Limits...
Resolution of severe macular edema in adult coats' disease with intravitreal triamcinolone and bevacizumab injection.

Jun JH, Kim YC, Kim KS - Korean J Ophthalmol (2008)

Bottom Line: The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection.An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema.The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea.

ABSTRACT
A 47 year old male patient visited our hospital with the chief complaint of deterioration of the visual acuity in the left eye. The fundus examination revealed thick hard exudates, multiple aneurysms and telangiectasias of the retinal vessels in the posterior pole. Fluorescein angiography demonstrated massive leakage over an area of the aneurysms. Optical coherence tomography (Stratus OCT; Zeiss-Humphrey, Dubin, CA) revealed diffuse and marked thickening of the retina. Laser photocoagulation was performed under the diagnosis of Coats' disease. However, the treatment could not be performed satisfactorily. On the first and 6th weeks, an intravitreal injection of bevacizumab and triamcinolone acetonide was administered, and laser photocoagulation was again attempted. The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection. At one week after the intravitreal bevacizumab injection, there was no improvement. An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema. Therefore, laser photocoagulation was performed sufficiently on telangiectasias. The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.

Show MeSH

Related in: MedlinePlus

Posttreatment findings. (A) At 6 weeks after triam-cinolone injection, macular edema recurred slightly, but thick hard exudates have been absorbed nearly totally at posterior pole (large arrows). focal laser photocoagulation scars were seen at temporal side of posterior pole (small arrows). And they are appropriate and sufficient. (B) Fluorescein angiography at 6 months after intravitreal triamcinolone injection, clinically significant macular edema was still remaining but leakage from telangiectatic vessels was much decreased, compared with angiography at initial diagnosis (large arrow). (C) 5th week after the intravitreal triamcinolone acetonide injection optical coherence tomogram shows decreased macular thickness and the reabsorption of serous retinal detachment. The retinal thickness at the central fovea is 244 µm. (D) At 6 months, the OCT showed that the macular edema had increased to 680 µm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2629899&req=5

Figure 2: Posttreatment findings. (A) At 6 weeks after triam-cinolone injection, macular edema recurred slightly, but thick hard exudates have been absorbed nearly totally at posterior pole (large arrows). focal laser photocoagulation scars were seen at temporal side of posterior pole (small arrows). And they are appropriate and sufficient. (B) Fluorescein angiography at 6 months after intravitreal triamcinolone injection, clinically significant macular edema was still remaining but leakage from telangiectatic vessels was much decreased, compared with angiography at initial diagnosis (large arrow). (C) 5th week after the intravitreal triamcinolone acetonide injection optical coherence tomogram shows decreased macular thickness and the reabsorption of serous retinal detachment. The retinal thickness at the central fovea is 244 µm. (D) At 6 months, the OCT showed that the macular edema had increased to 680 µm.

