Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Grid Laser Photocoagulation After Intravitreal Triamcinolone for Macular Edema Associated With Branch Retinal Vein Occlusion

분지망막정맥폐쇄에 합병된 황반부종에서 유리체강내 트리암시놀론 주입과 격자광응고술의 효과

Lee, Seung-Uk;Kim, Su-Jin;Park, Young-Min;Lee, Ji-Eun;Oum, Boo-Sup
이승욱;김수진;박영민;이지은;엄부섭

  • Published : 2009.05.15
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Abstract

Purpose: To evaluate the clinical outcomes of macular laser photocoagulation after intravitreal injection of triamcinolone acetonide (IVTA) for macular edema in branch retinal vein occlusion (BRVO). Methods: In this retrospective study we reviewed the medical records of patients who had been treated with an intravitreal injection of 4 mg triamcinolone acetonide for macular edema due to BRVO and followed up for more than six months. We divided the eyes into two groups, namely, the IVTA-only group and the additional grid laser group after IVTA. Visual acuity, macular thickness, intraocular pressure, and abundance of IVTA were compared. Results: A total of 41 eyes underwent IVTA, 21 of which were treated with additional macular grid photocoagulation. The difference in best corrected visual acuity before IVTA between the two groups was not statistically significant. Laser photocoagulation was performed at an average of 2.8 months after IVTA. Final VA and foveal thickness improved significantly after IVTA in both groups and showed no significant difference between the two groups. After six months a second injection was required in six eyes in the IVTA group and one eye in the photocoagulation group due to recurrence of macular edema, the difference of which was significant (p=0.04). Conclusions: IVTA in BRVO patients improved macular edema and visual acuity. Combined grid photocoagulation after IVTA lowered the recurrence rate of macular edema. Grid photocoagulation can be considered as a useful adjuvant for avoiding repeated administration of intravitreal triamcinolone.

목적: 분지망막정맥폐쇄로 인한 황반부종 환자에서 유리체강내 트리암시놀론 주입술과 추가로 시행한 격자광응고술의 임상적 결과를 알아보고자 하였다. 대상과 방법: 트리암시놀론 주사 후 6개월 이상 경과관찰이 가능하였던 환자의 의무기록을 후향적으로 분석하여, 주사 후 격자광응고술을 시행하였던 군과 하지 않았던 군으로 나누었고, 주사 전 및 주사 후 최대교정시력, OCT상 황반두께와 황반부종의 재발 빈도를 비교하였다. 결과: 주사 시행 받은 총 41안 중 격자광응고술은 20안에서 시행되었다. 레이저는 주사 후 평균 2.8개월에 실시하였으며, 최종시력은 두 군 사이 유의한 차이가 없었다. 중심황반두께는 두 군 모두 주사 후 유의하게 감소하였으며, 주사 후 6개월간 황반부종의 재발로 인한 재주사의 빈도는 주사만 시행 받았던 군에서 6안(30%)에서, 레이저를 받은 군에서는 1안(5%)으로 유의한 차이를 보였다(p=0.04). 결론: 망막정맥폐쇄에서 트리암시놀론 주입술은 황반부종을 감소시키고, 시력향상에 도움을 주었다. 주사 후 추가로 시행한 격자광응고 술은 부종의 재발을 억제하는 효과가 있으므로, 트리암시놀론 반복 주사에 따른 부작용을 줄일 수 있을 것으로 기대된다.

