Intravitreal injections for macular conditions during cataract surgery improve vision

CHICAGO — Performing intravitreal injections for macular conditions during cataract surgery is effective in improving vision, according to study results presented here at the American Society of Cataract and Refractive Surgery annual meeting.

Wan-Soo Kim, MD, PhD, and colleagues evaluated outcomes for six patients who received triamcinolone acetonide injections through the posterior capsulorrhexis after phacoemulsification for cataract. The patients received the injections in December 2007 for diabetic macular edema.

With "injection through the posterior capsulorrhexis of intravitreal triamcinolone, [there is] no need to penetrate the pars plana with intravitreal triamcinolone, therefore we can avoid vitreous hemorrhage and retinal detachment," Dr. Kim said.

All six eyes gained two or more lines of best corrected visual acuity after 4 weeks. Retinal thickness decreased from a mean of 420 µm to 330 µm.

No patient developed an IOP higher than 21 mm Hg up to 4 months postop, Dr. Kim noted.

In another study, Yoshihide Nakai, MD, and colleagues reviewed outcomes for seven eyes with posterior uveitis that received intravitreal triamcinolone injections and 22 eyes with macular edema that received intravitreal Avastin (bevacizumab, Genentech) injections, both during cataract surgery. Specifically, 14 eyes had diabetic macular edema and eight eyes had macular edema associated with branch retinal vein occlusion.

At 7 days postop, the mean visual acuity for all patients combined was 20/50.

Additionally, the mean retinal thickness decreased from 391 µm preoperatively to 223 µm at 1 month postop in the 14 diabetic macular edema patients and from 344 µm preoperatively to 197 µm at 1 month postop in the eight BRVO-associated macular edema patients.

"Pars plana injection of the drug during cataract extraction was effective for the improvement of postoperative visual acuity of patients with prolonged uveitis and those with diabetic or BRVO-associated macular edema," Dr. Nakai said.

In a discussion after the presentations, moderators questioned why patients would undergo cataract surgery before conditions such as macular edema were cleared.