Study: corticosteroid does not benefit subset of patients with macular edema

Intravitreal triamcinolone does not benefit patients with presumed macular edema resulting from parafoveal telangiectasia type 2A. This treatment has been associated with a high incidence of ocular complications.

Key Points

San Jose, Costa Rica-Intravitreal triamcinolone (Kenalog, Bristol-Myers Squibb) does not have a beneficial effect for patients with presumed macular edema resulting from parafoveal telangiectasia type 2A, according to Teodoro J. Evans, MD. In addition, the treatment is also associated with a high incidence of ocular complications.

"Idiopathic parafoveal telangiectasia type 2A is the most common type of the three groups in the classification that was described by Donald Gass, MD," said Dr. Evans, a vitreoretinal fellow, Instituto de Cirugia Ocular, San Jose, Costa Rica. "This group is characterized by bilateral symmetric acquired telangiectasia that affects the perifoveal capillaries.

"Another classification was proposed by Lawrence Yannuzzi, MD, who described two subtypes," he said.

A few single case reports show a beneficial effect, however, from treatment with intravitreally injected triamcinolone in eyes with presumed macular edema secondary to parafoveal telangiectasia type 2A, according to Dr. Evans. In these case reports, the patients had a gain of two to four lines of visual acuity.

Dr. Evans and colleagues carried out a multicenter, uncontrolled, interventional, retrospective case study to determine the visual outcomes and ocular complications in eyes without CNV that received intravitreal triamcinolone to treat presumed macular edema secondary to parafoveal telangiectasia type 2A. The study was conducted between September 2002 and September 2005 in Colombia, Costa Rica, Puerto Rico, and Venezuela. Fourteen consecutive patients (19 eyes) received intra–vitreal injections of triamcinolone (4 mg).

Ten of the 14 patients were women with an average age of 63 years. The mean follow-up was 20.3 months. Seven of the 19 eyes received one additional injection of triamcinolone.

"The mean visual acuity at different time points did not show any significant improvement in vision over time compared with the baseline values," Dr. Evans said. "At baseline, 5.3% had a visual acuity of 20/40 or better; 47.3% ranged from 20/50 to 20/160, and 47.3% had a visual acuity less than 20/200.

"In half of our patients (53%), the visual acuity level remained within one line of the baseline value; 21% of patients lost two or more lines of vision," he said.

Fifty-three percent of patients developed cataract and 37% developed elevated IOP as a result of treatment. No patients required surgical intervention. There were no cases of endophthalmitis or retinal detachment.

"Despite the presence of fluorescein leakage, ultra high-resolution optical coherence tomography (OCT) showed that poor vision is correlated with disruption of the photoreceptor layer and not with thickening of the retina as expected," Dr. Evans said. "In addition, fluorescein leakage is not associated with retinal thickening on OCT. It comes as no surprise that the majority of our patients did not have a significant improvement in visual acuity after treatment."

The study had some limitations in that it was an uncontrolled and retrospective case series with a small number of patients and variable follow-up, he concluded.