Keywords

References

  1. Finkelstein D, Clarkson JG. Branch Vein Occlusion Study Group. Branch and central vein occlusions. Focal points 1987:Clinical modules for ophthalmologists. Am Acad Ophthalmol 1987;5:1-11
  2. Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol 1984;98:271-82
  3. Wallow IH, Danis RP, Bindley C, Neider M. Cystoid degeneration in experimental branch vein occlusion. Ophthalmology 1988;95:1371-9
  4. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report number 1. Arch Ophthalmol 1985;103:1796-806
  5. Lee H, Shah GK. Intravitreal triamconoloneas primary treatment of cystoid macular edema secondary to branch retinal vein occlusion. Retina 2005;25:551-5 https://doi.org/10.1097/00006982-200507000-00001
  6. Jonas JB, S$\ddot{o}$fker A. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema. Am J Ophthalmol 2001;132:425-7 https://doi.org/10.1016/S0002-9394(01)01010-8
  7. Degenring RF, Kamppeter B, Kreissig I, Jonas JB. Morphological and functional changes after intravitreal triamcinolone acetonide for retinal vein occlusion. Acta Ophtalmol Scand 2003:81:548-50 https://doi.org/10.1034/j.1600-0420.2003.00176.x
  8. Beer PM, Bakri SJ, Singh RJ, et al. Intraocular concentration and pharmacokinetics of triamcinolone acetonide after a single intravitreal injection. Ophthalmology 2003;110:681-6 https://doi.org/10.1016/S0161-6420(02)01969-3
  9. Chen SD, Sundaram V, Lochhead J, Patel CK. Intravitreal triamcinolone for the treatment of ischemic macular edema associated with branch retinal vein occlusion. Am J Ophthalmol 2006;141:876-83 https://doi.org/10.1016/j.ajo.2005.12.011
  10. Ozdek S, Deren YT, Gurelik G, Hasanreisoglu B. Posterior subtenon triamcinolon, intravitreal triamcinolone and grid laser photocoagulation for the treatment of macular edema in branch retinal vein occlusion. Ophthalmic Res 2008;40:26-31 https://doi.org/10.1159/000111155
  11. Lee DG, Cho NC. Combination of laser treatment and intravitreal triamcinolone injection for macular edema with branch retinal vein occlusion. J Korean Ophthalmol Soc 2005;46:287-96
  12. Yang HN, Kim YJ, Kim JC, Shyn KH. Clinical evaluation for branch retinal vein occlusion. J Korean Ophthalmol Soc 1992;33:593-9
  13. Roseman RL, Olk RJ. Krypton red laser photocoagulation for branch retinal vein occlusion. Ophthalmology 1987;94:1120-5
  14. Kang SJ, Chin HS, MoonYS. Visual prognosis of macular edema associated with macular ischemia in branch retinal vein occlusion. J Korean Ophthalmol Soc 2002;43:1621-8
  15. Rehak J, Rehak M. Branch retinal vein occlusion: pathogenesis, visual prognosis, and treatment modalities. Curr Eye Res 2008;33:11-31
  16. Duff IF, Fall HF, Linman JW. Anticoagulant therapy in occlusive vascular disease of retina. AMA Arch Ophthalmol 1951;46:601-17 https://doi.org/10.1001/archopht.1951.01700020615001
  17. Michel RG, Gass JD. The natural course of retinal branch vein obstruction. Trans Am Acad Ophthalmol Otolaryngol 1974;78:166-77
  18. Weiter JJ, Zuckerman R. The influence of photoreceptor-RPE complex on the inner retina: explanation for beneficial effect of photocoagulation. Ophthalmology 1980;87:1133-9
  19. Gottfredottir MS, Stefansson E, Jonasson F, G$\acute{i}$slason I. Retinal vasoconstriction after laser treatment for diabetic macular edema. Am J Ophthalmol 1993;115:64-7
  20. Clover GM. The effects of argon and krypton photocoagulation on the retina: implications for the inner and outer blood retinal barrier. In: Gitter KA, Schatz H, Yannuzzi LA, McDinald HR, eds. Laser photocoagulation of retinal disease. San Francisco, Calif: Pacific medical Press, 1988: v. 11. chap. 17
  21. Amarsson A, Stefansson E. Laser treatment and the mechanism of edema reduction in branch retinal vein occlusion. Invest Ophthalmol Vis Sci 2000;41:877-9
  22. Kim HC, Kim PS, Kim HK. The macular circulatory change in branch retinal vein occlusion. J Korean Ophthalmol Soc 1999;40:1911-7
  23. Oh JY, Seo JH, Ahn JK, et al. Early versus late intravitreal triamcinolone acetonide for macular edema associated with branch retinal vein occlusion. Korean J Ophthalmol 2007;21:18-20 https://doi.org/10.3341/kjo.2007.21.1.18
  24. Yepremyan M, Wertz FD, Tivnan T, et al. Early treatment of cystoid macular edema secondary to branch retinal vein occlusion with intravitreal triamcinolone acetonide. Ophthalmic Surg Lasers Imaging 2005;36:30-6
  25. Lee J, Lee JH. The effect of intravitreal triamcinolone acetonide on cytoid macular edema. J Korean Ophthalmol Soc 2004;45:408-13
  26. Cakir M, Dogan M, Bayraktar Z, et al. Efficacy of intravitreal triamcinolone for the treatment of macular edema secondary to branch retinal vein occlusion in eyes with or without grid laser photocoagulation. Retina 2008;28:465-72 https://doi.org/10.1097/IAE.0b013e318154b9d1

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