Intravitreal triamcinolone for intraocular inflammation and associated macular edema

Abstract

Triamcinolone acetonide (TA) is a corticosteroid that has many uses in the treatment of ocular diseases because of its potent anti-infl ammatory and anti-permeability actions. Intraocular infl ammation broadly referred to as uveitis can result from several causes, including the immune system and after ophthalmic surgery. One of the most common reasons for vision loss with uveitis is macular edema. TA has been used for many years as an intravitreal injection for the treatment of ocular diseases. Several case control studies have been reported showing the effi cacy of TA in the treatment of intraocular infl ammation and associated macular edema caused by Behcet's disease, Vogt-Koyanagi-Harada syndrome, sympathetic ophthalmia and white dot syndromes. It has also been shown effi cacious in cases of pars planitis and idiopathic posterior uveitis. Some authors have reported its use in postoperative cystoid macular edema. Many of the studies on the use of TA in controlling intraocular infl ammation and concomitant macular edema showed its effect to be transient in many patients requiring reinjection. Complications can arise from intravitreal injection of TA including elevated intraocular pressure and cataract. Rarely, it can be associated with infectious and non-infectious endophthalmitis. TA may be useful as an adjuvant in the treatment of uveitis and its associated macular edema, especially in patients resistant or intolerant to standard treatment.

Intravitreal Steroids for the Treatment of Retinal Diseases

“…Based on several studies, intravitreal administration of triamcinolone acetonide (TA) has provided promising results for the treatment of disorders associated with an abnormal endothelial cell proliferation and conditions complicated by intraretinal and subretinal fluid accumulation. The anti-inflammatory, angiostatic, and antipermeability properties of TA have gained interest in chronic retinal diseases, such as proliferative diabetic retinopathy [ 39 ], DME [ 40 , 41 ], exudative AMD [ 42 – 44 ], presumed ocular histoplasmosis syndrome [ 45 ], CRVO [ 46 ], BRVO [ 47 ], neovascular glaucoma [ 48 ], proliferative vitreoretinopathy [ 49 ], persistent pseudophakic CME [ 50 ], perifoveal telangiectasias [ 51 ], sympathetic ophthalmia [ 52 ], ischemic ophthalmopathy [ 53 ], exudative retinal detachment [ 54 ], radiation induced macular edema [ 55 ], macular edema due to retinitis pigmentosa [ 56 ], Vogt-Koyanagi-Harada syndrome [ 57 ], and chronic uveitis [ 58 ].…”

The visualisation of vitreous using surface modified poly(lactic-co-glycolic acid) microparticles

“…Within this study, the characteristics (ie, particle shape and size) of these fabricated microparticles were shown to be comparable to the insoluble particulates found in the triamcinolone acetonide suspension which, based on the integration of the crystals into loosely organised collagen matrices, allows the visualisation of the vitreous. 23 However, in contrast, unmodified PLGA microparticles were unable to sufficiently adhere to vitreous without prior treatment, in this case, with the enzyme TG. TG, commonly referred to as a ‘biological glue’, has been reported extensively to act as a biocatalyst, to enhance cell adhesion, to promote surface modifications and to increase the biocompatibility of many tissue engineering scaffolds without inducing any significant immune response.…”

Efficacy of intravitreal dexamethasone implant in patients with Vogt–Koyanagi–Harada Disease and bilateral panuveitis

“…Corticosteroids are well-known for their anti-inflammatory effects, which can inhibit phospholipase A2 induction through lipocortin production, and further downregulate the production of many interleukins, prostaglandin, and tumor necrosis factor. [ 5 , 11 ] By means of anti-inflammatory effects, corticosteroids have been applied to the vast majority of inflammatory diseases via several forms and routes. The treatment modality of VKH disease is primarily early intravenous pulse therapy, and is maintained by oral prednisone for months.…”

“…[ 5 , 6 ] Recently, sub-tenon triamcinolone or intravitreal injection of dexamethasone implants together with systemic corticosteroids has been reported being effective in treating VKH disease which was refractory to systemic therapy. [ 5 , 8 ] Other reports also show that local therapy alone may be effective in the treatment of VKH disease. [ 6 , 10 ]…”

“…[1,3] However, in some patients with a disease of greater severity, systemic therapy cannot fully control the inflammation, while sub-tenon and intravitreal steroids provide a much better bioavailability. [4][5][6][7][8][9][10] In this study, we demonstrate two cases of bilateral panuveitis with VKH disease successfully controlled by dexamethasone intravitreal implants (Ozurdex, Allergan).…”