Intravitreal Triamcinolone for Diabetic Macular Edema

Hauser, David; Bukelman, Amir; Pokroy, Russell; Katz, Haia; Len, Ariela; Thein, Ran; Parness-Yossifon, Rehut; Pollack, Ayala

doi:10.1097/iae.0b013e318165767e

Cited by 47 publications

(35 citation statements)

References 24 publications

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“…The greatest improvement in BCVA at 12 months was in the 0.3 mg group (11.8 letter gain) compared to the 0.5 mg group (8.8 letter gain) or sham injection (1.4 letter loss). In this study, rescue laser was 114 Single dose Jonas et al 115 Single dose Joussen et al 116 Study protocol Avci and Kaderli 117 Anaesthetic technique Kang et al 118 Single dose Kim et al 119 Single injection and CME Lam et al 120 Single injection Lee 121 Single injection Maia et al 122 Single dose Massin et al 123 Single dose Mohamed et al 124 Post hoc analysis Nakamura et al 125 Single dose Spandau et al 126 Single dose Tunc 127 <6 months Verma et al 128 Single 13 Current treatments in diabetic macular oedema Current treatments in diabetic macular oedema 23 Current treatments in diabetic macular oedema Adverse events are shown in tables 9 and 16. Conjunctival haemorrhages were higher in the ranibizumab arms compared with laser (RESTORE) or no treatment (RESOLVE).…”

Section: Ranibizumabmentioning

confidence: 92%

Current treatments in diabetic macular oedema: systematic review and meta-analysis

et al. 2013

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ObjectivesThe aim of this systematic review is to appraise the evidence for the use of anti-VEGF drugs and steroids in diabetic macular oedema (DMO) as assessed by change in best corrected visual acuity (BCVA), central macular thickness and adverse eventsData sourceMEDLINE, EMBASE, Web of Science with Conference Proceedings and the Cochrane Library (inception to July 2012). Certain conference abstracts and drug regulatory web sites were also searched.Study eligibility criteria, participants and interventionsRandomised controlled trials were used to assess clinical effectiveness and observational trials were used for safety. Trials which assessed triamcinolone, dexamethasone, fluocinolone, bevacizumab, ranibizumab, pegaptanib or aflibercept in patients with DMO were included.Study appraisal and synthesis methodsRisk of bias was assessed using the Cochrane risk of bias tool. Study results are narratively described and, where appropriate, data were pooled using random effects meta-analysis.ResultsAnti-VEGF drugs are effective compared to both laser and placebo and seem to be more effective than steroids in improving BCVA. They have been shown to be safe in the short term but require frequent injections. Studies assessing steroids (triamcinolone, dexamethasone and fluocinolone) have reported mixed results when compared with laser or placebo. Steroids have been associated with increased incidence of cataracts and intraocular pressure rise but require fewer injections, especially when steroid implants are used.LimitationsThe quality of included studies varied considerably. Five of 14 meta-analyses had moderate or high statistical heterogeneity.Conclusions and implications of key findingsThe anti-VEGFs ranibizumab and bevacizumab have consistently shown good clinical effectiveness without major unwanted side effects. Steroid results have been mixed and are usually associated with cataract formation and intraocular pressure increase. Despite the current wider spectrum of treatments for DMO, only a small proportion of patients recover good vision (≥20/40), and thus the search for new therapies needs to continue.

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Section: Ranibizumabmentioning

confidence: 92%

Current treatments in diabetic macular oedema: systematic review and meta-analysis

et al. 2013

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“…Both Hauser et al [239] and Audren et al [240] showed that the use of the higher 4-mg dose of IVTA does not have enough advantages over the lower 1- or 2-mg dose. However, Lam et al [241] published a comparison between 4- and 8-mg doses and showed that the higher dose had a more sustained effect on both visual acuity and central macular thickness although with a trend to more ocular hypertensive responses.…”

Section: Clinical Studies: Ta As Drug Treatment For Macular Edemamentioning

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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“…IVTA was shown to significantly improve visual acuity, foveal thickness, macular function, macular thickness, and retinal arteriolar and venular diameter in patients with DME [11][12][13]. A recently published 2-year multicenter trial in patients with DME demonstrated that preservative-free IVTA (1 or 4 mg) was inferior to focal/grid photocoagulation in preventing visual acuity loss and was associated with a higher incidence of IOP elevation [2 ].…”

Section: Triamcinolone Acetonidementioning

confidence: 99%

Recent advances in drug delivery systems for treating ocular complications of systemic diseases

Lee

Hughes²,

Robinson³

2009

Current Opinion in Ophthalmology

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Intravitreal Triamcinolone for Diabetic Macular Edema

Abstract: Regarding eyes with refractory diffuse DME with cystic changes, 4 mg IVTA does not appear to be more effective than 1 or 2 mg IVTA.

Cited by 47 publications

References 24 publications

Current treatments in diabetic macular oedema: systematic review and meta-analysis

Current treatments in diabetic macular oedema: systematic review and meta-analysis

Intravitreal Triamcinolone

Recent advances in drug delivery systems for treating ocular complications of systemic diseases

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