What is the role of triamcinolone therapy in the treatment of central retinal vein occlusion (CRVO)?

Updated: Apr 18, 2019
  • Author: Lakshmana M Kooragayala, MD; Chief Editor: Douglas R Lazzaro, MD, FAAO, FACS  more...
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Answer

Intravitreal injection of triamcinolone

The Standard Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) study is a National Eye Institute–sponsored randomized controlled trial comparing 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone acetonide versus observation for visual acuity loss due to macular edema associated with perfused CRVO.

The SCORE study reported that intravitreal triamcinolone (both 1-mg and 4-mg dose groups) yielded better visual acuity outcomes over 12 months than observation alone. Beyond 12 months, the greater likelihood of visual acuity gain with triamcinolone persists, although there is a mild attenuation of the effect of triamcinolone with respect to mean change in visual acuity.

Both triamcinolone groups had a similar change in mean visual acuity letter score compared with the observation group, but the 4-mg group had the highest rate of cataract formation, cataract surgery, and intraocular pressure (IOP) elevation. The risk factors for IOP-related events included higher treatment dose, younger age, and higher baseline IOP. IOP-related events may take several months from the time of first triamcinolone injection to occur, so it is recommended to assess the risks and benefits of triamcinolone therapy and to maintain long-term follow-up of patients at risk for this complication.

Based on safety and efficacy findings from the SCORE-CRVO trial, administering intravitreal triamcinolone in a 1-mg dose and following the retreatment criteria used in this study should be considered for up to 1 year, and possibly 2 years, in patients with vision loss associated with macular edema secondary to CRVO. [28, 29]


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