The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment

Hong, In Hwan; Choi, Wonseok; Han, Jae Ryong

doi:10.1007/s10384-019-00710-6

Cited by 16 publications

(21 citation statements)

References 17 publications

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“…Over recent years, several studies have showed the safety and efficacy of IVTA injections in patients with DME. Our results are substantially in according with these studies, but we did not observe a drop in outcomes at month 6 [19][20][21][22]. Also, we have been positive impressed by our data at month 6: no further improved outcomes compared to month 3, but not significant worsened at all.…”

Section: Discussionsupporting

confidence: 85%

Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)

2021

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Purpose To suggest the safety and efficacy of preservative-free triamcinolone acetonide intravitreal injectable suspension (Taioftal) for the treatment of diabetic macular edema. Methods A prospective clinical study involved 49 patients (49 eyes), that were treated with Taioftal and followed-up for six months. Complete ophthalmic examination, including spectral domain optical coherence tomography, was performed at baseline, and at month 1, 3, 6 after the intravitreal injection. Accurate collection and analysis of best-corrected visual acuity (BCVA), central foveal thickness (CFT), intraocular pressure (IOP), and adverse events (AEs) were carried out in order to evaluate visual function and macular morphology before and after treatment Results Median BCVA value chosen as comparing statistics was significantly improved at every follow-up time points (gain of 6 letters at month 1, 12 at month 3 –improvement up to 24% at month 3 with stabilization until month 6) compared to baseline, as certified by Kruskal-Wallis rank sum test (P<0.05). Median CFT significantly waned at each follow-up times (decrease of about 65 μm at month 1, 155 at month 3 –reduction up to 28% at month 3 keeping good outcome until month 6) compared to baseline (P<0.05). IOP elevation, with no severe increases, was the most common among spotted AEs (median of 23 mmHg at month 1, 20 at month 3). Conclusion Intravitreal injection of preservative-free triamcinolone (Taioftal) is an effective, safe and inexpensive drug used to improve visual acuity and reduce central foveal thickness in eyes affected by diabetic macular edema during an average time of 6 months. Temporary, never severe, elevation of IOP is totally manageable with topical medications. No serious vision-threatening complications are related to the use of intravitreal triamcinolone injections.

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Section: Discussionsupporting

confidence: 85%

Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)

2021

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“…[ 15 ] Switching to intravitreal triamcinolone acetonide demonstrated significant visual and anatomical improvement in 64 eyes affected by DME refractory to anti-VEGF therapy. [ 16 ] Yolcu and Sobaci reported that combined intravitreal bevacizumab and triamcinolone resulted in nearly 0.2 logMAR visual gains and obvious macular edema reduction in 25 eyes with refractory DME to prior intravitreal bevacizumab or triamcinolone monotherapy. [ 17 ] However, the incidence of ocular hypertension which required treatments was as high as 32.97% after intravitreal dexamethasone implant injections for DME in a multicenter study.…”

Section: Discussionmentioning

confidence: 99%

Combined intravitreal ranibizumab and posterior subtenon triamcinolone acetonide injections for patients with diabetic macular edema refractory to intravitreal ranibizumab monotherapy

Chiu¹,

Huang²,

Chang³

et al. 2021

Taiwan J Ophthalmol

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PURPOSE: The purpose of this study is to compare the efficacy of intravitreal ranibizumab (IVR) alone and concurrent IVR with posterior subtenon triamcinolone acetonide (PSTA) injection for patients with diabetic macular edema (DME) refractory to IVR monotherapy. MATERIALS AND METHODS: We enrolled 43 eyes of 43 patients with DME who received at least three times of IVR, which resulted in poor anatomical responses, with central foveal thickness (CFT) reduction <10% and postinjection CFT >300 μm. All the eyes received initial 3 monthly then pro re nata (PRN) IVR 0.5-mg injections. Twenty eyes continued PRN injections and 23 eyes received combined IVR 0.5 mg and PSTA 40 mg with at least 1-year follow-up. Best-corrected visual acuity (BCVA) and CFT were recorded from 1-month to 1-year follow-up. RESULTS: Following switch to combined therapy, the mean BCVA significantly improved from 0.61 ± 0.32 logarithm of the minimum angle of resolution (logMAR) to 0.45±0.39 logMAR at 6 month ( P = 0.003), 0.43±0.35 logMAR at 9 months ( P < 0.001), and 0.48±0.45 logMAR at 1 year ( P = 0.03). In eyes with IVR alone, no significant VA improvement was noted throughout the year. Significantly better BCVA was noted in the combined group at 6-month, 9-month, and 1-year follow-up compared to IVR-alone group. The timing of combined therapy showed a significant association with 1-year BCVA ( t = 3.25, P = 0.018). CONCLUSION: Concurrent IVR and PSTA resulted in significantly better visual outcomes in 1-year follow-up for those refractory to preceding ranibizumab monotherapy for DME. Early addition of PSTA predicted a better visual outcome.

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“…The zero-order kinetics of dexamethasone implant theoretically improves its IOP pro le in contrast to large-bolus triamcinolone injections. Both treatments have been assessed separately to measure e cacy with regard to diabetic macular edema [2,3]. They have also been directly, prospectively compared in a comparative effectiveness trial for the treatment of uveitic macular edema and retrospectively for retinal vein occlusions [4,5].…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Intravitreal Triamcinolone and Dexamethasone Intravitreal Implant for Diabetic Macular Edema

Kerley

Barr

Wang

et al. 2021

Preprint

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Purpose: To compare the efficacy, adverse effects, and treatment burden of two injectable corticosteroids, triamcinolone acetonide (Kenalog® or Triesence®) and the dexamethasone intravitreal implant (Ozurdex®), for treating diabetic macular edema (DME). Methods: This was a retrospective review at a single tertiary care center. Eyes treated with either intravitreal triamcinolone two mg (IVTA) or the intravitreal dexamethasone 0.7 mg implant for center-involving DME and with follow up of at least six months were included. Main outcomes were visual acuity (VA), intraocular pressure (IOP), IOP medication use, central macular thickness (CMT), and time to next treatment of any kind.Results: There were 24 eyes in the IVTA group and 15 eyes in the dex group. Baseline mean VA was 20/60 (range 20/30-20/800) in the IVTA group and 20/35 (range 20/20-20/100) in the dex group (p=0.0011). Only the subgroup of pseudophakic IVTA patients experienced a statistically significant increase in vision early on (+2 letters at month 1, +3 letters at month three), though not at month six. Mean IOP increased by 2.5 and 0.20 mmHg at month one in the IVTA and dex groups, respectively (p=0.27). Mean CMT decreased by 143 mm with IVTA and 39 mm with dex at month one (p=0.00025). Mean time to next treatment of any kind was 19 weeks for IVTA and 20.3 weeks for dex (p=0.41). Conclusions: Intravitreal triamcinolone and the intravitreal dexamethasone implant both show similar efficacy at reducing DME and its treatment burden, but neither significantly affected visual acuity over six months.

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The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment

Cited by 16 publications

References 17 publications

Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)

Diabetic macular edema: Safe and effective treatment with intravitreal triamcinolone acetonide (Taioftal)

Combined intravitreal ranibizumab and posterior subtenon triamcinolone acetonide injections for patients with diabetic macular edema refractory to intravitreal ranibizumab monotherapy

Comparative Efficacy of Intravitreal Triamcinolone and Dexamethasone Intravitreal Implant for Diabetic Macular Edema

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