One year of intravitreal injections of steroids.

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.