Intravitreal Toxicity of the Kenalog Vehicle (Benzyl Alcohol) in Rabbits

Morrison, Victoria; Koh, Hyoung Jun; Cheng, Lingyun; Bessho, Kenichiro; Davidson, Marie C.; Freeman, William R.

doi:10.1097/00006982-200603000-00014

Cited by 109 publications

(65 citation statements)

References 36 publications

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“…With regard to the retinal haemorrage, it has been previously suggested that it may be caused by the vehicle used in the preparation of intravitreal TA (26).…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Micronized Triamcinolone versus Triamcinolone Acetonide: A Clinical and Morphological Comparative Study

Salvolini

Neri

Orciani

et al. 2008

Int J Immunopathol Pharmacol

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Nowadays many authors suggest the use ofintravitreal triamcinolone acetonide (TA) for the treatment of vitreoretinal diseases, although it can be associated with a high risk of local toxicity. In order to develop a safer injection for clinical use, the purpose of our study is to evaluate the in situ safety of two different triamcinolone preparations, a commercially available TA and a micronized triamcinolone. The experiments were performed on 18 adult male age-matched New Zealand rabbits. The clinical examination included funduscopy with an indirect ophthalmoscope and intraocular pressure (lOP) measurement. At the end of the clinical observations, the animals were sacrified and the eyes enucleated and processed for the morphological evaluation. In our study the main side effect observed was the lOP elevation in the group injected with triamcinolone acetonide. In addition, in the TA-injected group, one eye was enucleated following an endophthalmitis. Our study highlights that doses as low as 4 mg of triamcinolone acetonide injected into the rabbit vitreous may have a local toxic effect in terms of lOP elevation, endophthalmitis occurrence and changes in the retinal morphology. In contrast, the micronized triamcinolone injection shows a less toxic effect in situ, thus suggesting the alternative use of this more reliable preparation which seems to be safer for a clinical use. Intraocularneovascularization, often accompanied and stimulated by intraocular inflammation, has remained an important problem in clinical ophthalmology. Moreover, defects in the blood-retina barrier due to capillary leakage, with accumulation offluid in the intraretinal and subretinal spaces of the macula, are other major causes of impaired vision. The reasons for such conditions are various and include diabetic retinopathy, retinal vein occlusions and uveitis, to mention only a few.Corticosteroids are known to reduce intraocular inflammation and tighten the capillary walls, and, depending on the concentration, to suppress cell proliferation. For these reasons steroids have been widely used in the treatment ofmany ocular diseases, applied topically as drops, given sistemically or injected into the subconjunctival or sub-Tenon space. Often, however, the intraocular concentration of corticosteroids is too low or the systemic side effects are too pronounced to allow an extended treatment.In order to overcome these limitations, Machemer et al. have suggested the intravitreal application of a crystalline form of steroid that provides intraocularly available drug for a considerably longer period (l). In particular, the intravitreal injection of triamcinolone acetonide . (TA) (9a-fluoro-16a-hydroxyprednisolone) was first proposed in an

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“…With regard to the retinal haemorrage, it has been previously suggested that it may be caused by the vehicle used in the preparation of intravitreal TA (26).…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Micronized Triamcinolone versus Triamcinolone Acetonide: A Clinical and Morphological Comparative Study

Salvolini

Neri

Orciani

et al. 2008

Int J Immunopathol Pharmacol

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“…63 Foi proposto, recentemente, que o preservativo álcool benzílico presente no veículo da TA seria responsável pela indução de lesões retinianas. 64,18 (Figura 11e Tabela 1)…”

