EyeWorld Asia-Pacific June 2011 Issue

June 2011 43 EW CORNEA months in a row. “Once the eyes have no edema and look reasonably stable, then I usually just observe them from there,” Dr. Berrocal said. She added that practitioners need to be wary of fibrous tissue in diabetic eyes, which can contract and cause tractional retinal detachment or rhegmatogenous retinal detachment. Also, in eyes with massive edema, she cautioned that the injections could cause precipitation of lipid exudates near the fovea and subsequent decrease of vision. “You have to be careful,” she said. Steroid injections Anti-VEGF injections aren’t the only treatment in the retinal specialists’ armamentarium. Practitioners also inject steroid treatments when necessary. “Steroids still have a role,” Dr. Dugel said. “We still use steroids in certain cases, usually in patients with recalcitrant diabetic macular edema or vein occlusion.” The go-to steroid in those cases is intravitreal triamcinolone acetonide (Kenalog, Bristol-Myers Squibb, New York, NY, USA). The disadvantages of using steroid injections are twofold. The main side effect of any steroid is increased IOP; the second is cataract formation. “Increased IOP can be prohibitive, especially in patients who are genetically susceptible or have glaucoma,” Dr. Dugel said. Dr. Dugel added that in the past there was a concern about the increased risk of endophthalmitis with the Kenalog injection. “The steroid itself is a suspension, so when it floats to the front of the eye after being injected, it can kind of look like endophthalmitis, but it may not be actual endophthalmitis. The term pseudoendophthalmitis has been used. It’s still a bit of a controversial topic.” EW Editors’ note: The physicians interviewed have no financial interests related to their comments . Contact information Berrocal: mariahberrocal@hotmail.com Dugel: pdugel@gmail.com