SCORE Study Report 5: A Randomized Trial Comparing the Efficacy & Safety of Intravitreal Triamcinolone with Observation to Treat Vision Loss Associated with Macular Edema Secondary to Central Retinal Vein Occlusion...

Publication Type
Journal Article
Year of Publication
2009
Authors
Ip, MS; Scott, IU; Van Veldhuisen, P; Oden, NL; Blodi, BA; Fisher, M; Singerman, LJ; Tolentino, M; Chan, CK; Gonzalez, VH; The SCORE Study Research Group
Secondary
Archives of Ophthalmology
Volume
127
Start Page
1101
Pagination
1101-1114
Date Published
09/2009
Keywords
Fluorescein Angiography; Glucocorticoids; Injections; macular edema; retinal vein occlusion; Retreatment; Tomography-Optical Coherence; Triamcinolone Acetonide; Vision Disorders; visual acuity; Vitreous Body
Abstract

OBJECTIVE: To compare the efficacy and safety of 1-mg and 4-mg doses of preservative-free intravitreal triamcinolone with observation for eyes with vision loss associated with macular edema secondary to perfused central retinal vein occlusion (CRVO)

METHODS Multicenter, randomized, clinical trial of 271 participants.

MAIN OUTCOME MEASURE: Gain in visual acuity letter score of 15 or more from baseline to month 12.

RESULTS: Seven percent, 27%, and 26% of participants achieved the primary outcome in the observation, 1-mg, and 4-mg groups, respectively. The odds of achieving the primary outcome were 5.0 times greater in the 1-mg group than the observation group (odds ratio [OR], 5.0; 95% confidence interval [CI], 1.8-14.1; P = .001) and 5.0 times greater in 4-mg group than the observation group (OR, 5.0; 95% CI, 1.8-14.4; P = .001); there was no difference identified between the 1-mg and 4-mg groups (OR, 1.0; 95% CI, 0.5-2.1; P = .97). The rates of elevated intraocular pressure and cataract were similar for the observation and 1-mg groups, but higher in the 4-mg group.

CONCLUSIONS: Intravitreal triamcinolone is superior to observation for treating vision loss associated with macular edema secondary to CRVO in patients who have characteristics similar to those in the SCORE-CRVO trial. The 1-mg dose has a safety profile superior to that of the 4-mg dose. Application to Clinical Practice Intravitreal triamcinolone in a 1-mg dose, following the retreatment criteria applied in the SCORE Study, should be considered for up to 1 year, and possibly 2 years, for patients with characteristics similar to those in the SCORE-CRVO trial.