Carboxymethylcellulose as a new carrier substance for intravitreal injection of reproducible amounts of triamcinolone

Kube, T.; Sutter, M.; Trittler, Rainer; Feltgen, Nicolas; Hansen, Lutz L.; Agostini, Hansjürgen

doi:10.1007/s00417-006-0326-2

Cited by 11 publications

(7 citation statements)

References 49 publications

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“…However, their drawbacks are known side effects, such as cataract progression and rise of intraocular pressure (IOP). The off-label triamcinolone acetonide is crystalline and is commercially available as Kenalog (Kenalog, 40 mg/mL, Bristol-Myers Squibb, Princeton, NJ), Trivaris (Pharm Allergan Inc., Irvine California) or prepared for injection with methocel [7]. Dexamethasone is more potent and soluble in comparison to triamcinolone and various attempts have been made to construct a slow-release device.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion: a Systematic Review

et al. 2013

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BackgroundIntravitreal agents have replaced observation in macular edema in central (CRVO) and grid laser photocoagulation in branch retinal vein occlusion (BRVO). We conducted a systematic review to evaluate efficacy and safety outcomes of intravitreal therapies for macular edema in CRVO and BRVO.Methods And Findings: MEDLINE, Embase, and the Cochrane Library were systematically searched for RCTs with no limitations of language and year of publication. 11 RCTs investigating anti-VEGF agents (ranibizumab, bevacizumab, aflibercept) and steroids (triamcinolone, dexamethasone implant) with a minimum follow-up of 1 year were evaluated.Efficacy: CRVOGreatest gain in visual acuity after 12 months was observed both under aflibercept 2 mg: +16.2 letters (8.5 injections), and under bevacizumab 1.25 mg: +16.1 letters (8 injections). Ranibizumab 0.5 mg improved vision by +13.9 letters (8.8 injections). Triamcinolone 1 mg and 4 mg stabilized visual acuity at a lower injection frequency (-1.2 letters, 2 injections).BRVORanibizumab 0.5 mg resulted in a visual acuity gain of +18.3 letters (8.4 injections). The effect of dexamethasone implant was transient after 1.9 implants in both indications.SafetySerious ocular adverse events were rare, e.g., endophthalmitis occurred in 0.0-0.9%. Major differences were found in an indirect comparison between steroids and anti-VEGF agents for cataract progression (19.8-35.0% vs. 0.9-7.0%) and in required treatment of increased intraocular pressure (7.0-41.0% vs. none). No major differences were identified in systemic adverse events.ConclusionsAnti-VEGF agents result in a promising gain of visual acuity, but require a high injection frequency. Dexamethasone implant might be an alternative, but comparison is impaired as the effect is temporary and it has not yet been tested in PRN regimen. The ocular risk profile seems to be favorable for anti-VEGF agents in comparison to steroids. Because comparative data from head-to-head trials are missing currently, clinicians and patients should carefully weigh the benefit-harm ratio.

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Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion: a Systematic Review

et al. 2013

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“…Triamcinolone is a synthetic, lipophilic corticosteroid with low solubility in aqueous solution. 7 Its rapid bioavail- ability and sustained-release characteristics make it ideal for intraocular injection, and its biochemical effects have been shown to expedite resolution of CME due to various causes, including diabetic retinopathy, retinal vein occlusion, and pseudophakia. It may potentiate laser therapy for DME and choroidal neovascularization.…”

Section: Commentmentioning

confidence: 99%

“…It may potentiate laser therapy for DME and choroidal neovascularization. [7][8][9][10] Triamcinolone-associated maculopathy is a novel syndrome that develops exclusively in patients after IVTA injection for treatment of diabetic CME or macular edema of other causes such as branch retinal vein occlusion. No patients in this study were West African or were intravenous drug users, nor did any have a history of tamoxifen, canthaxanthine, or nitrofurantoin use or exposure to other medications known to be associated with crystalline maculopathies.…”

Section: Commentmentioning

confidence: 99%

Triamcinolone-Associated Crystalline Maculopathy

Sarraf

Vyas²,

Jain³

et al. 2010

Arch Ophthalmol

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To describe the findings of a new crystalline maculopathy exclusively affecting individuals who have previously received intravitreous triamcinolone acetonide injections. Methods: In a retrospective, observational, noncomparative case series, 21 eyes of 13 patients referred over a 9-year period were identified as having a characteristic crystalline maculopathy. Each patient underwent detailed historical questioning and comprehensive ocular evaluation, including formal retinal examination, fundus photography, fluorescein angiography, and optical coherence tomography. Results: Each of the 21 eyes was treated with intravitreous triamcinolone (preserved in all but 2 eyes) for macular edema (18 eyes due to diabetes, 2 due to pseudophakic cystoid macular edema, and 1 due to a vein occlusion). The crystals were superficial, refractile, white or yellow-Author Affiliations are listed at the end of this article.

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“…Meist werden 4 mg gegeben. Die exakte Dosierung stellt ein Problem dar, da sie durch den Waschvorgang und durch Absorption an den Wänden der Kunststoffspritze unsicher ist[38]. Triamcinolon-Acetonid (TA) hat aufgrund seines geringen Löslichkeitsgleichgewichts von 25-30 µg/ml im nicht vitrektomierten Auge eine Depotwirkung über mehrere Monate[5,22,49,54].…”

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Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands zur intravitrealen Therapie des Makulaödems bei Uveitis (Stand: 02. 07. 2014)

Heiligenhaus

Bertram²,

Heinz³

et al. 2014

Klin Monatsbl Augenheilkd

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Carboxymethylcellulose as a new carrier substance for intravitreal injection of reproducible amounts of triamcinolone

Abstract: Common methods for preparing triamcinolone acetonide vary in the amount of drug actually injected intravitreally. Carboxymethylcellulose is an ideal carrier substance for intravitreal application of an exact dose of triamcinolone acetonide without preservatives.

Cited by 11 publications

References 49 publications

Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion: a Systematic Review

Efficacy and Safety of Intravitreal Therapy in Macular Edema Due to Branch and Central Retinal Vein Occlusion: a Systematic Review

Triamcinolone-Associated Crystalline Maculopathy

Stellungnahme der Deutschen Ophthalmologischen Gesellschaft, der Retinologischen Gesellschaft und des Berufsverbandes der Augenärzte Deutschlands zur intravitrealen Therapie des Makulaödems bei Uveitis (Stand: 02. 07. 2014)

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