Repeated Intravitreal Injection of Triamcinolone for Exudative Age-Related Macular Degeneration

Jonas, Jost B.; Spandau, Ulrich; Kamppeter, Bernd A.; Vossmerbaeumer, Urs; Harder, Ben

doi:10.1159/000096226

Cited by 16 publications

(24 citation statements)

References 66 publications

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“…20 Patients retreated with an intravitreal injection of 20 mg of triamcinolone acetonide showed a significant reincrease in visual acuity after the second intravitreal injection. 17 These clinical studies are in agreement with experimental studies on an angiostatic effect of intravitreal cortisone on experimental subretinal neovascularization and other types of intraocular blood vessel proliferation. 4,5,7,29 The results of the present study show less beneficial results than the previous studies mentioned above.…”

Section: Discussionsupporting

confidence: 86%

Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration

Jonas

Spandau

Kamppeter

et al. 2006

Eye

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Purpose To report on the follow-up of patients who received an intravitreal triamcinolone acetonide injection (IVTA) as treatment of exudative age-related macular degeneration.Methods The clinical interventional caseseries study included 205 patients (222 eyes) with progressive exudative age-related macular degeneration with subfoveal neovascularization who consecutively received an IVTA of about 20 mg as only therapeutic procedure and for whom follow-up was at least 3 months. Mean follow-up was 10.477.1 months (range, 3-35.7 months). Results Visual acuity improved significantly (Po0.001) from baseline (0.9070.45 logarithm of the minimum angle of resolution (LogMar)) to a mean minimum of 0.7970.42 LogMar during follow-up. In 86 (38.7%) eyes and in 55 (24.8%) eyes, best visual acuity increased by at least two and three Snellen lines, respectively. Comparing the measurements at specific postinjection examination dates showed that visual acuity measurements taken at 1, 2, and 3 months after injection were not significantly different from the baseline value. Measurements taken at 6, 9, and 12 months after the injection were significantly (Po0.001) lower than the measurements at baseline. Mean loss at 6 months was 1.473.8 Snellen lines, at 9 months, 2.574.6 lines, and at 12 months after the injection, 2.674.0 lines. Intraocular pressure increased significantly (Po0.001) during the first 6 months, and returned to baseline at 9 months after injection.Conclusions Single injection high-dosage IVTA did not show an apparent benefit at 12 months after injection in patients with neovascular age-related macular degeneration.

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Section: Discussionsupporting

confidence: 86%

Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration

Jonas

Spandau

Kamppeter

et al. 2006

Eye

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“…Of the 20 eyes with initial visual acuity of 0.10 or better, vision was stabilized in 11 eyes (55%), while 6 eyes (30%) suffered severe visual loss (6 or more lines). Similar results on a possibly positive effect of intravitreal triamcinolone for exudative age-related macular degeneration were reported based on a randomized clinical trial by Danis et al [109] and on other case series studies and nonrandomized comparative investigations [110,112,117,118,121,123,134,136] . One of these studies looked for factors influencing visual acuity after an intravitreal injection of triamcinolone acetonide as treatment of exudative age-related macular degeneration [118] .…”

Section: Exudative Age-related Macular Degeneration Treated By Intravsupporting

confidence: 77%

“…The effect of intravitreal triamcinolone acetonide on visual acuity in patients with exudative age-related macular degeneration lasted about 6-8 months if a dosage of about 20 mg was used. If after that time visual acuity decreased again, some patients received a repeated injection of about 20 mg triamcinolone acetonide with a reincrease in visual acuity [117] .…”

