Triamcinolone: a potential first line treatment for post-surgical Cystoid Macular Oedema

Management of Cystoid Macular Oedema (CMO) following cataract surgery or pars plana Vitrectomy (PPV) remains a contentious issue and is a well-established complication following anterior segment surgery. However, there is limited evidence regarding CMO following PPV. Post-PPV CMO can be defined as the presence of intraretinal cysts seen on Optical Coherence Tomography (OCT).

A new retrospective study in Journal of Clinical Ophthalmology aimed to demonstrate the efficacy of sub-tenon’s triamcinolone injections on a pro re nata basis for the treatment of post-operative CMO with respect to change in visual acuity and Central Macular Thickness (CMT). The study demonstrated triamcinolone as a potential first line treatment for post-surgical CMO, observing improvement in anatomical and functional parameters.

The researchers collected data were retrospectively collected on 50 eyes of 44 patients who were treated with periocular injections of Triamcinolone acetonide for post-vitrectomy or post-phacoemulsification CMO (defined clinically as the presence of intraretinal cysts on OCT). Data collated included baseline demographics (age, gender), indication, number of injections, pre- and post- injection visual acuity (LogMAR), CMT (µm) and additional treatments required.

The key findings of the study

• Mean age of presentation was 70 ± 14 years and 59.1% (26/44) of study candidates were male. Two patients required 4 injections, two required 3 injections, six required 2 injections and the remaining patients all required one injection.

• The average time between injections varied between 7 and 24 weeks. Mean number of injections per eye was 1.26.

• Mean pre- injection logMAR visual acuity was 0.43 and post-injection, 0.31. A difference found to be statistically significant using a paired sample t-test (p=0.0381).

• Mean pre-injection CMT was 435.06 µm and post-injection was 350.60 µm, giving a mean reduction in CMT of 84.46 µm (p<0.0001, paired sample t-test).

• 14% of patients required additional treatment with an intravitreal Dexamethasone implant. There were no cases of globe perforation during periorbital injection of triamcinolone.

Researchers concluded that “In conclusion, our study shows the potential use of periocular Triamcinolone injections as a cost-effective, safe and efficacious first-line treatment for post-operative CMO. This retrospective study demonstrated triamcinolone as a potential first line treatment for post-surgical CMO, observing improvement in anatomical and functional parameters.”

Reference: Ibrar A, Panayiotis M, Mohammed EL-A. Periorbital triamcinolone in the management of post-operative cystoid macular oedemas. J Clin Ophthalmol. 2023; 7(2):6 32-6 33.