Section: Corantes Vitais Para O Vítreounclassified

Cromovitrectomia

Maia¹,

Guerra²,

Farah³

et al. 2015

e-oftalmo

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RESUMOObjetivos:Discutir o conhecimento sobre o uso de corantes vitais em cirurgias de vitrectomia e fornecer algumas recomendações com o objetivo de minimizar os riscos associados à toxicidade. Métodos: foi realizada uma revisão da literatura com o objetivo de integrar e compilar artigos disponíveis sobre cromovitrectomia.Foi feita uma análise dos artigos e descrição das indicações clínicas, técnicas de aplicação assim como aspectos como toxicidade e perfil de segurança dos principais corantes vitais utilizados cirurgias de vitrectomia posterior. Resultados:A Triancinolona acetonida é "padrão ouro" para identificação do vítreo da base e da hialoide posterior; deve ser utilizado 0.3 mL em uma concentração de 40mg/mL e sem álcool benzílico em sua composição. O Azul Tripan é o corante ideal para identificação de MER; deve ser utilizado 0.2-0/3mL do corante em uma concentração de 1.2-1.5mg/ml. O Azul Brilhante é o corante ideal para identificação de MLI; deve ser utilizado 0.2-0.3mL do corante em uma concentração de 0.25mg/mL. Outros corantes naturais estão sendo estudados em cromovitrectomia.Conclusão: Esse artigo descreve propriedades, técnicas de aplicação , indicações e toxicidade retiniana dos principais corantes vitais descritos na literatura. A cromovitrectomia representa uma área de pesquisa em expansão e novos corantes estão em desenvolvimento.

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“…The safety of TA to the retina has been demonstrated by several in-vitro and in-vivo studies (8) ; intravitreal injection of TA in high concentration (up to 30mg) yielded no relevant retina toxicity, while our investigation disclosed no damage to the retinal tissue after subretinal preservative-free TA-injection in rabbits (69) . It has been recently proposed that the preservative benzyl alcohol present in TA-vehicle induce most retinal damage and nowadays the crystals deposition of TA is considered the gold standard substance for posterior hyaloid and vitreous base identification ( figure 10 and table 1) (19,70) .…”

Section: Triancinolone Acetonidementioning

confidence: 99%

State of the art in chromovitrectomy

Caiado¹,

Moraes-Filho²,

Maia³

et al. 2014

Revista Brasileira De Oftalmologia

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Vitrectomy is a surgery that involves complex and delicate techniques that treat diseases such as macular hole, epiretinal membrane and diabetic macular edema. Chromovitrectomy is one of these techniques and includes the use of coloring agents such as vital dyes or crystals to enhanced visibility of transparent structures during vitrectomy. The aim of this study was to present a modern approach, based on scientific evidence, about the application and indication of vital coloring agents during vitrectomy. The use of such agents has made this surgery more predictable and has increased its post-operative prognosis. Although research on chromovitrectomy is currently expanding there is still not an established gold standard dyeing agent.Keywords: Vitrectomy; Vitreous body; Macular hole; Retina; Dyeing agents; Epiretinal membrane RESUMOA cirurgia vitreorretiniana é uma cirurgia que envolve técnicas complexas e delicadas que tratam doenças como buraco macular, membrana epirretiniana e o edema macular diabético. A cromovitrectomia é uma dessas técnicas que incluem o uso de corantes compostos de pigmentos vitais ou cristais para melhorar a visibilização de estruturas transparentes durante a cirurgia de vitrectomia. O objetivo desse artigo foi apresentar uma abordagem atual, baseada em evidências, sobre a aplicação e indicação de corantes vitais durante a cirurgia vitreorretiniana. O emprego desses corantes possibilitou uma maior previsibilidade para a cirurgia, melhorando assim seu prognóstico pós-operatório. Apesar do campo da cromovitrectomia está em plena expansão de pesquisas, um corante gold standard para cromovitrectomia ainda não está estabelecido.

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Intravitreal Toxicity of the Kenalog Vehicle (Benzyl Alcohol) in Rabbits

Cited by 109 publications

References 36 publications

Intravitreal Micronized Triamcinolone versus Triamcinolone Acetonide: A Clinical and Morphological Comparative Study

Intravitreal Micronized Triamcinolone versus Triamcinolone Acetonide: A Clinical and Morphological Comparative Study

Cromovitrectomia

State of the art in chromovitrectomy

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