Section: Exudative Age-related Macular Degeneration Treated By Intravmentioning

confidence: 99%

Intravitreal Triamcinolone Acetonide: A Change in a Paradigm

Jonas¹

2006

Ophthalmic Res

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148

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Background: Based on experimental studies and clinical observations by Robert Machemer, Gholam Peyman and others, the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of intraocular diseases. Methods and Results: The most widely injected drug so far has been triamcinolone acetonide for various intraocular neovascular and edematous 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 has been achieved for intraretinal edematous diseases such as diffuse diabetic macular edema, branch retinal vein occlusion, central retinal vein occlusion, and pseudophakic cystoid macular edema. In eyes with various types of noninfectious uveitis including acute or chronic sympathetic ophthalmia and Adamantiadis-Behçet’s disease, visual acuity increased and the degree of intraocular inflammation decreased. Some studies have suggested that intra- vitreal triamcinolone may be useful as an angiostatic agent in eyes with iris neovascularization and proliferative ischemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration, particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure 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 intraocular pressure 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% in elderly patients within 1 year after injection; postoperative infectious endophthalmitis with a rate of about 1:1,000; noninfectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudoendophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other types of intraocular surgery 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 vision redecreases. In nonvitrectomized 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. It has remained unclear so far, whether and how to remove the solvent agent. In the future, intravitreal triamcinolone may be combined with other antiangiogenic drugs for the treatment of exudative age-related macular degeneration or with neuroprotective drugs for treatment of diabetic retinopathy. Conclusions: Despite an exponentially increasing number of mostly case-series studies, the intravitreal injection of triamcinolo...

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“…Following Robert Machemer, Gholam Peyman, and others, [1][2][3][4][5][6] intravitreal triamcinolone acetonide has increasingly been used in recent studies as treatment for other intraocular proliferative, oedematous, and neovascular diseases, such as diffuse diabetic macular oedema, [7][8][9][10][11][12][13] central retinal vein occlusion, [14][15][16][17] branch retinal vein occlusion, [18][19][20] chronic uveitis, [21][22][23][24][25] persistent pseudophakic cystoid macular oedema, [26][27][28][29] exudative age-related macular degeneration, [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] and other diseases. 6 It has remained unclear so far, whether the various ocular disorders differ in their response to intravitreal triamcinolone acetonide in terms of an increase in visual acuity and a rise in intraocular pressure.…”

Section: Introductionmentioning

confidence: 99%

Visual acuity and intraocular pressure after high-dose intravitreal triamcinolone acetonide in selected ocular diseases

Jonas¹,

Schlichtenbrede²

2007

Eye

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Purpose Within the last 5 years, intravitreal injections of triamcinolone acetonide have been for a wide variety of ocular diseases with intraocular oedema and neovascularization. With clinical experience accumulating, the question arises for which indication the side effects outweigh the therapeutic efficacy of intravitreal triamcinolone monotherapy. Scope Comparing different diseases, increase in visual acuity was lower in patients receiving intravitreal triamcinolone monotherapy for exudative age-related macular degeneration than in patients with diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion, uveitis, and pseudophakic cystoid macular oedema. Rise in intraocular pressure was significantly higher in relatively young patients with uveitis than in any other patient group. Conclusions Improvement in vision after intravitreal triamcinolone monotherapy is highest in non-ischaemic diseases with an intraretinal macular oedema such as pseudophakic cystoid macular oedema; it is lower in partially ischaemic diseases with intraretinal macular oedema such as diabetic macular oedema or retinal vein occlusions; and it is lowest in diseases with a primarily subretinal location of the disease such as exudative age-related macular degeneration. For the latter diseases, intravitreal triamcinolone monotherapy is, therefore, no longer up-to-date, particularly with the upcoming intravitreal application of vascular endothelial growth factor blocking drugs. For diseases with intraretinal oedema, the rule of thumb may be that intravitreal triamcinolone increases vision as much as retinal ischaemia and tissue destruction by the underlying disease allow it. The rise in intraocular pressure is higher in relatively young patients with uveitis than in elderly patients with other reasons for macular oedema.

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Repeated Intravitreal Injection of Triamcinolone for Exudative Age-Related Macular Degeneration

Cited by 16 publications

References 66 publications

Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration

Follow-up after intravitreal triamcinolone acetonide for exudative age-related macular degeneration

Intravitreal Triamcinolone Acetonide: A Change in a Paradigm

Visual acuity and intraocular pressure after high-dose intravitreal triamcinolone acetonide in selected ocular diseases

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