Mentions: A 47 year old male patient visited our hospital with the chief complaint ofacute progressive deterioration of the visual acuity of his left eye that had begun 2 months earlier. No specific findings were detected in his prior history. Thetotal cholesterol, component ratio of triglycerides, HDL-cholesterol and LDL-cholesterol were within the normal range. At the initial examination, the corrected visual acuity of his right and left eye was 1.0 and 0.02, respectively. The intraocular pressure of the right and left eye, measured using a non-contact tonometer, was 19 mmHg and 16 mmHg, respectively. The slit lamp examination revealed no specific special findings in the anterior segment and no rubeosis. The bilateral fundus examination showed normal findings in his right eye, and thick macular edema in the posterior pole in his left (Fig. 1A). Fluorescein angiography revealed profuse leakage with capillary dropout and a club shape thatdiffused to the blood vessels in the vicinity of the posterior pole (Fig. 1B). OCT showed that the retina thickness had thickened noticeably to 1,187 µm as a result of macular edema (Fig. 1C). Focal laser photocoagulation was attempted in the dilated vessel area but it was difficult to perform satisfactorily because of the thick retinal edema. The OCT taken 1 week after his first visit did not show any improvement of the macular edema. Therefore, bevacizumab (Avastin™, 25 mg/ml, 4 ml, Roche, USA) 1.25 mg (0.5 ml) was injected into the vitreal cavity in order to subside the retinal edema and facilitate focal laser photocoagulation on the telangiectatic vessels. Additional focal laser photocoagulation was then performed. However, OCT taken at 3 week visit after the injection showed that the macular thickness had barely changed. On the 6th week after treatment, an intravitreal injection of triamcinolone acetonide (Triamcinolone inj®, 40 mg/ml, 5 ml, Dongkwang pharma, Korea) 4 mg (0.1 ml) was performed to resolve the retinal edema for focal laser photocoagulation. One week after the triamcinolone acetonide injection, the visual acuity was 0.02 and showed no improvement. However, there was a noticeable reabsorption of the macular edema. At the 2nd week after the injection, the foveal structures began to recover. After 5 weeks, the retinal thickness had decreased to 244 µm (Fig. 2C). The visual acuity improved slightly to 0.04, and additional focal laser photocoagulation could be performed easily and satisfactorily with the absorption of the retinal edema. Repeated focal laser photocoagulation was performed at each visit until 10 weeks after injection, and the retinal edema remained stable. At 6 months, the OCT showed that the macular edema had increased to 680 µm (Fig. 2D). However, on color fundus photography, thick circinate hard exudates was much absorbed (Fig. 2A) and, fluorescein angiography revealed a significant decrease in leakage from telangiectactic vessels compared with that performed at the time ofthe initial diagnosis (Fig. 2B). Consequently, repeated injection of triamcinolone acetonide and repeated aggressive laser photocoagulation was planned in order to prevent further progression.


Resolution of severe macular edema in adult coats' disease with intravitreal triamcinolone and bevacizumab injection.

Jun JH, Kim YC, Kim KS - Korean J Ophthalmol (2008)

Posttreatment findings. (A) At 6 weeks after triam-cinolone injection, macular edema recurred slightly, but thick hard exudates have been absorbed nearly totally at posterior pole (large arrows). focal laser photocoagulation scars were seen at temporal side of posterior pole (small arrows). And they are appropriate and sufficient. (B) Fluorescein angiography at 6 months after intravitreal triamcinolone injection, clinically significant macular edema was still remaining but leakage from telangiectatic vessels was much decreased, compared with angiography at initial diagnosis (large arrow). (C) 5th week after the intravitreal triamcinolone acetonide injection optical coherence tomogram shows decreased macular thickness and the reabsorption of serous retinal detachment. The retinal thickness at the central fovea is 244 µm. (D) At 6 months, the OCT showed that the macular edema had increased to 680 µm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2629899&req=5

