Suprachoroidal administration of triamcinolone acetonide in patients with macular edema after vitrectomy: Technique and results

Abstract

Aim – to study the effectiveness of triamcinolone acetonide (TA) injection into the suprachoroidal space using a microneedle for the treatment of macular edema after vitrectomy. Material and methods. During the study, the results of suprachoroidal administration of triamcinolone acetonide were analyzed in 8 patients (8 eyes) who were observed with macular edema as a complication of vitrectomy. Ophthalmological examination included visometry, non-contact tonometry, indirect ophthalmoscopy with lens 78 D, and optical coherence tomography (OCT) of the macular area. Best corrected visual acuity (BCVA) before the operation ranged from 0.1 to 0.8 (0.25 (0.10; 0.50), retinal thickness in the foveolar area varied from 342 to 728 µm (513.0 (443.0; 585.5) according to OCT data. During the operation, all patients underwent the injection of 0.1 ml of triamcinolone acetonide using a microneedle into the suprachoroidal space 3.5-4.0 mm posterior to the limbus. Results. One month after suprachoroidal injection of TA, the thickness of macular edema statistically significantly decreased to 327.5 (309.0; 380.5) μm (p = 0.011719) and BCVA increased to 0.45 (0.25; 0.80) (p = 0.027709). Three months after surgery, the retinal thickness in the macular area was 333.5 (311.5; 503.0) (p = 0.068704). The lack of statistical significance in the reduction of macular edema 3 months after suprachoroidal TA injection is explained by the fact that 3 out of 8 patients (37.5%) experienced a recurrence of macular edema after 3 months. However, BCVA has significantly increased to 0.6 (0.25; 0.90) (p = 0.043115). In 5 out of 8 patients (62.5%) a stable positive result was achieved within 3 months in the form of relief of macular edema. In the postoperative period, an increase in intraocular pressure was noted only in 2 cases of measurements, in patients observed for secondary glaucoma as a concomitant diagnosis. Intraocular pressure was compensated in both cases after correction of the treatment regimen. Conclusion. The presented technique is effective in treatment of macular edema associated with vitrectomy, as well as safe, which may be the reason for its further study.