Intravitreal Triamcinolone Acetonide as Primary Treatment for Diffuse Diabetic Macular Edema: A Prospective Noncomparative Interventional Case Series

Nicolò, Massimo; Nasciuti, Francesca; Lai, Sheng; Ghiglione, D; Borgia, Luigi; Calabria, G.

doi:10.1177/112067210601600120

Cited by 10 publications

(13 citation statements)

References 29 publications

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“…Robert Machemer and colleagues in particular thought about intravitreal triamcinolone acetonide (IVTA) as a therapy of proliferative vitreoretinopathy [1,3,4,9,13,14,15,16]. As a consequence of Machemer’s suggestion, IVTA has been used for the treatment of other intraocular proliferative, edematous and neovascular diseases such as proliferative diabetic retinopathy [17,18], diffuse diabetic macular edema (DME) and diabetic retinopathy in general [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79], branch retinal vein occlusion (BRVO) [80,81,82,83,84,85,86,87,88,89,90,91,92], central retinal vein occlusion (CRVO) […”

Section: Introductionmentioning

confidence: 99%

Intravitreal Triamcinolone

Tao

Jonas

2010

Ophthalmologica

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Background: To provide an update on the intravitreal use of triamcinolone acetonide. Methods: Review of literature regarding triamcinolone-related research. Results: After the introduction of bevacizumab and ranibizumab into clinical practice, intravitreal triamcinolone has lost its leading position as the drug most often injected intravitreally. Due to its properties as a long-acting steroid, triamcinolone has still been used for various conditions such as diffuse diabetic macular edema, retinal vein occlusions, pseudophakic cystoid macular edema, chronic prephthisical ocular hypotony and uveitis, and in combination with bevacizumab or ranibizumab. The complications of intravitreal triamcinolone therapy include secondary ocular hypertension in about 40% of the eyes injected, cataract and postoperative infectious or noninfectious endophthalmitis. Conclusions: Due to its widespread biological effects as a steroid and due to a relatively large therapeutic window, intravitreal triamcinolone has remained in clinical use for a variety of intraocular disorders, and it may be a promising candidate for intravitreal medical combination therapies.

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Section: Introductionmentioning

confidence: 99%

Intravitreal Triamcinolone

Tao

Jonas

2010

Ophthalmologica

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“…In patients with DM and diffuse macular edema, the use of triamcinolone alone was evaluated in a single study (18) . Despite favourable results in OCT and visual acuity in this non-controlled study, a much higher triamcinolone dose was used as compared to the present study (25 mg vs. 4 mg).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, data about possible improvement using laser after intravitreal triamcinolone are controversial (16,17) . A single noncontrolled study with a high dose of intravitreal triamcinolone (25 mg) assessed this injection as a primary treatment for diabetic macular edema (18) . Most studies with triamcinolone and laser photocoagulation consider visual acuity as an outcome parameter, thus evaluating especially foveal function.…”

Section: Introductionmentioning

confidence: 99%

Treatment of diffuse diabetic maculopathy with intravitreal triamcinolone and laser photocoagulation: randomized clinical trial with morphological and functional evaluation

Gil¹,

Azevedo²,

Tomasetto³

et al. 2011

Arq. Bras. Oftalmol.

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Purpose: Treatment of diffuse macular edema in diabetes mellitus is currently unsatisfactory. The purpose of this double blind randomized clinical trial was to compare the treatment of diffuse diabetic macular edema with intravitreal triamcinolone or laser in type 2 diabetes mellitus patients using a morphofunctional assessment. Methods: Fourteen patients (21 eyes) with clinically significant diffuse macular-edema, previously untreated and with a macular thickness >250 μm at optical coherence tomography were randomized for treatment with laser or intravitreal injection of triamcinolone acetate. Optical coherence tomography, biomicroscopy, fundoscopy, fluorescein angiography, tonometry, scotometry, visual and contrast acuities were performed at 0, 1, 3 and 6 months. Results: At pre-treatment stage, Laser (n=9) and Triamcinolone (n=12) groups did not differ regarding retinal thickness, visual and contrast acuities. In Triamcinolone group macular thickness decreased after 1 month (424.1 ± 19.9 μm to 358.4 ± 18.2 μm; p=0.04) and started to return to the initial values in the 3 rd month (p=0.02). No changes occurred in macular scotometry and visual and contrast acuities. No side effects were observed with both treatments. Conclusion: During the study macular thickness diminished in the triamcinolone group, especially in the first month of treatment. At 3 and 6 months there was no difference. Macular thickness did not change during the study in the laser group. In the study sample it was not possible to demonstrate differences relates to visual acuity and scotometry between the two groups. ClinicalTrials.

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“…There is an unmet need to develop safe and sustainable ocular formulation of cidofovir. Previously we have tried to develop a crystalline drug depository formulation using lipid prodrug strategy, which allowed formation of a drug depot in vitreous and offer a slow release, similar to triamcinolone acetonide intravitreal application [11]. However, this type of delivery can cause unpredictable localized retinal toxicity if the drug depot touches the retina [7, 12].…”

Section: Introductionmentioning

confidence: 99%

Micelle formulation of hexadecyloxypropyl-cidofovir (HDP-CDV) as an intravitreal long-lasting delivery system

Nan

Lee

et al. 2015

European Journal of Pharmaceutics and Biopharmaceutics

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There still is an unmet need for a safe and sustained intravitreal drug delivery system. In this study we are proposing and characterizing a micelle based, clear-media intravitreal drug delivery system using the lipid derivatized nucleoside analog, hexadecyloxypropyl-cidofovir (HDP-CDV, CMX 001). HDP-CDV forms micelles in water and in vitreous supernatant with the critical micelle concentration of 19 μg/mL and 9 μg/mL, respectively at 37°C. The formed micelles had the average size of 274.7 nm and the Zeta potential of −47.1 mV. Drug release study in the excised rabbit vitreous showed a sustained release profile with a half-life of 2.7 days. The micelle formulation of HDP-CDV demonstrated a good safety profile in two animal species (rabbit and guinea pig) following intravitreal injection. The sustained efficacy was tested in a pretreatment study design and the drug potency was tested in an ongoing herpes simplex virus (HSV-1) retinitis model. The pretreatment studies using single intravitreal injection and later HSV-1 infection revealed at least 9 weeks of vitreous presence and therapeutic level of HDP-CDV, with 71% eyes protection from infection. The treatment study demonstrated that intravitreal administration halted active HSV-1 retinitis in 80% of the infected eyes while cidofovir (CDV) treatment failed to suppress active HSV-1 retinitis. In summary, lipid derivatized nucleoside analogs can be formulated as a micelle intravitreal injection and provides a sustained drug release in vitreous for chronic retinal diseases.

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Intravitreal Triamcinolone Acetonide as Primary Treatment for Diffuse Diabetic Macular Edema: A Prospective Noncomparative Interventional Case Series

Cited by 10 publications

References 29 publications

Intravitreal Triamcinolone

Intravitreal Triamcinolone

Treatment of diffuse diabetic maculopathy with intravitreal triamcinolone and laser photocoagulation: randomized clinical trial with morphological and functional evaluation

Micelle formulation of hexadecyloxypropyl-cidofovir (HDP-CDV) as an intravitreal long-lasting delivery system

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