Effects of intravitreal triamcinolone acetonide injection with and without preservative

Maia, Maurício; Farah, Michel Eid; Penha, Fernando M.; Filho, Acácio Alves Souza Lima; Aggio, Fábio Bom; Belfort, Rubens

doi:10.1136/bjo.2007.115386

Cited by 64 publications

(40 citation statements)

References 18 publications

(23 reference statements)

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“…79,80,81 The term non-infectious endophthalmitis is reserved for true infl ammation that is thought to represent a immunologic response to TA or its preservative, benzyl alcohol. 82,83,84,85,86 Another entity referred to as pseudoendophthalmitis describes TA crystals masquerading as infl ammatory cells. 80,87 While there are several distinctive differences between these entities clinically, many times the clinical presentation overlaps.…”

Section: Intravitreal Triamcinolonementioning

confidence: 99%

Intravitreal triamcinolone for intraocular inflammation and associated macular edema

Couch¹

2008

OPTH

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Triamcinolone acetonide (TA) is a corticosteroid that has many uses in the treatment of ocular diseases because of its potent anti-infl ammatory and anti-permeability actions. Intraocular infl ammation broadly referred to as uveitis can result from several causes, including the immune system and after ophthalmic surgery. One of the most common reasons for vision loss with uveitis is macular edema. TA has been used for many years as an intravitreal injection for the treatment of ocular diseases. Several case control studies have been reported showing the effi cacy of TA in the treatment of intraocular infl ammation and associated macular edema caused by Behcet's disease, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia and white dot syndromes. It has also been shown effi cacious in cases of pars planitis and idiopathic posterior uveitis. Some authors have reported its use in postoperative cystoid macular edema. Many of the studies on the use of TA in controlling intraocular infl ammation and concomitant macular edema showed its effect to be transient in many patients requiring reinjection. Complications can arise from intravitreal injection of TA including elevated intraocular pressure and cataract. Rarely, it can be associated with infectious and non-infectious endophthalmitis. TA may be useful as an adjuvant in the treatment of uveitis and its associated macular edema, especially in patients resistant or intolerant to standard treatment.

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Section: Intravitreal Triamcinolonementioning

confidence: 99%

Intravitreal triamcinolone for intraocular inflammation and associated macular edema

Couch¹

2008

OPTH

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“…Moreover, nonclinical studies have demonstrated that the vehicle or preservatives in the most commonly used IVTA formulation (Kenalog 40 mg/ml) have been shown in animal models to induce an acute inflammatory reaction by exerting a direct toxic effect on retinal cells [16,17] has demonstrated toxicity in the rabbit eye at concentrations of 0.073% or more (0.022% corresponds to the dose in 0.1 ml of commercially available TA in the USA) [18]. However, in clinical practice, filtering the benzyl alcohol has not significantly reduced the incidence of noninfectious endophthalmitis, with reported rates of 3.5-7.3% in eyes injected with filtered TA, which reportedly removed 90% of the preservatives [4,8].…”

Section: "Dispersion Of Intravitrealmentioning

confidence: 99%

“…The most commonly used IVTA off-label formulation in the past was Kenalog, a sterile suspension of TA crystals in an aqueous medium that contains 0.99% benzyl alcohol as a preservative and bacteriocidal agent [17]. Considering that benzyl alcohol may induce inflammation in the vitreous, filtered TA and PFTA have been investigated [4,8,10].…”

Section: "Dispersion Of Intravitrealmentioning

confidence: 99%

“…The suggested etiologies include the potential effect of endotoxins [4], preservatives in some TA formulations [5] and the dispersion of triamcinolone acetonide (TA) crystals in the vitreous [6]. Alternative preservative-free TA (PFTA) formulations have been investigated in the hope that they may limit the occurrence of inflammatory conditions that mimic endophthalmitis [4,5,[7][8][9][10]. Herein, we review the current understanding of the pathogenesis of noninfectious endophthalmitis after IVTA and discuss the propensity for noninfectious endophthalmitis among commercially available TA formulations for intravitreal injection.…”

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Inflammatory reactions after intravitreal triamcinolone acetonide: possible mechanisms and therapeutic options

