light dose of 50 J/cm(2) at 600 mW/cm(2)). All patients received 4 mg IVTA administered on the same day as RPDT or SPDT. Microperimetry, visual acuity testing (ETDRS) and fluorescein angiography (FA) were performed at baseline, and at months 3, 6, 9 and 12. Main outcome parameters were mean differential light threshold (DLT), and absolute and relative scotoma size., Results: Mean DLT decreased from 4.71 dB at baseline to 3.45 dB after 12 months in the SPDT + IVTA group (mean decrease 1.26 dB; p > 0.05) and from 5.42 dB to 4.92 dB in the RPDT + IVTA group (mean decrease 0.5 dB; p > 0.05). Absolute and relative scotoma sizes remained stable in both groups at 12 months (mean change 0 and -0.6 test-points; p > 0.05). Mean DLT values and absolute scotoma sizes correlated well with early and late leakage areas in FA (r = -0.45 to -0.80, p < 0.02)., Conclusions: With regard to MS, RPDT + IVTA did not show significant benefits over SPDT + IVTA at 12 months. Macular sensitivity correlated well with angiographic outcomes., (© 2009 The Authors. Journal compilation © 2009 Acta Ophthalmol.)

Purpose: To investigate the correlation between integrity of foveal photoreceptor layer and initial as well as final visual acuity (VA) after successful resolution of macular oedema (ME) associated with retinal vein occlusion (RVO)., Methods: We retrospectively studied 31 eyes of 31 patients with resolved ME secondary to RVO. The integrity of foveal photoreceptor layer was studied using the junction between photoreceptor inner and outer segment (IS/OS) on spectral domain optical coherence tomography (SD OCT). The study eyes were categorized into three groups at final visit; V group with completely visible IS/OS, P group with partially detected IS/OS and I group with invisible IS/OS. Disrupted length of IS/OS and external limiting membrane (ELM) were measured., Results: Final VA (logMAR) was closely associated with the IS/OS integrity at final visit; final VA in V group (0.03 ± 0.05) was better than that in P group (0.21 ± 0.23) (p = 0.027) and final VA in P group was better than that in I group (0.70 ± 0.36) (p = 0.004). Better initial VA (logMAR) and shorter length of disrupted IS/OS at initial visit were closely associated with better final VA (logMAR). In addition, final VA (logMAR) was closely associated with the length of disrupted IS/OS and ELM at final visit., Conclusions:   After resolution of ME associated with RVO, the final VA is associated with the integrity of foveal photoreceptor layer. Better VA and the smaller length of disrupted IS/OS on SD OCT at initial visit are indicators of better visual outcome in patients with RVO., (© 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To report the outcome of orbital floor corticosteroid injection (OFCI) in the management of uveitis in children., Methods:   A retrospective noncomparative interventional case series. The medical records of 15 consecutive children (19 eyes) with various forms of uveitis treated with OFCI of 40 mg/ml methylprednisolone acetate or a combination of 20 mg/0.5 ml Triamcinolone and 2 mg/0.5 ml dexamethasone were reviewed. Data were collected 6 months postinjection and included details of uveitis, best corrected visual acuity (BCVA), ocular inflammation, systemic therapy required and potential complications of OFCI., Results: The mean BCVA improvement was 0.18 logarithm of the minimum angle of resolution (p < 0.001), at a mean of 6 weeks (range, 4-20). Fourteen eyes (74%) had significant improvement in inflammation, 4-7 weeks post-OFCI, with a median of 4 weeks. Anterior uveitis was treated effectively in all eyes, vitritis resolved in all but one case and resolution of cystoid macular oedema was achieved in six eyes (55%). Uveitis relapsed in seven eyes (50%) after a median time of 4 months (range, 2-5 months). Four eyes (21%) underwent more than one injection. The dosage of immunosuppressive systemic therapy was reduced or able to be stopped in three patients (50%). Steroid-induced cataract was observed in four eyes (21%), 5 months post-OFCI. One patient developed cushingoid features 6 weeks post his second OFCI., Conclusion: Corticosteroid orbital floor injections resulted in control of active uveitis and visual acuity improvement in most children. However, the effect might be transient and induce cataract formation., (© 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: To evaluate best-corrected visual acuity (BCVA) and foveal thickness (FT) changes in occult subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) after intravitreal bevacizumab (IVB, 1.25 mg/0.05 ml), pegaptanib (IVP, 0.3 mg/0.09 ml) and triamcinolone acetonide (IVTA, 4 mg/0.1 ml) injected on an as needed basis., Methods:   Retrospective, interventional, comparative study. BCVA (Early Treatment Diabetic Retinopathy Study LogMAR) and FT by optical coherence tomography (OCT) were evaluated during 12 months from first treatment. Patients were retreated if signs of neovascular activity were still present on angiography or OCT., Results: Forty-eight eyes received IVB, 43 eyes received IVP, 52 eyes received IVTA. BCVA and FT at baseline were 1.22 ± 0.49 LogMAR and 410.2 ± 41.83 μm in the IVB group, 1.25 ± 0.43 LogMAR and 452.3 ± 44.83 μm in the IVP group and 1.31 ± 0.4 LogMAR and 456.6 ± 48.27 μm in the IVTA group. BCVA and FT improved in the three groups during follow-up. A significantly greater improvement of BCVA was present at month-3, month-6 and at month-12 in the IVB and IVP groups (p = 0.01). Improvement of FT was greater in the IVTA group at month-3 (p = 0.02), while it was greater in the anti-Vascular Endothelial Growth Factor (VEGF) groups at month-6 and month-12 (p = 0.01). A postoperative increase of intraocular pressure was detected in 9/52 (17.3%) eyes treated with IVTA, and in two cases it was resistant to topical therapy., Conclusion:   Intravitreal injection of anti-VEGF drugs administered on an as needed basis for AMD-related occult CNVs provided functional and anatomic improvement during 12 months of follow-up., (© 2010 The Authors. Acta Ophthalmologica © 2010 Acta Ophthalmologica Scandinavica Foundation.)

