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Steroid injections offer 'vision restoration' hope for patients with blocked eye veins.



Byline: ANI

Washington, September 15 (ANI): The injections of the steroid corticosteroid corticosteroid /cor·ti·co·ster·oid/ (-ster´oid) any of the steroids elaborated by the adrenal cortex (excluding the sex hormones) or any synthetic equivalents; divided into two major groups, the glucocorticoids and  triamcinolone triamcinolone /tri·am·cin·o·lone/ (tri?am-sin´o-lon) a synthetic glucocorticoid used in replacement therapy for adrenocortical insufficiency and as an antiinflammatory and immunosuppressant in a wide variety of disorders.  may help restore vision in some patients with retinal vein occlusion Retinal Vein Occlusion Definition

Retinal vein occlusion refers to the closure of the central retinal vein that drains the retina or to that of one of its branches.
, an important cause of vision loss that results from blockages in the blood vessels Blood vessels

Tubular channels for blood transport, of which there are three principal types: arteries, capillaries, and veins. Only the larger arteries and veins in the body bear distinct names.
 in the retina, say two research papers.

Retinal vein occlusion is an important cause of vision loss worldwide, according to background information in the articles published in the September issue of Archives of Ophthalmology This article is about the journal published by the American Medical Association. For other journals and uses, see Ophthalmology (disambiguation).

The Archives of Ophthalmology
.

The condition frequently occurs in individuals with diabetes, and leads to macular edema macular edema Ophthalmology Waxing and waning retinal thickening due to the accumulation of fluid, seen in Pts with diabetic retinopathy, seen with a binocular slit lamp or stereoscopic fundus photography; while ME has no visual consequences, it is often , or fluid build-up in the retina.

Although a laser treatment of the retina called grid photocoagulation photocoagulation /pho·to·co·ag·u·la·tion/ (-ko-ag?u-la´shun) condensation of protein material by the controlled use of an intense beam of light (e.g.  has shown a benefit in improving the vision of patients with blockages in smaller branches of the retinal vein, there is presently no effective therapy for vision loss associated with macular edema after central retinal vein Central retinal vein
Central blood vessel and its branches that drains the retina.

Mentioned in: Retinal Vein Occlusion
 occlusion-blockage in the main portion of the retinal vein, at the optic nerve optic nerve: see vision. .

One of the research papers reports the results of a randomised Adj. 1. randomised - set up or distributed in a deliberately random way
randomized

irregular - contrary to rule or accepted order or general practice; "irregular hiring practices"
 clinical trial involving 271 participants with macular edema from central retinal vein occlusion.

Ninety-two of the participants were assigned to receive 1 milligram milligram /mil·li·gram/ (mg) (mil´i-gram) one thousandth (10-3) of a gram.

mil·li·gram
n. Abbr. mg
A metric unit of mass equal to one thousandth (10-3) of a gram.
 of intravitreal (injected into the eye) triamcinolone, 91 received a 4-milligram dose and 88 were assigned to an observation group that did not receive treatment.

The participants were evaluated every four months for 12 months, and those in the triamcinolone group received additional injections at each follow-up visit unless there was a specific reason not to re-treat them. Additional follow-up data were collected annually through 36 months, although complete 24- and 36-month outcome assessments were not available for analysis.

After one year, says the study report, vision improved significantly in 7 percent of those in the observation group, 27 percent of those in the 1-milligram triamcinolone group, and 26 percent of those in the 4-milligram triamcinolone group.

The odds of reaching a predetermined pre·de·ter·mine  
v. pre·de·ter·mined, pre·de·ter·min·ing, pre·de·ter·mines

v.tr.
1. To determine, decide, or establish in advance:
 level of visual improvement were five times greater among individuals receiving either dose of triamcinolone than those not receiving treatment.

Cataracts and elevated intraocular pressure (pressure within the eyeball), potential adverse events associated with corticosteroid treatment, were similar for the observation and 1-milligram group but higher for the 4-milligram group.

"The superior safety profile of the 1-milligram dose compared with the 4-milligram dose, particularly with respect to glaucoma and cataract, renders it the preferred dose," the authors write.

Based on the results, the authors concluded: "Intravitreal triamcinolone in a 1-milligram dose and following the retreatment criteria used in this study should be considered for up to one year, and possibly two years, in patients with vision loss associated with macular edema secondary to central retinal vein occlusion who have characteristics similar to the participants studied in this trial."

The second study by the same research group compared the safety and efficacy of triamcinolone with standard care-grid photocoagulation in eyes without hemorrhage, or deferring photocoagulation until hemorrhage clears-for 411 patients with macular edema from branch retinal vein occlusion.

A group of 137 was assigned to receive standard care, 136 to receive a 1-milligram dose of intravitreal triamcinolone and 138 to receive a 4-milligram dose. Similar to the central retinal occlusion trial, participants were evaluated and re-treated as indicated every four months.

After one year, 29 percent of participants in the standard care group, 26 percent in the 1-milligram triamcinolone group and 27 percent in the 4-milligram group experienced improved vision.

"The rates of adverse events with respect to cataract surgery and elevated intraocular pressure were similar between the standard care and 1-milligram groups, but the potential for added risks of procedure-related complications in the 1-milligram group (as exemplified by the one case of endophthalmitis [inflammation inside the eye] reported in the 4-milligram group) suggests a superior safety profile for the standard care group," the authors write.

According to them, adverse event rates were higher in the 4-milligram group.

"Thus, current study results (up to 12 months and possibly up to 36 months) support grid photocoagulation as the continued standard of care for patients with decreased visual acuity associated with macular edema secondary to branch retinal vein occlusion who have similar characteristics to the cohort in this clinical trial.

The results of this trial also support the idea that grid photocoagulation, as applied in the current study, should be the benchmark against which other treatments for vision loss associated with macular edema secondary to branch retinal vein occlusion are compared in clinical trials," the authors concluded. (ANI)

Copyright 2009 Asian News International The Asian News International (ANI) agency provides multimedia news to China and 50 bureaus in India. It covers virtually all of South Asia since its foundation and presently claims, on its official website, to be the leading South Asia-wide news agency.  (ANI) - All Rights Reserved.

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Publication:Asian News International
Date:Sep 15, 2009
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