Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema and Macular Edema Secondary to Retinal Vein Occlusion: A Meta-Analysis

Abstract

Background: The comparative safety and efficacy of different doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema (DME) and macular edema (ME) secondary to retinal vein occlusion (RVO) is unclear. Objectives: This meta-analysis aimed to compare the safety and efficacy of different doses of IVTA in this setting. Methods: A systematic literature search for randomized clinical trials (RCTs) was conducted on Cochrane Library, Ovid MEDLINE and EMBASE from January 2005 to May 2022. Studies reporting on patients with DME or ME secondary to RVO that received treatment with different doses of IVTA. A random effects meta-analysis was performed. Cochrane’s risk of bias tool 2 was used to assess the risk of bias and grading of recommendations, assessment, development and evaluation (GRADE) guidelines were used to assess certainty of evidence. Results: Five RCTs reporting on 1,041 eyes at baseline were included in this meta-analysis. In eyes with ME secondary to RVO, high dose (4 mg) IVTA achieved a significantly better change in best-corrected visual acuity (WMD=-4.75 ETDRS letters, 95%CI=[-7.73, -1.78], p=.002) and reduction in retinal thickness (WMD=-93.02 µm, 95%CI=[-153.23, -32.82], p=.002) at months 4-6 compared to low dose (1-2 mg) IVTA. However, high dose IVTA had a higher risk of intraocular pressure (IOP)-related adverse events (RR=2.99, 95%CI=[1.05, 8.50], p=.04) and cataract surgery (RR=5.67, 95%CI=[3.09, 10.41], p<.00001) than low dose IVTA in eyes with ME secondary to RVO. These efficacy and safety differences in high dose and low dose IVTA were not observed in DME eyes. Conclusions: The RCT evidence in this setting is limited. High dose IVTA achieved greater improvements in visual acuity and reductions in retinal thickness than low dose IVTA at months 4-6. However, high dose IVTA had a less favourable safety profile than low dose IVTA. The significance of these outcomes was based on patients with ME secondary to RVO, but not DME.

Calculated Drug Concentrations in Currently Available Intravitreal Therapies: Determination of Dilution Factor and Deviation From Recommended Doses

“…In the literature, there are various case reports of retinal intoxications following high-dose intravitreal amphotericin B injections [ 32 , 33 ]. Furthermore, other studies showed that higher doses of intravitreal triamcinolone acetonide (IVTA) for diabetic macular edema achieved greater improvements in visual acuity and reductions in retinal thickness than lower doses [ 34 ].…”