Purpose: We aimed to evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on macular function in patients with diabetic macular oedema (DMO)., Methods: Eleven eyes in 11 patients with DMO were enrolled. In each eye, at baseline and at 30 days after IVTA injection, logMAR visual acuity (VA), macular sensitivity, fixation stability and fixation location by MP-1 microperimetry and optical coherence tomography (OCT) foveal thickness were assessed., Results: Thirty days after IVTA injection, eyes with DMO showed a significant (p<0.001) reduction in foveal thickness and significant (p<0.01) increases in logMAR VA and MP-1 retinal sensitivity (p<0.001). There was also significant (p=0.046) improvement in fixation location and some improvement in fixation stability, although the latter was not significant (p=0.08)., Conclusions: In eyes with DMO, short-term improvement in retinal sensitivity and fixation properties can be achieved by IVTA injection.

Objectives: This study aimed to evaluate the evidence for the effects of steroid injection in addition to macular laser grid (MLG) photocoagulation versus those of MLG photocoagulation alone on visual acuity (VA) in patients with diabetic macular oedema (DMO)., Methods: An extensive literature search in Medline (PubMed), Experta Medica (EMBASE) and the Cochrane Library (CENTRAL) using synonyms for MLG photocoagulation, steroid injection and DMO found 181 articles. Of the articles that met selection criteria, three studies in which patients receiving MLG photocoagulation were randomized to additional pretreatment with steroids provided the best available evidence. In addition to VA, central foveal thickness (CFT) was measured at baseline and at 6 months in all three studies., Results: Two studies, with total populations of 73 and 42 eyes, respectively, reported no additional effect of steroid injection on VA. One study, with a total of 41 eyes, reported a beneficial effect of pretreatment with steroids on VA of -0.21 ETDRS logMAR units. All three studies reported larger reductions in CFT in eyes pretreated with steroids, the smallest of which was 64 microm., Conclusions: Although there is a greater reduction in CFT in eyes pretreated with steroids, this does not consistently result in higher VA. The literature search does not provide sufficiently strong evidence to recommend steroid injection before MLG photocoagulation in DMO.

