Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases

Intravitreal triamcinolone acetonide (IVTA) has increasingly been applied as treatment for various intraocular neovascular and oedematous diseases. Comparing the various diseases with respect to effect and side-effects of the treatment, the best response in terms of gain in visual acuity (VA) has been achieved for intraretinal oedematous diseases such as diffuse diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion and pseudophakic cystoid macular oedema. In eyes with various types of non-infectious uveitis, including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, VA increased and the degree of intraocular inflammation decreased. Some studies have suggested that intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischaemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration (AMD), particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure (IOP) and may stabilize the eye. The complications of intravitreal triamcinolone therapy include: secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high IOP leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% of elderly patients within 1 year of injection; postoperative infectious endophthalmitis occurring at a rate of about one per 1000; non-infectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudo-endophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other intraocular surgeries, including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated if the resultant benefits decrease after the initial IVTA injection. In non-vitrectomized eyes, the duration of the effect and side-effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. So far, it has remained unclear whether the solvent agent should be removed, and if so, how.     

Intravitreal triamcinolone acetonide and intraocular pressure

PURPOSE: To analyze the incidence of intraocular pressure (IOP) elevation following intravitreal triamcinolone injection. DESIGN: Retrospective observational case series. METHODS: Charts of patients undergoing intravitreal triamcinolone injection in one clinical practice were reviewed. A pressure elevation was defined as a pressure of 24 mm Hg or higher during follow-up. RESULTS: There were 89 patients with a mean age of 76.4 years. The mean baseline IOP was 14.9 mm Hg with a mean change of 8.0 mm Hg. Thirty-six patients (40.4%) experienced a pressure elevation to 24 mm Hg or higher at a mean of 100.6 days (SD = 83.1 day) after treatment. Of nonglaucomatous patients with baseline IOP of 15 mm Hg or above, 60.0% experienced a pressure elevation, compared with only 22.7% of those with baseline pressures below 15 mm Hg (relative risk = 2.1, P < .01). In glaucoma patients, 6 of 12 (50%) experienced a pressure elevation, and this elevation was not correlated with baseline pressure. Thirty-two patients (36.0%) received repeat injections, and there was no difference in the incidence of procedure elevation in patients receiving multiple injections versus those receiving a single injection. Pressure elevation was controlled with topical medications in all patients. CONCLUSIONS: IOP elevation after intravitreal triamcinolone injection is common and may take an extended period of time to manifest. The proportion of patients who developed a pressure elevation to at least 24 mm Hg was much higher for those with baseline IOP 15 mm Hg or greater.     

Treatment of oedematous,proliferative and neovascular diseases by intravitreal triamcinolone acetonide

BACKGROUND: Recent studies have suggested that intravitreal triamcinolone acetonide may be a therapeutical possibility for treating of various intraocular neovascular, oedematous and proliferative diseases. METHODS AND RESULTS: Gain in visual acuity was relatively highest for eyes with intraretinal oedematous diseases such as diffuse diabetic macular oedema and various types of cystoid macular oedema due to reasons such as retinal venous occlusions and uveitis. Intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularisation and proliferative ischaemic retinopathies. Possibly, intravitreal triamcinolone may be helpful for exudative age-related macular degeneration. In eyes with chronic therapy resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure. The role of intravitreal triamcinolone as adjunctive treatment of proliferative vitreoretinopathy has not been determined so far. Complications of intravitreal triamcinolone include secondary ocular hypertension in about 50 % of the eyes injected, with one per cent of the eyes necessitating antiglaucomatous filtrating surgery; a cataractogenic effect; and postoperative infectious endophthalmitis. Long-term studies of more than 3 years follow-up have been missing so far, so that there is no reliable information on long-term complications. The injection can be combined with cataract surgery. Cataract surgery performed some months after the injection did not show a markedly elevated rate of complications. If vision increases after the intravitreal triamcinolone injection, the injection can be repeated. The duration of the effect of a single intravitreal injection of triamcinolone ranges between 2 and 9 months. Triamcinolone acetonide was detected in the aqueous humour nine months after an intravitreal injection of 25 mg. CONCLUSIONS: Intravitreal triamcinolone acetonide may offer a possibility for adjunctive treatment of intraocular oedematous, neovascular and proliferative diseases.     

