Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases

Abstract

ABSTRACT.Intravitreal triamcinolone acetonide (IVTA) has increasingly been applied as treatment for various intraocular neovascular and oedematous diseases. Comparing the various diseases with respect to effect and side-effects of the treatment, the best response in terms of gain in visual acuity (VA) has been achieved for intraretinal oedematous diseases such as diffuse diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion and pseudophakic cystoid macular oedema. In eyes with various types of non-infectious uveitis, including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, VA increased and the degree of intraocular inflammation decreased. Some studies have suggested that intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischaemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration (AMD), particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure (IOP) and may stabilize the eye. The complications of intravitreal triamcinolone therapy include: secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high IOP leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% of elderly patients within 1 year of injection; postoperative infectious endophthalmitis occurring at a rate of about one per 1000; non-infectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudo-endophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other intraocular surgeries, including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated if the resultant benefits decrease after the initial IVTA injection. In non-vitrectomized eyes, the duration of the effect and side-effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. So far, it has remained unclear whether the solvent agent should be removed, and if so, how.

Intravitreal bevacizumab vs triamcinolone acetonide for macular oedema due to central retinal vein occlusion

“…6,7,[9][10][11][12][13][14][15][16][17][18][19] A disturbed balance of angiogenic and inflammatory cytokines has been reported to be associated with retinal vein occlusion, 20 and experimental investigations and clinical studies have suggested a temporary antioedematous and antiangiogenic effect of intravitreal triamcinolone in eyes with CRVO. 6,7,[9][10][11][12][13][14][15][16][17][18][19] The two major side effects of the intravitreal triamcinolone were a steroid induced increase in intraocular pressure and development of cataract.…”

“…6,7,[9][10][11][12][13][14][15][16][17][18][19] A disturbed balance of angiogenic and inflammatory cytokines has been reported to be associated with retinal vein occlusion, 20 and experimental investigations and clinical studies have suggested a temporary antioedematous and antiangiogenic effect of intravitreal triamcinolone in eyes with CRVO. 6,7,[9][10][11][12][13][14][15][16][17][18][19] The two major side effects of the intravitreal triamcinolone were a steroid induced increase in intraocular pressure and development of cataract. [21][22][23][24][25] In contrast, studies on intravitreal bevacizumab by Rosenfeld et al and other researchers showed an improvement in visual acuity, reduction in macular thickness, and only minor complications in patients with CRVOs, [26][27][28][29][30][31][32][33][34] so that intravitreal triamcinolone was rapidly exchanged by intravitreal bevacizumab for the treatment of CRVO.…”

“…5 In the past 8 years, a change in a paradigm has taken place, now to consider the vitreous cavity as drug reservoir for the treatment of retinal disorders, such as diabetic retinopathy and retinal vein occlusions. 6 The first drug, which was intravitreally injected was triamcinolone, [7][8][9][10][11][12][13][14] followed by ranibizumab and bevacizumab. [15][16][17][18][19][20][21][22] Both drugs differ in the spectrum of side effect and potentially in the magnitude and duration of their effect.…”

Adherence to diabetic eye examination guidelines in Australia: the National Eye Health Survey

“…triamcinolone acetate, IVTA), provide continuous exposure for considerably longer periods, with absorption occurring over 2 to 6 months, 666 . Use of IVTA in managing retinal diseases was recently reviewed 668 . Two key studies are shown in Table 3.3.3.…”

Acute Retinal Necrosis After Intravitreal Triamcinolone Acetonide For Aphakic Macular Edema- A Case Report

“…Machemer used for the first time intravitreal injection Triamcinolone Acetonide (IVTA) to prevent cellular proliferation after retinal detachment surgery [1].Recent studies showed the use of IVTA in various ophthalmolgic conditions like uveitis, vasculitis, proliferative vitreoretinopathy, macular degeneration, clinically significant diabetic macular edema (CSDME), pseudophakic/aphakic cystoids macular edema etc. These effects are due to the antiinflammatory, anti-angiogenic, and anti-permeability properties of corticosteroids [2][3][4].Many complications have been reported after IVTA which include elevation of intraocular pressure, progression of cataract, Acute Retinal Necrosis (ARN), retinal hemorrhage, retinal detachment, and endophthalmitis etc. Many case reports have shown the local immunue modulatory effects after IVTA may cause viral retinitis, therefore close observation is obligatory [5][6][7][8].Various studies have shown that intraocular corticosteroids might reduce the ocular immune response resulting in either a primary infection or a latent viral reactivation.…”