Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries

Ghoraba, Hammouda Hamdy; Leila, Mahmoud; Elgouhary, Sameh Mohamed; Elgemai, Emad Eldin Mohamed; Abdelfattah, Haithem Mamon; Ghoraba, Hashem; Heikal, Mohamed Amin

doi:10.2147/opth.s185274

Cited by 14 publications

(15 citation statements)

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“…However, different corticosteroids were not directly compared in a single study to explore their relative efficacy. Meanwhile, in view of the high cost of DEX and FA implants, especially for lower-middle-income countries, evaluating the value of intravitreal TA as a low-cost alternative for DME patients is still worthwhile [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials

2021

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Background To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME). Methods Four databases were systematically searched for randomized controlled trials comparing different intravitreal corticosteroids for treating DME. The primary outcome was the change in best-corrected visual acuity (BCVA) within 6 months after the first injection (short-term BCVA). Secondary outcomes were the change in BCVA over 1 year (long-term BCVA) and changes in central macular thickness (CMT) and intraocular pressure (IOP) within 6 months after the first injection. Network meta-analysis was performed to aggregate the results from the individual studies. Results Nineteen trials involving 2839 eyes were included. Intravitreal triamcinolone acetonide (TA) injections (≥ 8 mg and 4–8 mg), fluocinolone acetonide (FA) implants (0.5 µg/day) and dexamethasone (DEX) implants (700 µg) improved short-term BCVA (mean changes in logMAR [95% confidence interval] − 0.27 [− 0.40, − 0.15]; − 0.12 [− 0.18, − 0.06]; − 0.10 [− 0.21, − 0.01]; and − 0.06 [− 0.11, − 0.01]). Intravitreal TA injections (4 mg, multiple times), FA implants (0.5 µg/day and 0.2 µg/day), and DEX implants (350 µg) improved long-term BCVA (mean changes in logMAR [95% confidence interval] − 0.11 [− 0.21, − 0.02]; − 0.09 [− 0.15, − 0.03]; − 0.09 [− 0.14, − 0.02]; and − 0.04 [− 0.07, − 0.01]). All intravitreal corticosteroids reduced CMT, and different dosages of TA did not show significant differences in increasing IOP. Conclusions Intravitreal corticosteroids effectively improved BCVA in DME patients, with higher dosages showing greater efficacies. TA was not inferior to FA or DEX and may be considered a low-cost alternative choice for DME patients. The long-term efficacy and safety of different corticosteroids deserve further investigation. Trial registration Prospectively registered: PROSPERO, CRD42020219870

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Section: Discussionmentioning

confidence: 99%

Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials

2021

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“…10,11 According to literature, median number of injections required for DME in a single patient ranged from 9-11 in first year of treatment and mount to 17 injections over 5 years. 4,12 Based on a simulated model of one year follow up of RESTORE trial, incremental cost for ranibizumab is ₤4,191 for 0.17 Quality Adjusted Life Year (QALY) and may reach ₤ 24,028 for estimated 15 year time. 4 The efficacy of IVTA in treating DME is also well proven over the last many decades.…”

Section: Discussionmentioning

confidence: 99%

“…4,12 Based on a simulated model of one year follow up of RESTORE trial, incremental cost for ranibizumab is ₤4,191 for 0.17 Quality Adjusted Life Year (QALY) and may reach ₤ 24,028 for estimated 15 year time. 4 The efficacy of IVTA in treating DME is also well proven over the last many decades. But repeated studies have shown very high occurrence of cataract formation and increased IOP over time.…”

Section: Discussionmentioning

confidence: 99%

“…Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema DME when compared to standard controlled clinical trials. 4 For a long time, Intra-Vitreal Triamcinolone Acetonide (IVTA) has been an alternative drug for cases not responsive to anti VEGF agents; or where compliance has been an issue. Although, IVTA has very good effect in reversing macular edema and reestablishing the compromised blood retinal barrier; its use has been plagued by certain non-desirable effects.…”