Purpose: To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO)., Methods: Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization., Results: Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t-test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months., Conclusions: PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery.

Purpose: To investigate the effectiveness of repeated injections of intravitreal triamcinolone acetonide (IVTA) in the treatment of macular oedema caused by central retinal vein occlusion (CRVO)., Methods: Seventeen pseudophakic or aphakic eyes of 17 patients (10 male, seven female) with macular oedema caused by CRVO received a repeat injection of 4 mg IVTA, 16 weeks after the first injection of the same dose. The examination included measurements of best-corrected visual acuity (BCVA) for distance and central foveal thickness (CFT) by optical coherence tomography (OCT), preoperatively and 1, 2, 3 and 4 months postoperatively. The values were compared by paired-t test. Side-effects were monitored., Results: BCVA and CFT were not significantly different before initial and repeat injections. Transient improvements of BCVA and CFT were achieved after both injections. At the end of follow-up, BCVA and CFT were significantly different compared to pre-injection values in the same group (P = 0.032, 0.049 in the initial-injection group and P = 0.001, 0.008 in the repeat-injection group, respectively). However, compared to the initial injection, BCVA measurements were significantly worse at each time-point (P = 0.043, 0.011, 0.010 and 0.012, respectively) after the repeat injection, as were CFT at 1, 2 and 3 months post-injection (P = 0.040, 0.015 and 0.025, respectively). The achieved maximum mean intraocular pressures were 20.00 [standard deviation (SD) 2.06] mmHg and 18.56 (SD 3.65) mmHg after the first and repeat injections, respectively. These values were not significantly different (P = 0.467). No other significant adverse events were noted during the study., Conclusion: A repeat injection of 4 mg IVTA may not be as effective as an initial injection for the treatment of macular oedema caused by CRVO.

Purpose: To assess the effect of triamcinolone acetonide over 3 months on hard exudates in patients with diabetic macular oedema (DMO)., Methods: Thirty-two eyes of 16 patients with DMO and hard exudates were included in a randomized, placebo-controlled trial. Treated eyes received a single-dose (4 mg) intravitreal injection of triamcinolone acetonide. Control eyes received an injection of subconjunctival saline., Results: The overall area of hard exudates decreased significantly between the baseline and 3-month visits in treated eyes, but not in control eyes. The mean change in level of hard exudates between the two visits was -0.75 arbitrary units (AU) (95% confidence interval [CI] -1.32 to -0.18) in the central plus inner circle (1500 microm) and -0.81 AU (95% CI -1.49 to -0.13) over the whole grid (3000 microm) in treated eyes, compared with 0.31 AU (95% CI -0.19 to 0.82) and 0.31 AU (95% CI -0.11 to 0.74), respectively, in control eyes (p < 0.001). Mean visual acuity improved by five letters in treated but not in control eyes (p = 0.01)., Conclusions: Intravitreal triamcinolone reduces hard exudates in the short-term in eyes with DMO.

Purpose: This study aimed to investigate the functional results, efficacy and complications after photodynamic therapy (PDT) combined with intravitreal triamcinolone acetonide injection (IVTA) in patients with choroidal neovascularization (CNV) caused by age-related macular degeneration (AMD)., Methods: A retrospective analysis of clinical data for 54 patients with CNV resulting from AMD was carried out. All patients had a follow-up of 12 months. The patients were treated with standardized PDT and IVTA (4 mg) as a first-line treatment or following PDT failure. Visual acuity (VA), greatest linear diameter (GLD) of the CNV and foveal thickness were evaluated., Results: Mean VA at baseline was 0.8 logMAR (0.4-1.4). After 12 months VA improved (> 2 lines) in 20.4% of patients and stabilized (+/- 2 lines) in 64.8%. There was no statistical significance in VA outcome between patients undergoing first-line treatment and patients with PDT failure; however, fewer PDT treatments were required to stop CNV activity in patients undergoing first-line treatment. At 12 months, a reduction in foveal thickness was seen in 67.7% of patients and a reduction in CNV GLD in 32.7%. Complications occurred in 22% of patients and included a transient rise in intraocular pressure, cataract and sterile hypopyon., Conclusions: Our analysis shows that fewer PDT treatments were required to stop CNV activity when triamcinolone was used as first-line treatment. We can thus conclude that PDT combines synergistically with IVTA and the combination may lead to a cost reduction compared with PDT therapy alone. The overall complication rate of 22% is high and must be compared with complication rates caused by new intravitreal anti-VEGF (vascular endothelial growth factor) drugs in combination with PDT.

