Intravitreal steroid injections

The patient needs urgent examination by an ophthalmologist , preferably a vitreoretinal specialist who will usually decide for urgent intervention to provide intravitreal injection of potent antibiotics. Injections of vancomycin (to kill Gram-positive bacteria) and ceftazidime (to kill Gram-negative bacteria) are routine. Even though antibiotics can have negative impacts on the retina in high concentrations, the facts that visual acuity worsens in 65% of endophthalmitis patients and prognosis gets poorer the longer an infection goes untreated make immediate intervention necessary. [9] Endophthalmitis patients may also require an urgent surgery (pars plana vitrectomy ), and evisceration may be necessary to remove a severe and intractable infection which could result in a blind and painful eye.

Laser is a very bright light that is very focused so it makes tiny burns on the retina. The burns are so tiny they cause very little damage when treating this type of maculopathy. Once again, controlling your blood pressure, sugar, and fat levels (see Prevention) can help to stop this condition getting worse. Laser for this type of retinopathy is not painful, and is moderately effective (see evidence) . Sometimes the leak needs more than one laser treatment or injection treatment. More often than not more leaks develop over the next few years, again needing laser, as below. See photo , another Content on this page requires a newer version of Adobe Flash Player.

Macular oedema is one of the most significant causes of reduced vision in patients with diabetic retinopathy. Focal macular oedema is typically amenable to focal argon laser coagulation. However, eyes with diffuse macular oedema are much less responsive to macular laser treatment ( Olk 1990 ; Lee & Olk 1991 ). Recent studies have suggested that IVTA may be an alternative treatment option that may help to reduce macular oedema and, depending on the degree of macular ischaemia, increase visual acuity (VA). The first case report describing the outcome of IVTA in diabetic macular oedema (DMO) was published by Massin et al. (2004 ). Since then, approximately 25 observational case series and three randomized controlled trials (RCTs) on its use have been published. The main outcome measures in these studies included improvement in vision, decrease in central macular thickness (CMT) by OCT and/or reduced leakage on fluorescein angiography. Complication rates were recorded in most studies, with steroid-induced ocular hypertension being the most common. Table 1 summarizes a selection of the case series and Table 2 summarizes the RCTs. The follow-up periods of most of these series are short, with a mean of < 12 months, and there is little data on longterm efficacy of IVTA in this condition. Jonas et al. (2004a ) noted that the duration of effect of 25 mg IVTA in diffuse macular oedema was approximately 7–8 months.

Another Cochrane Review examined the effectiveness and safety of two intravitreal steroid treatments, triamcinolone acetonide and dexamethasone , for patients with from CRVO-ME. [17] The results from one trial showed that patients treated with triamcinolone acetonide were significantly more likely to show improvements in visual acuity than those in the control group, though outcome data was missing for a large proportion of the control group. The second trial showed that patients treated with dexamethasone implants did not show improvements in visual acuity, compared to patients in the control group.

Intravitreal steroid injections

intravitreal steroid injections

Another Cochrane Review examined the effectiveness and safety of two intravitreal steroid treatments, triamcinolone acetonide and dexamethasone , for patients with from CRVO-ME. [17] The results from one trial showed that patients treated with triamcinolone acetonide were significantly more likely to show improvements in visual acuity than those in the control group, though outcome data was missing for a large proportion of the control group. The second trial showed that patients treated with dexamethasone implants did not show improvements in visual acuity, compared to patients in the control group.

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