Intravitreal triamcinolone acetonide for exudative age related macular degeneration

AIM: To evaluate the effect of intravitreal triamcinolone acetonide on the visual acuity of patients with exudative age related macular degeneration, to assess the duration of a possible effect, and to evaluate clinical side effects of the treatment. METHODS: The study included 67 patients (71 eyes) who presented with exudative age related macular degeneration of predominantly or total occult type (n = 68) or classic type (n = 3), and who received once, or repeatedly, an intravitreal injection of 25 mg of crystalline triamcinolone acetonide. Mean follow up time was 7.46 (SD 3.54) months (range 3.1-19.57 months). RESULTS: Visual acuity increased significantly (p <0.001) from 0.16 (0.11) to a mean maximum of 0.23 (0.17). Postoperative visual acuity was highest 1-3 months after the injection. 47 (66.2%) eyes gained in maximal visual acuity and 11 (15.5%) eyes lost in visual acuity. Intraocular pressure increased significantly (p <0.001) from 15.1 (3.1) mm Hg at baseline to a maximal value of 23.0 (8.25) mm Hg. At the end of follow up, intraocular pressure again decreased significantly (p<0.001) to 16.8 (4.9) mm Hg. No cases of postoperative infectious endophthalmitis, rhegmatogenous retinal detachment, or proliferative vitreoretinopathy occurred. Owing to a decrease in visual acuity after an initial increase, six patients received a second intravitreal triamcinolone acetonide injection after which visual acuity increased again in three eyes. CONCLUSIONS: Intravitreal injection of 25 mg of crystalline triamcinolone acetonide merits further study for the treatment of exudative age related macular degeneration.     

Intravitreal triamcinolone acetonide for florid proliferative diabetic retinopathy

Background The spectrum of ocular indications in which intravitreal injections of triamcinolone acetonide may be therapeutically useful has recently been expanding.Methods Prospective clinical interventional case study in a young adult male with florid proliferative diabetic retinopathy (FPDR).Results A greater reduction of retinal thickening and fluorescein leakage from retinal new vessels was observed in the right eye after intravitreal injection of triamcinolone followed by scatter panretinal photocoagulation (PKP) than in the left eye treated only by laser.Conclusion Intravitreal injection of triamcinolone acetonide may be a useful adjunct to scatter panretinal photocoagulation for FPDR.     

Intravitreal triamcinolone acetonide in exudative age-related macular degeneration

PURPOSE: To examine the effects of intravitreal injection of 4.0 mg triamcinolone acetonide on the visual and clinical course of exudative age-related macular degeneration. METHODS: A randomized clinical trial of a single injection of triamcinolone acetonide into the vitreous cavity of experimental eyes at baseline versus observation of untreated subjects was performed in 27 patients followed up for 6 months. Inclusion criteria included exudative age-related macular degeneration with subfoveal or occult choroidal neovascularization, and visual acuity between 20/40 and 20/400. Examination, acuity assessment, fundus photography, and fluorescein angiography were performed at baseline and at 3 and 6 months after enrollment. LogMAR visual acuity was compared between groups by a repeated measures analysis of variance model. Masked assessment of photographic studies was performed and groups were compared with Fisher's exact test. RESULTS: Visual acuity was significantly better in the treated group compared with control subjects at 3 and 6 months (P < 0.005). Fundus photography and angiography were more likely to show stability or improvement at 3 and 6 months in the treated group (P = 0.05). Intraocular pressure elevation was seen in 25% of treated patients, but was controlled with topical medications. Progression of cataract was more frequently seen in the treated group. CONCLUSIONS: Intravitreal triamcinolone acetonide may provide short-term improvement in visual acuity and fundus findings in exudative macular degeneration. These findings must be considered preliminary and should be followed by multicenter, masked, placebo-controlled trials with long-term follow-up.     

玻璃体腔注射曲安奈德后行复合式小梁切除术治疗新生血管性青光眼

目的 探讨玻璃体腔注射曲安奈德后行复合式小梁切除术对新生血管性青光眼的治疗效果.方法 新生血管性青光眼51例(51眼).随机分为两组,试验组26例,对照组25例.试验组先在局麻下玻璃体腔注射曲安奈德4 mg,待虹膜新生血管消退后再行复合式小梁切除术.对照组行常规复合式小梁切除术.术后随访6 ～ 24个月,观察玻璃体腔注射曲安奈德后虹膜及前房角新生血管消退时间,注药后眼压、晶状体改变,以及复合式小梁切除术后眼压、前房、视力、滤过泡、前房积血、前房渗出情况.结果 玻璃体腔注药后26眼4～10 d虹膜新生血管完全消退.复合式小梁切除术后两组眼压、前房、滤过泡差异有统计学意义(P＜0.05);两组术后视力差异无统计学意义(P＞0.05).结论 玻璃体内注射曲安奈德后再行复合式小梁切除术能有效治疗新生血管性青光眼,可以使虹膜新生血管快速消退或萎缩,降低术后前房积血的发生率、提高手术成功率.     