Purpose: In this study, we aimed to evaluate the efficacy of peribulbar triamcinolone injections to treat inflammatory signs of Graves' ophthalmopathy (GO) in patients with moderate to severe GO and associated optic neuropathy (ON)., Methods: Twenty-one patients with active GO [clinical activity score (CAS) > or = 4] and systemic thyroid disease under control were enrolled in this prospective pilot study. Peribulbar triamcinolone acetonide was injected in each orbit (42 eyes), in four doses of 20 mg at 2-week intervals. Ophthalmological examination including CAS evaluation, visual field, computerized tomography (CT) scan and digital photography were performed before and after treatment., Results: Twenty-one patients (11 with moderate disease, 10 with ON) were enrolled in this study and followed for at least 14 months. Initial mean CAS was 6.38 +/- 1.49, which dropped to 1.8 +/- 1.12 after 6 months of treatment (P = 0.01; mean difference of 4.57 +/- 1.56; range 1-8 score points). ON was diagnosed in 10 patients. Of these, 66% improved with peribulbar triamcinolone exclusively. A transitory increase in intraocular pressure in two patients was controlled with topic medication., Conclusion: Peribulbar triamcinolone injections reduce the inflammatory signs of moderate GO, as measured by the CAS, and could also be used as an alternative treatment for ON. Randomized clinical trials are needed to compare the results of triamcinolone peribulbar injections to those of other treatment modalities.

Purpose: To explore the efficacy, safety and tolerability of 1 mg intracameral triamcinolone acetonide (TA) in controlling ocular inflammation in patients undergoing cataract surgery., Methods: Sixty eyes of 60 patients undergoing cataract extraction with phacoemulsification at the Department of Ophthalmology, Baskent University School of Medicine were randomized into two groups. After surgery, eyes in group A were injected with 1 mg/0.1 ml TA into the anterior chamber, but eyes in group B were not. Postoperatively; in group B, topical prednisolone acetate 1% eyedrops were administered six times per day for 7 days, then four times per day for 15 days, to control postoperative inflammation. In group A, topical corticosteroids were not used. To evaluate the efficacy of intracameral TA, anterior chamber cells, anterior chamber flare and conjunctival hyperaemia were measured on postoperative days 1, 7 and 30 by slit-lamp biomicroscopy. The safety of intracameral TA was evaluated by visual acuity measurements, intraocular pressure values and fundus examination. Tolerance variables were assessed by the degree of burning, stinging and blurred vision., Results: Both treatments were equally effective in controlling postoperative inflammation following phacoemulsification. No statistically significant differences between groups were observed for the efficacy, safety and tolerance variables, and no serious adverse events were observed., Conclusions: Intracameral TA of 1 mg can effectively be used to control postoperative inflammation after uncomplicated cataract surgery with phacoemulsification. This makes it possible to decrease the dosage and duration of topical prednisolone acetate.

