Efficacy and complications of intravitreal injection of triamcinolone acetonide for macular edema

Background Triamcinolone acetonide can effectively treat various types of macular edema, which may cause many complications due to surgical procedures and preparation techniques.

Objective To analyze the efficacy of intravitreal injection of triamcinolone acetonide for macular edema and the causes of complications.

Methods Patients who underwent intravitreal triamcinolone acetonide injection in our hospital from January 2017 to June 2020 due to macular edema were selected, 4 mg/0.1 mL of triamcinolone acetonide was injected into the vitreous cavity, and their visual acuity and complications at 1 day, 1 month, 3 months, and 6 months after surgery were evaluated.

Results Totally 189 patients (104 males and 85 females, 289 eyes) were included in the analysis, with age ranging from 45 to 82 years and a mean age of (53.3 ± 9.6) years. The cause of macular edema was retinal vein occlusion in 97 (51.3%) cases, diabetic retinopathy in 62 (32.8%) cases, optic disc vasculitis (type Ⅱ) in 20 (10.6%) cases, and cataract extraction in 10 (5.3%) cases. At 6-month postoperative follow-up, the patients' macular edema subsided, and their best-corrected visual acuity improved to varying degrees after injection Md(IQR): 0.2 (0.1, 0.4) vs 0.5 (0.25, 0.6), P < 0.01. The results of correlation analysis showed a high correlation between postoperative visual acuity and preoperative visual acuity (r=0.655, P < 0.01). Further analysis of the response of macular edema of different etiologies to drug injection in the four groups showed that visual acuity improved in all groups after drug injection, and the differences between the four groups were not statistically significant (P＞0.05). The main postoperative complications were high intraocular pressure (42 cases, 22.2%), cataract (46 cases, 24.3%), subconjunctival hemorrhage (21 cases, 6.3%), corneal epithelial detachment (7 cases, 2.1%), non-infectious endophthalmitis (5 cases, 1.5%) and infectious endophthalmitis (1 case, 0.3%).

Conclusion Intravitreous injection of triamcinolone acetonide can effectively treat macular edema and improve visual function, but there is still a possibility of serious complications. Strict control of perioperative infection related risk factors and improvement of excipients are needed to reduce the incidence of serious complications.