Figure 2: Posttreatment findings. (A) At 6 weeks after triam-cinolone injection, macular edema recurred slightly, but thick hard exudates have been absorbed nearly totally at posterior pole (large arrows). focal laser photocoagulation scars were seen at temporal side of posterior pole (small arrows). And they are appropriate and sufficient. (B) Fluorescein angiography at 6 months after intravitreal triamcinolone injection, clinically significant macular edema was still remaining but leakage from telangiectatic vessels was much decreased, compared with angiography at initial diagnosis (large arrow). (C) 5th week after the intravitreal triamcinolone acetonide injection optical coherence tomogram shows decreased macular thickness and the reabsorption of serous retinal detachment. The retinal thickness at the central fovea is 244 µm. (D) At 6 months, the OCT showed that the macular edema had increased to 680 µm.
Mentions: A 47 year old male patient visited our hospital with the chief complaint ofacute progressive deterioration of the visual acuity of his left eye that had begun 2 months earlier. No specific findings were detected in his prior history. Thetotal cholesterol, component ratio of triglycerides, HDL-cholesterol and LDL-cholesterol were within the normal range. At the initial examination, the corrected visual acuity of his right and left eye was 1.0 and 0.02, respectively. The intraocular pressure of the right and left eye, measured using a non-contact tonometer, was 19 mmHg and 16 mmHg, respectively. The slit lamp examination revealed no specific special findings in the anterior segment and no rubeosis. The bilateral fundus examination showed normal findings in his right eye, and thick macular edema in the posterior pole in his left (Fig. 1A). Fluorescein angiography revealed profuse leakage with capillary dropout and a club shape thatdiffused to the blood vessels in the vicinity of the posterior pole (Fig. 1B). OCT showed that the retina thickness had thickened noticeably to 1,187 µm as a result of macular edema (Fig. 1C). Focal laser photocoagulation was attempted in the dilated vessel area but it was difficult to perform satisfactorily because of the thick retinal edema. The OCT taken 1 week after his first visit did not show any improvement of the macular edema. Therefore, bevacizumab (Avastin™, 25 mg/ml, 4 ml, Roche, USA) 1.25 mg (0.5 ml) was injected into the vitreal cavity in order to subside the retinal edema and facilitate focal laser photocoagulation on the telangiectatic vessels. Additional focal laser photocoagulation was then performed. However, OCT taken at 3 week visit after the injection showed that the macular thickness had barely changed. On the 6th week after treatment, an intravitreal injection of triamcinolone acetonide (Triamcinolone inj®, 40 mg/ml, 5 ml, Dongkwang pharma, Korea) 4 mg (0.1 ml) was performed to resolve the retinal edema for focal laser photocoagulation. One week after the triamcinolone acetonide injection, the visual acuity was 0.02 and showed no improvement. However, there was a noticeable reabsorption of the macular edema. At the 2nd week after the injection, the foveal structures began to recover. After 5 weeks, the retinal thickness had decreased to 244 µm (Fig. 2C). The visual acuity improved slightly to 0.04, and additional focal laser photocoagulation could be performed easily and satisfactorily with the absorption of the retinal edema. Repeated focal laser photocoagulation was performed at each visit until 10 weeks after injection, and the retinal edema remained stable. At 6 months, the OCT showed that the macular edema had increased to 680 µm (Fig. 2D). However, on color fundus photography, thick circinate hard exudates was much absorbed (Fig. 2A) and, fluorescein angiography revealed a significant decrease in leakage from telangiectactic vessels compared with that performed at the time ofthe initial diagnosis (Fig. 2B). Consequently, repeated injection of triamcinolone acetonide and repeated aggressive laser photocoagulation was planned in order to prevent further progression.

Bottom Line: The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection.An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema.The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, School of Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea.

ABSTRACT
A 47 year old male patient visited our hospital with the chief complaint of deterioration of the visual acuity in the left eye. The fundus examination revealed thick hard exudates, multiple aneurysms and telangiectasias of the retinal vessels in the posterior pole. Fluorescein angiography demonstrated massive leakage over an area of the aneurysms. Optical coherence tomography (Stratus OCT; Zeiss-Humphrey, Dubin, CA) revealed diffuse and marked thickening of the retina. Laser photocoagulation was performed under the diagnosis of Coats' disease. However, the treatment could not be performed satisfactorily. On the first and 6th weeks, an intravitreal injection of bevacizumab and triamcinolone acetonide was administered, and laser photocoagulation was again attempted. The effectiveness of eachagent on retinal edema was evaluated at the follow-up performed at 1, 2, 5, 7, 10 weeks and 6 months after the injection. At one week after the intravitreal bevacizumab injection, there was no improvement. An intravitreal injection of triamcinolone acetonide was performed 6 weeks after the initial diagnosis,which resulted in a reduction in the thickness of the macular edema. Therefore, laser photocoagulation was performed sufficiently on telangiectasias. The follow-up at 6 months showed a relative increase in the macular edema, but there was reduced leakage from the telangiectasias compared with the previous angiograph.

Show MeSH
Related in: MedlinePlus