Section: Original Articlementioning

confidence: 99%

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Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema

Tayyab¹,

Ahmed²,

Sadiq³

2019

Pak J Med Sci

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Objective: To evaluate the safety and efficacy of Suprachoroidal Triamcinolone Acetonide (SCTA) injection in patients with treatment resistant Diabetic Macular Edema (DME). Methods: This was a prospective non randomized interventional study conducted in the vitreoretinal department of Al Ehsan Welfare Eye Hospital, Lahore, Pakistan from March 2018 to September 2018. A total of 24 eyes of 24 patients were included. Baseline Best Corrected Visual Acuity (BCVA), Intra Ocular Pressure (IOP) and Central Subfield Thickness (CST) was recorded. After SCTA, patient was followed up at one and three months and same clinical parameters were recorded again and results analyzed. Results: Out of 24 patients, 11(45.83%) were males and 13(54.16%) were females. Mean pre injection CST was 636.5 ± 200.11 um. Mean pre injection BCVA was 0.8 ± 0.24 on ETDRS chart. Mean post injection CST at one and three months was 304.54 ± 67.43 and 302.66 ± 66.93 um. Mean post injection BCVA at one and three months was 0.47 ± 0.3 and 0.45 ± 0.27 on ETDRS chart. The results were statistically significant for pre and post injection CST at both one and three months (p-value < 0.00001). Pre and post injection BCVA was also statistically significant (p-value < 0.05). Conclusion: Preliminary evidence suggests that SCTA is well tolerated and may help in improving functional and structural outcomes of treatment resistant DME. doi: https://doi.org/10.12669/pjms.36.1.1194 How to cite this:Tayyab H, Ahmed CN, Sadiq MAA. Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema. Pak J Med Sci. 2020;36(1):---------. doi: https://doi.org/10.12669/pjms.36.1.1194 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Although injection of Ozurdex has become the main treatment for macular edema in recent years[1], TA injection is an effective and inexpensive treatment and is still used in developing countries or regions. Recent research has indicated that intravitreal injection of TA is an efficient approach in the treatment of a variety of proliferative, edematous, neovascular and inflammatory ocular disorders[2-4]. Despite the efficacy of intravitreal TA injection, attention should be paid to its associated complications.…”

Section: Introductionmentioning

confidence: 99%

Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases

Zheng

Liu

2019

WJCC

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BACKGROUNDIntravitreal injection has become an efficient approach for delivering drugs at therapeutic levels to the posterior segment in retinal diseases. However, the increased frequency and number of intravitreal injections have raised concerns about their side effects. As manipulation during surgery is relatively simple, details of the procedure are easily overlooked. Iatrogenic crystalline lens injury is a rare complication caused by improper manipulation during surgical procedures. We report two cases of crystalline lens injury during intravitreal injection of triamcinolone acetonide (TA) with the hope of providing an insight into this treatment.CASE SUMMARYCase 1 was a 62-year-old woman with macular edema caused by central retinal vein occlusion in her right eye, and Case 2 was a 65-year-old man with macular edema caused by branch retinal vein occlusion in his right eye. In view of the patients’ condition and economic constraints, an intravitreal injection of TA was administered. Due to inappropriate manipulation during surgery, the lens was injured. The site of lens injury and clinical manifestations were different in the two cases. Symptomatic treatment and continuous follow-up were carried out. The therapeutic effect following phacoemulsification of the cataract was satisfactory.CONCLUSIONWell-defined surgical incision under proper anesthesia, sufficient patient information and proficient anatomical skills of the physician are mandatory to prevent this rare adverse event. Careful and meticulous phacoemulsification of the cataract is suggested.

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Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries

Cited by 14 publications

References 51 publications

Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials

Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials

Efficacy and safety of suprachoroidal triamcinolone acetonide in cases of resistant diabetic macular edema

Iatrogenic crystalline lens injury during intravitreal injection of triamcinolone acetonide: A report of two cases

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