One year of intravitreal injections of steroids

Chronic macular oedema sometimes does not respond to classic treatment such as laserphotocoagulation, periocular and systemic steroids or carbonic anhydrase inhibitors. High dose intravitreal injection of steroids can be a valuable alternative in these patients.

Sixty-four eyes of 51 patients with chronic macular oedema, refractory to conventional treatments, received an intravitreal injection of 4 mg Kenacort (triamcinolone acetonide). At postoperative controls (1 day, 1 month, 3 months, 6 months, 1 year), the visual acuity, intraocular pressure, central retinal thickness on OCT II were analyzed retrospectively.

In the diabetic group, but also in cases of chronic uveitis, retinal vein thrombosis, birdshot chorioretinopathy, Irvine Gass syndrome, cellophane maculopathy and age-related macular degeneration with classic subfoveolar neovascular membrane, dramatic decrease of the oedema was observed on funduscopy and OCT. A statistically significant reduction of mean central foveal thickness of 61% at 1 week and 49% at 3 months post-injection was demonstrated on OCT. Considerable gain in visual acuity was noted. The highest benefit in post-operative visual acuity was achieved after 3 months and averaged a gain of +3.55 Snellen lines (n=39). In 17% of eyes a rise in intraocular pressure was noted. Unfortunately we had one case of endophthalmitis in a poorly regulated diabetic woman. Six eyes were retreated because of recurrence of macular oedema.

Intravitreal injection of steroids can dramatically help in some cases of chronic macular oedema, not reacting to classic treatment. The injection should be performed under sterile conditions since endophthalmitis is a potential risk. The most frequent complication seems to be a rise in intraocular pressure in cortisone responders.