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

Jonas, Jost B.; Schlichtenbrede, Frank C.

doi:10.1038/sj.eye.6702734

Cited by 25 publications

(14 citation statements)

References 49 publications

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“…Similarly, the doses of TRIAM are comparable to or higher than those used clinically to suppress severe extraocular or intraocular inflammation. In humans, 2- to 4-mg doses of IVit TRIAM are used in the treatment of refractory, clinically significant diabetic macular edema,33 and 4 mg for most other intraocular diseases,34 although higher doses may be used 35. In dogs, IVit injections of 8 mg TRIAM in a 0.2-mL volume without anterior chamber paracentesis caused immediate, but transient elevations of intraocular pressure (IOP); thereafter, the IOP returned to baseline and remained normal 36.…”

Section: Discussionmentioning

confidence: 99%

Steroids Do Not Prevent Photoreceptor Degeneration in the Light-Exposed T4R Rhodopsin Mutant Dog Retina Irrespective of AP-1 Inhibition

Beltran

Pearce-Kelling

et al. 2009

Invest. Ophthalmol. Vis. Sci.

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PURPOSE AP-1 has been proposed as a key intermediate linking exposure to light and photoreceptor cell death in rodent light damage models. Inhibition of AP-1 associated with steroid administration also prevents light damage. In this study the role of steroids in inhibiting AP-1 activation and/or in preventing photoreceptor degeneration was examined in the rhodopsin mutant dog model. METHODS The dogs were dark adapted overnight, eyes dilated with mydriatics; the right eye was light occluded and the fundus of the left eye photographed (∼15-17 overlapping frames) with a fundus camera. For biochemical studies, the dogs remained in the dark for 1 to 3 hours after exposure. Twenty-four hours before exposure to light, some dogs were treated with systemic dexamethasone or intravitreal/subconjunctival triamcinolone. AP-1 DNA-binding activity was determined by electrophoresis mobility shift assay (EMSA) and phosphorylation of c-Fos and activation of ERK1/2 were determined by immunoblot analyses. The eyes were collected 1 hour and 2 weeks after exposure to light, for histopathology and immunocytochemistry. RESULTS Inhibition of AP-1 activation, and phosphorylation of ERK1/2 and c-Fos were found after dexamethasone treatment in light-exposed T4R RHO mutant dog retinas. In contrast, increased AP-1 activity and phosphorylation of c-Fos and ERK1/2 were found in triamcinolone-treated mutant retinas. Similar extensive rod degeneration was found after exposure to light with or without treatment, and areas with surviving photoreceptor nuclei consisted primarily of cones. Only with systemic dexamethasone did the RPE cell layer remain. CONCLUSIONS Intraocular or systemic steroids fail to prevent light-induced photoreceptor degeneration in the T4R RHO dog retina. Finding that systemic dexamethasone prevents AP-1 activation, yet does not prevent retinal light damage, further supports the hypothesis that AP-1 is not the critical player in the cell-death signal that occurs in rods.

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Section: Discussionmentioning

confidence: 99%

Steroids Do Not Prevent Photoreceptor Degeneration in the Light-Exposed T4R Rhodopsin Mutant Dog Retina Irrespective of AP-1 Inhibition

Beltran

Pearce-Kelling

et al. 2009

Invest. Ophthalmol. Vis. Sci.

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“…The rate of posterior subcapsular cataract formation is higher than previously reported, and there is a small but potential risk of endophthalmitis [37 ]. The rise in intraocular pressure is more common in relatively young patients with uveitis than in elderly patients with other reasons for CME, and increases with multiple injections [38]. Intravitreal application of 4 mg triamcinolone in diabetic patients with already abnormal electroretinographic findings showed no additional evidence of a retinotoxic effect [39].…”

Section: Treatment Of Cystoid Macular Edemamentioning

confidence: 93%

Inflammatory cystoid macular edema

Rothová

2007

Current Opinion in Ophthalmology

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“…Many different risk factors have been found to be predictive of an IOP elevation secondary to IVTA, such as younger age (in a meta-analysis by Jonas et al [159]), a baseline IOP >16 mmHg (in a retrospective consecutive case series by Rhee et al [160]), and a history of uveitis (in a review by Jonas et al [161]). Another review points to different risk factors in developing TA-induced ocular hypertension i.e.…”

Section: Ocular Complicationsmentioning

confidence: 97%

Clinical Evidence of Intravitreal Triamcinolone Acetonide in the Management of Age-Related Macular Degeneration

Becerra

Morescalchi

Gandolfo

et al. 2011

CDT

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Triamcinolone acetonide (TA) is one of the first pharmacologic compounds evaluated for the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The most important effects of TA consist in the stabilisation of the blood-retinal barrier and the down-regulation of inflammation. TA also has anti-angiogenic and anti-fibrotic properties. The peculiar characteristic of being well tolerated by ocular tissues and the capability to remain active for many months after a single intravitreal injection, make this drug a safe and effective alternative. In the past decade, intravitreal injection of TA (IVTA) has emerged as a useful treatment of several ocular diseases such as uveitis, macular edema secondary to retinal vasculature disease, neovascularisation and vitreoretinopathy. In this paper, we review all the available evidence of its use in AMD as mono-therapy or in combination with other treatments, and we discuss which role TA will play in the treatment of AMD in the future. The first experiences with IVTA as monotherapy for the treatment of exudative AMD reported a positive outcome in transiently reducing the leakage from CNV. However, in the long-term follow-up, IVTA as monotherapy had no effect on the risk of severe visual acuity loss, despite a significant anti-angiogenic effect found 3 months after the treatment. Consequently, studies using the combination of IVTA and photodynamic therapy (PDT), which acts synergistically, were performed. They reported to improve vision and to reduce the number of re-treatments with PDT. A large number of publications confirmed the positive synergic role of combining TA and PDT (therapies) for the treatment of all types of CNV: classic or predominantly classic, occult or minimally classic and RAP (Retinal Angiomatous Proliferation) lesions. The advantages registered with the use of IVTA plus PDT compared to PDT alone were partially limited by the side effects, such as the rapid evolution of cataract. Nevertheless, cataract surgery may stimulate the development of CNV (result in stimulating CNV). However, in large, randomized, clinical trials on combination therapy of TA and PDT, visual acuity failed to show an improvement, even though the lesion size and subretinal fluid had decreased, compared to controls treated with PDT alone. Some authors reported an increased risk of developing macular atrophy after the combination therapy with IVTA and PDT. Reduction of the PDT fluence rate in association with the use of steroids resulted in reducing the risk of macular atrophy and in a better visual acuity outcome. The introduction of anti-VEGF-based drugs has revolutionized the treatment of AMD and has replaced all the previous therapies used for CNV. Visual improvement becomes an expectation in a higher proportion of patients, previously limited to minimizing vision loss. Anti-VEGF therapy also resulted in superior visual improvement compared to all types of combination therapy with IVT and PDT. Nevertheless, anti-VEGF monotherapy also has many...

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

Cited by 25 publications

References 49 publications

Steroids Do Not Prevent Photoreceptor Degeneration in the Light-Exposed T4R Rhodopsin Mutant Dog Retina Irrespective of AP-1 Inhibition

Steroids Do Not Prevent Photoreceptor Degeneration in the Light-Exposed T4R Rhodopsin Mutant Dog Retina Irrespective of AP-1 Inhibition

Inflammatory cystoid macular edema

Clinical Evidence of Intravitreal Triamcinolone Acetonide in the Management of Age-Related Macular Degeneration

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