Purpose: To evaluate the effect of intravitreal injections of triamcinolone acetonide (IVTA) combined with panretinal photocoagulation (PRP) on visual acuity (VA) and foveal thickness in patients with concomitant high-risk proliferative diabetic retinopathy (PDR) and clinically significant macular oedema (CSMO)., Methods: This retrospective interventional case series included seven eyes diagnosed with both high-risk PDR and CSMO that underwent PRP and a single injection of 4 mg of IVTA. The main outcome measures were VA and foveal thickness, measured by optical coherence tomography (OCT) before treatment and throughout the follow-up period., Results: Median follow-up was 301 days (range 180-715 days). Foveal thickness data were available for four of seven eyes. Before the combined treatment, median LogMAR (logarithm of the minimum angle of resolution) VA and median foveal thickness were 1 (Snellen 20/200, range 20/40-20/800) and 559 microm (range 333-689 microm), respectively. After treatment, median vision improved to LogMAR 0.544 (Snellen 20/70, range 20/40-20/1000) (P = 0.13). Vision improved or remained stable in six of seven eyes. Median foveal thickness at final follow-up was 436 microm (range 259-623 microm) (P = 0.15). Foveal thickness decreased or remained stable in all eyes., Conclusion: The addition of IVTA to PRP in the treatment of eyes with high-risk PDR and CSMO may prevent PRP-induced foveal thickening and loss of vision.

Purpose: The efficacy and toxicity of triamcinolone acetonide and other lipid formulae--calcium palmitate, cholesterol and 11-deoxycortisol--in the visualization of the prolapsed vitreous body in the anterior chamber after posterior capsule rupture were investigated in animal models., Methods: In porcine eyes, a suspension of calcium palmitate, cholesterol, triamcinolone acetonide and 11-deoxycortisol was injected into the anterior chamber after intentionally creating posterior capsule rupture. Following gentle irrigation and aspiration, the vitreous body prolapsed in the anterior chamber was removed using an anterior vitrectomy cutter. In phakic rabbit eyes, the side-effects of the reagents were assessed for biomicroscopic appearance, intraocular pressure (IOP) and corneal histology., Results: The suspension of calcium palmitate, cholesterol, triamcinolone acetonide and 11-deoxycortisol was effective in the visualization of the vitreous body prolapsed in the anterior chamber after posterior capsule rupture. When cholesterol and calcium palmitate were injected into the anterior chamber, they remained there; this induced a significant increase in IOP and corneal oedema. In contrast, most of the triamcinolone acetonide and 11-deoxycortisol that was injected into the anterior chamber had disappeared a day after the injection without affecting IOP or corneal endothelial density. When injected into the intravitreous cavity, triamcinolone led to a significant increase in IOP 2 and 4 weeks after the injection. However, calcium palmitate, cholesterol and 11-deoxycortisol injected into the vitreous cavity had no effect on IOP at 4 weeks., Conclusion: The suspension of triamcinolone acetonide and 11-deoxycortisol was effective in visualizing the vitreous body prolapsed in the anterior chamber after posterior capsule rupture. However, the amount of the reagent must be kept to a minimum to prevent the potential risk of ocular toxicities and postoperative late-onset ocular hypertension.

Twenty chalazia were treated with intralesional triamcinolone acetonide injections. The diameter of 9 of the chalazia was less than 6 mm. Eight of them were cured after a single injection and 1 after 2 injections. The diameter of 11 of the chalazia was greater than or equal to 6 mm. Four cases responded to 1 injection and 5 to 2 injections. Two were operated on. Six patients had a recurrence 3-6 months later and were operated on. Corticosteroid injection is a serviceable alternative to surgery in the treatment of small chalazia. The indications are discussed.

A comparative study of intralesional steroid versus incision and curettage was carried out on 60 chalazia divided into 3 groups according to size. Intralesional therapy proved equally effective in small, multiple and marginal chalazia, while in large lesions incision and curettage scored better.

Corticosteroid (triamcinolone acetonide) injection of chalazion intralesionally is an effective, easy and a safe method. Perfect recovery was achieved in 88% of 24 chalazion cases (22 patients). Most of them were cured with a single injection. The steroid therapy is most effective when the chalazion has not been secondarily infected. If this has already happened surgery is the method of choice. If the steroid injections are limited only to common non-infected chalazia, the results will be excellent in about 100% of the cases. This treatment may be recommended especially for children and persons with allergy to local anaesthetics. It is particularly suitable for chalazia located close to the lacrimal punctum. Because of its simplicity, efficiency and almost non-existent risks, this method should also be convenient to physicians other than ophthalmologists.