Intravitreal triamcinolone for the treatment of refractory diabetic macular oedema with hard exudates: an optical coherence tomography study

Ciardella, Antonio P.; Klancnik, James M.; Schiff, William M.; Barile, Gaetano R.; Langton, Kevin; Chang, Stanley

doi:10.1136/bjo.2004.041707

Cited by 127 publications

(108 citation statements)

References 39 publications

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“…[13][14][15][16] The most commonly reported complication associated with IVTA injection is elevation of IOP. [17][18][19] The rate of this complication shows wide variation in published studies ranging from 20.8 to 52% of operated eyes. 18,13 The dose of triamcinolone acetonide injected into the vitreous also varies from 4 to 25 mg and this may potentially affect the rate and level of IOP elevation.…”

Section: Discussionmentioning

confidence: 99%

Ocular morbidity associated with intravitreal triamcinolone acetonide

Konstantopoulos¹,

Williams²,

Newsom³

et al. 2006

Eye

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Aim To report on the complications associated with the use of intravitreal triamcinolone acetonide (IVTA) in a tertiary referral hospital setting. Materials and methods A retrospective case series review of all IVTA injections carried out over a period of 30 months. Results One hundred and thirty IVTA injections were performed; nine with limited local follow-up were excluded. Thus, 121 injections (108 patients, 114 eyes) were included in the study. Triamcinolone (4 mg) was used in all cases. Indications were diabetic macular oedema (n ¼ 41 eyes), retinal vein occlusions (n ¼ 27), postoperative cystoid macular oedema (n ¼ 24), exudative age-related macular degeneration (n ¼ 16), and others (n ¼ 6). No intraoperative complications were recorded. Postoperative intraocular pressure (IOP) readings of 22, 28, 35, and 40 mmHg or higher were recorded in 46.5, 29.8, 12.3, and 7.9% of eyes, respectively. IOP elevation was treated with antiglaucoma medication in all but one eye (0.9%) that required trabeculectomy and one (0.9%) that required vitrectomy with cataract extraction for suspected phacoanaphylactic glaucoma. Two eyes (1.8%) developed retinal detachment; both had previously been treated for retinal breaks. One eye (0.9%) developed culture-positive endophthalmitis. Conclusions Significant morbidity is associated with IVTA injection; clinicians should be aware when considering treatment options.

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Section: Discussionmentioning

confidence: 99%

Ocular morbidity associated with intravitreal triamcinolone acetonide

Konstantopoulos¹,

Williams²,

Newsom³

et al. 2006

Eye

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“…El uso de triamcinolona ha sido tema de múltiples publicaciones (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) en donde se ha visto un beneficio tangible en la reducción del grosor macular y en algunos casos mejoría en la agudeza visual, sobretodo en los estudios iniciales (11)(12)(13)(14). En ellos, se empleó para el tratamiento de edema macular refractario a laserterapia; sin embargo, el efecto del medicamento sigue siendo temporal (20) y en muchas ocasiones se requieren reinyecciones con los riesgos que esto implica (hipertensión ocular, desprendimiento de retina, hemorragia vítrea, endoftalmitis tanto estéril como infecciosa) (29)(30)(31)(32).…”

Section: Gráf 2: Comparación Del Oct Basal Y 6 Mesesunclassified

“…Sin embargo, en muchos casos no se consigue controlar o disminuir el engrosamiento macular y los resultados visuales en el largo plazo son más bien pobres (10). Otros tratamientos empleados en años recientes, han sido: esteroides intravítreos como la triamcinolona) (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), fármacos antiangiogénicos (bevacizumab) (24,25) y recursos quirúrgicos (vitrectomía) (26)(27)(28). Todos los anteriores empleados en forma aislada tienen sus ventajas; pero al mismo tiempo, tienen ciertos riesgos así como también efectos transitorios como en el caso de los fár-macos intravítreos (29)(30)(31)(32).…”

Section: Introductionunclassified

Uso de triamcinolona y bevacizumab en cirugía de faco-vitrectomía 25G para el tratamiento de catarata y edema macular diabético

Mota

Chacón-Lara²,

Hernández-Vázquez

2008

Arch Soc Esp Oftalmol

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RESUMENObjetivo: Evaluar la seguridad y eficacia de la cirugía combinada de facoemulsificación y vitrectomía asistida con triamcinolona y aplicación de bevacizumab intravítreo en pacientes con catarata y edema macular diabético difuso. Pacientes y métodos: Estudio prospectivo, longitudinal, no aleatorizado, ensayo clínico no controlado. Se incluyeron trece pacientes en forma consecutiva que presentaron esencialmente catarata subcapsular posterior y edema macular difuso, a los que se les realizó cirugía de facoemulsificación, vitrectomía a tres puertos 25G asistida con triamcinolona, endofotocoagulación y aplicación de bevacizumab intravítreo. Se realizó seguimiento con medición de agudeza visual, fluorangiografía retiniana y tomografía óptica coherente (OCT) basal, a las 2 semanas, en el primer, tercero y sexto meses. Resultados: Se encontró una mejoría visual de al menos 2 líneas de visión al final del seguimiento en diez de los pacientes. En cuanto al grosor central ARTÍCULO ORIGINAL ABSTRACTObjective: To evaluate the safety and efficacy of combined phacoemulsification and triamcinoloneassisted vitrectomy with intravitreal injection of bevacizumab in patients with cataract and diffuse diabetic macular edema. Methods: In this prospective, non randomized, interventional case series we included 13 eyes of 13 patients with posterior subcapsular cataracts and diffuse macular edema who underwent phacoemulsification, 25G triamcinolone-assisted vitrectomy, endophotocoagulation and had a bevacizumab injection at the end of the procedure. The follow-up consisted of basal best corrected visual acuity, fluorescein angiography, and optical coherent tomography performed at 2 weeks, one, three and six months post-operatively. Results: An improvement in the best corrected visual acuity of at least two lines was seen in 10 of the 13 patients. The basal average central macular thickness initially was 358.23 µ (SD 50 µ) while at the end of follow-up was 216.6 µ (SD 23.2 µ).

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“…Intravitreal triamcinolone alone has been reported to reduce macula oedema and the amount of hard exudates. 4,5 Takagi et al, 6 Sakuraba et al, 7 and Takaya et al 8 have removed macular hard exudates surgically following vitrectomy. Despite good anatomical results, visual acuity improvement was not maintained long term with surgical removal alone because of atrophic or degenerative changes.…”

Section: Commentmentioning

confidence: 99%