Intravitreal triamcinolone acetonide for exudative age-related macular degeneration among Japanese patients

AIM: To study the results of intravitreal triamcinolone acetonide (TA) for exudative age-related macular degeneration (AMD) among Japanese patients. METHODS: 13 eyes of 12 Japanese patients (9 males and 3 females) with subfoveal choroidal neovascularization (CNV) of exudative AMD received intravitreal TA (8 mg). Visual acuity, size of CNV and serous retinal detachment, and complications related to treatment were evaluated for 6 months or longer. RESULTS: Postoperative maximum visual acuity significantly improved (p < 0.05). Postoperative eyes had a greater probability of a reduced size of CNV and/or retinal detachment compared to preoperative eyes. Seven eyes showed increased intraocular pressure (21 mm Hg or over), which was controlled well by medication. Cataract development and advancement were observed in 90% of phakic eyes. No other serious complications were found. CONCLUSIONS: Intravitreal TA might be an effective treatment for subfoveal CNV of exudative AMD among Japanese as well as Caucasian patients for a comparatively short period.     

Intravitreal triamcinolone acetonide treatment for serpiginous choroiditis

PURPOSE: To report the efficacy of intravitreal triamcinolone acetonide injection for acute treatment of a patient with serpiginous choroiditis. METHODS: A 50-year-old male patient with serpiginous choroiditis presenting with the complaint of decreased visual acuity in his right eye for the last 10 days. The best corrected visual acuity (BCVA) of the patient was counting finger from 1 meter. Fundus examination and fundus fluorescein angiography of right eye revealed active macular choroiditis in right eye. Intravitreal triamcinolone acetonide (4 mg/0.1 ml) was injected into vitreous, and the patient was followed with visual acuity testing, intraocular pressure measurement, and fundus examination, including fundus fluorescein angiography. RESULTS: Visual acuity of the patient improved to 20/100 after 2 weeks in spite of the triamcinolone crystals, and to 20/50 after 4 weeks with a single dose intravitreal triamcinolone acetonide injection. Complete resolution of the active lesion has been maintained during the 6 months of follow-up. CONCLUSIONS: Single dose intravitreal triamcinolone acetonide injection is sufficient for controlling the active lesions in serpiginous choroiditis. It needs further evaluation as an alternative treatment for achieving rapid and significant visual acuity recovery.     

Intravitreal triamcinolone acetonide for treatment of sympathetic ophthalmia

PURPOSE: To report on the treatment of long-standing sympathetic ophthalmia by intravitreal triamcinolone acetonide. DESIGN: Clinical interventional case report. METHODS: A 47-year-old patient who suffered from sympathetic ophthalmia and who was treated with intensive systemic immunosuppressive therapy received an intravitreal injection of 25 mg of triamcinolone acetonide. Before injection, intraocular pressure ranged between 5 and 8 mm Hg; visual acuity measured 6/20. RESULTS: Within the first 4 weeks after the injection, visual acuity improved from 6/20 to 6/12, intraocular pressure increased to values between 10 mm Hg and 13 mm Hg, and intraocular flare measurements decreased by approximately 50%. Systemic immunosuppressive treatment was reduced to 10 mg prednisolone/day at the first postoperative day and could not be stopped due to an adrenal insufficiency. Three months after the injection, visual acuity regressed to 6/20, intraocular pressure was reduced to values between 5 mm Hg and 10 mm Hg, and anterior chamber flare increased. The patient received a second intravitreal injection of 25 mg of triamcinolone acetonide after which intraocular pressure increased again to values between 10 mm and 13 mm Hg, and anterior chamber flare decreased. After the injection, perimetry revealed a marked enlargement of the originally constricted visual field with a decrease in mean visual field defect from approximately 11 dB to values lower than 7 dB. CONCLUSIONS: Intravitreal injections of triamcinolone acetonide may be an additional tool in the treatment for sympathetic ophthalmia.     

Intravitreal bevacizumab and triamcinolone acetonide combination therapy for exudative neovascular age-related macular degeneration: short-term optical coherence tomography results.

PURPOSE: The aim of this study to describe the short-term anatomical results after an intravitreal injection of bevacizumab and triamcinolone acetonide in patients with foveal edema and/or subfoveal fluid associated with neovascularization (NV) due to age-related macular degeneration (AMD). METHODS: A retrospective, noncomparative case series was conducted in patients with foveal edema and/or subfoveal fluid associated with NV due to AMD during a 3-month period. Patients were treated with intravitreal injections of bevacizumab (1.25 mg/0.05 mL) and followed immediately with triamcinolone acetonide (2 mg/ 0.05 mL) in separate syringes. Ophthalmoscopic examination with optical coherence tomography analysis of foveal edema and subfoveal fluid volume was performed at baseline and follow-up visits. RESULTS: There were 30 consecutive eyes of 27 patients who received a short-term follow-up between 1 and 8 weeks after injection. Foveal thickness and subfoveal fluid volume were each statistically significantly reduced in the short term (paired Student t test; P < 0.01). No complications of intraocular pressure greater than 30 mmHg, endophthalmitis, retinal detachment, or vitreous hemorrhage developed. CONCLUSIONS: Reduction of foveal edema and subfoveal fluid in patients with NV due to AMD suggests that combination treatment with intravitreal bevacizumab and triamcinolone merits further investigation.     