Roth¹,

Lee

Flynn

et al. 2010

Expert Review of Ophthalmology

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“…Una percentuale tra lo 0,87% e il 7,3% (24,25) dei pazienti sviluppa l'endoftalmite non infettiva o sterile poco dopo l'iniezione intravitreale di TA o PFTA. Questa condizione è una reazione infiammatoria acuta nella quale, di solito, l'acuità visiva diminuisce in modo significativo, ma i pazienti raramente esperimentano dolore o disagio.…”

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Corticosteroidi per via Intravitreale per il Trattamento Dell'edema Maculare: Revisione e Valutazione Della Qualità Dell'evidenza

Marchetti

Urbina

Oradei

et al. 2017

Global & Regional Health Technology Assessment

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ORIGINAL RESEARCH ARTICLEpatologia si manifesta, principalmente, come complicanza di disturbi infiammatori, di retinopatie vascolari (tra le quali la retinopatia diabetica e l'occlusione venosa retinale) e della neovascolarizzazione coroideale (1).La disabilità visiva associata all'edema maculare ha un grande impatto sulla qualità della vita dei pazienti nonché sulla sanità pubblica. Tale impatto giustifica il notevole interesse dei ricercatori nei confronti dei trattamenti utilizzati per questa patologia.Nel presente documento si terrà conto di due condizioni in particolare, per le quali sono indicati i corticosteroidi intravitreali:1. Edema maculare diabetico (DME): la retinopatia diabetica costituisce una complicanza microvascolare del diabete, ed è prevalente nel 34,6% dei diabetici (2). Quando in questa condizione si presenta la rottura della barriera Introduzione L'edema maculare si verifica quando si accumulano liquidi e proteine nello spazio extracellulare della retina neurosensoriale, e si caratterizza da un ispessimento della macula. TaleIntravitreal corticosteroids for the treatment of macular edema: review and assessment of quality of the evidence Introduction: Treatment options for macular edema include intravitreal corticosteroids. Traditionally, an injectable suspension of triamcinolone acetonide (TA) had been employed off-label; in recent years, authorities have approved sustained-release drug delivery systems (DDSs) for corticosteroids. This review aims to compare the quality of the evidence on efficacy and safety of three different formulations of intravitreal corticosteroids: the dexamethasone (DEX) implant, the fluocinolone acetonide (FA) implant, and the preservative-free injectable suspensions of TA, in the management of two retinal pathologies: diabetic macular edema (DME) and macular edema secondary to retinal vein occlusion (RVO). Methods: A search of clinical trials on MEDLINE from 01/01/2000 to 12/16/2015 was performed. Studies were included in the analysis if they met the following criteria: i) related to at least one of the preparations of interest in patients with DME or macular edema secondary to RVO; ii) included a control group treated with placebo, observation, sham procedures or conventional treatments; and iii) included visual acuity, retinal thickness and/or safety parameters as outcomes. Results were summarized in a narrative manner. Results: Twenty-five publications from 19 RCTs were included. We observed increased attention of researchers towards TA compared to DEX and FA; however, studies for TA are less robust. Scientific publications related to DEX and FA implants are of higher quality, especially in terms of randomization and masking procedures. Discussion: Although trials on TA are numerous, evidence on DEX and FA implants is more robust. Since their introduction, these relatively new DDSs have been included in the main guidelines for the management of macular edema.

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Effects of intravitreal triamcinolone acetonide injection with and without preservative

Abstract: Non-infectious endophthalmitis was observed significantly more often after KE injections (7.3%) than after PFTA injections (1.2%) (p<0.05). An inflammatory reaction was more clinically relevant in the KE group than in the PFTA group.

Cited by 64 publications

References 18 publications

Intravitreal triamcinolone for intraocular inflammation and associated macular edema

Intravitreal triamcinolone for intraocular inflammation and associated macular edema

Inflammatory reactions after intravitreal triamcinolone acetonide: possible mechanisms and therapeutic options

Corticosteroidi per via Intravitreale per il Trattamento Dell'edema Maculare: Revisione e Valutazione Della Qualità Dell'evidenza

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