Intravitreal triamcinolone acetonide for exudative age related macular degeneration

Abstract

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.

Cataract surgery after intravitreal injection of triamcinolone acetonide

“…The intravitreal injection had been performed as treatment of exudative age-related macular degeneration (n ¼ 22) 7,8 or diffuse diabetic macular oedema (n ¼ 4). 9,11 The injection had been carried out 10.574.2 months (median, 9.1 months; range, 5.4-22.4 months) prior to cataract surgery.…”

“…Recently, intravitreal injections of triamcinolone acetonide have increasingly been used as a treatment for these diseases such as exudative age-related macular degeneration, [1][2][3][4][5][6][7][8] diffuse diabetic macular oedema, [6][7][8][9][10][11] central retinal vein occlusion, 12,13 persistent pseudophakic cystoid macular oedema, proliferative diabetic retinopathy, 14 proliferative vitreoretinopathy, 15 iris neovascularisation, 16 chronic prephthisical ocular hypotony, 17 chronic uveitis, [18][19][20][21] and neovascular glaucoma. 22 Complications and side-effects of the intravitreal injection of triamcinolone acetonide include secondary ocular hypertension developing in about 50% of the eyes injected and leading to high intraocular pressure up to 60 mmHg with the need for antiglaucomatous filtering surgery in about 1% of the eyes; 23 infectious endophthalmitis in less than 1% of the eyes, if the injection was performed under sterile criteria in the operation room; and, because of the cataractogenic effect of steroids, a cataract that has eventually to undergo surgery.…”

“…22 Complications and side-effects of the intravitreal injection of triamcinolone acetonide include secondary ocular hypertension developing in about 50% of the eyes injected and leading to high intraocular pressure up to 60 mmHg with the need for antiglaucomatous filtering surgery in about 1% of the eyes; 23 infectious endophthalmitis in less than 1% of the eyes, if the injection was performed under sterile criteria in the operation room; and, because of the cataractogenic effect of steroids, a cataract that has eventually to undergo surgery. 8 Since the megadosage of steroids injected into the eye may change the internal structures of the eye, and as a result may increase or change the spectrum of surgical complications, the purpose of the present study was to evaluate the frequency and profile of complications of standard cataract surgery following an intravitreal injection of triamcinolone acetonide.…”

Ocular morbidity associated with intravitreal triamcinolone acetonide

“…[1][2][3][4] In the past few years, there has been a remarkable interest in its use. This is demonstrated by an increasing number of publications; Pubmed search of 'intravitreal triamcinolone' resulted in 145 publications during the year 2005 compared to 81 during 2004 and 50 for the year before.…”

HLA B27 as Predisposition Factor to Suffer Age Related Macular Degeneration

“…On the other hand, although the mechanism of action is unknown, it seems that the intravitreal triamcinolone acetonide has shown some promise in the treatment of this pathology (18,19). After the treatment, decrease in the HLA expression was observed in the retina (20).…”