TA玻璃体腔注射结合玻璃体切割术治疗PDR

目的:探讨曲安奈德(triamcinolone acetonide,TA)玻璃体腔注射联合玻璃体切割术治疗增殖性糖尿病视网膜病变(proliferative diabetic retinopathy,PDR)的优点和并发症。方法:对36例48眼具有玻璃体积血的PDR眼,术前5～7d玻璃体腔内注入TA0.1mL(40g/L)后行玻璃体切割术,术中玻璃体腔内注入TA0.3～0.5mL以帮助辨认玻璃体后皮质。结果:炎症反应程度:有4眼(8%)术后瞳孔区可见少量渗出膜,术后5～7d渗出吸收;15眼(31%)房水闪辉,术后3～5d,房水闪辉消失。所有病例都没有发现手术后感染。视力改善情况:39眼(81%)视力较手术前有不同程度提高(大于2行),7眼(15%)手术后视力较术前没有改善。眼压变化:玻璃体腔注入TA前后平均眼压比较其差异没有显著性;手术后1wk内监测平均眼压比术前高,其差异有显著性。手术后第3mo和术前相比,其差异没有显著性。结论:TA玻璃体腔注射联合玻璃体切割在治疗PDR中有较好的效果,临床上没有严重的并发症。     

Intravitreal triamcinolone acetonide for serous retinal pigment epithelial detachments in exudative age-related macular degeneration

BACKGROUND: Due to the high risk of RPE tears PDT is usually not performed in eyes with serous RPE detachments (sRPED). For this reason this subform of exudative AMD was so far untreatable. PATIENTS AND METHODS: We report on a prospective uncontrolled observational case series. 20 eyes of 20 patients with subfoveal sRPED demonstrated by OCT were treated between June 2005 and April 2006 with intravitreal triamcinolone acetonide (IVTA). In 15 cases there was a primary sRPED, in 5 cases it had developed after one or more sessions of photodynamic therapy with Visudyne. RESULTS: There was a trend for better average visual acuity in the group with primary sRPED from 0.73 logMAR (0.19 Snellen equivalent) at baseline (n = 15) to 0.68 logMAR (0.21 Snellen) after one month (n = 15) (p = 0.19) and to 0.60 logMAR (0.25 Snellen) after three months (n = 14) (p = 0.41). The maximal height of sRPED decreased to an average of 35.3 % after one month (n = 15) and increased again to 56.9 % after 3 months (n = 14). One patient was lost to follow-up. In the group of eyes with sRPED after PDT, one eye developed an RPE tear with severe vision loss two weeks after IVTA. In the remaining four eyes average visual acuity improved from 0.90 logMAR (0.13 Snellen) at baseline to 0.73 logMAR (0.19 Snellen) after one month and to 0.80 logMAR (0.16 Snellen) after 3 months. Complete resolution of sRPED was observed in 8/20 eyes (4/5 eyes with sRPED after PDT and 4/15 eyes with primary sRPED). CONCLUSIONS: IVTA seems to be a therapeutic option in otherwise untreatable eyes with sRPED.     

Intravitreal triamcinolone acetonide as treatment of ischemic ophthalmopathy

PURPOSE: To describe the clinical course of a patient receiving repeated intravitreal injections of triamcinolone acetonide (25 mg) as treatment of ischemic ophthalmopathy. METHODS: A 70-year-old patient with Waldenstr?m disease presented with progressive iris neovascularization, vitreous hemorrhage, and ocular hypotony due to ischemic ophthalmopathy. Visual acuity was 0.05. Within 2.5 years, he received three intravitreal injections of 25 mg of triamcinolone acetonide. Additionally, penetrating keratoplasty and synechiolysis were performed during the follow-up. RESULTS: After each intravitreal injection, visual acuity and intraocular pressure increased, iris neovascularization regressed, and vitreous haze cleared up. CONCLUSIONS: Intravitreal triamcinolone acetonide may induce regression of iris neovascularization, increase intraocular pressure, and improve visual acuity in eyes presenting with ocular hypotony, vitreous hemorrhage, and progressive intraocular neovascularization due to ischemic ophthalmopathy.