Safety of intravitreal triamcinolone and its impact on optic nerve morphology in patients treated for diabetic macular edema

Abstract

Purpose: To assess the impact of one intravitreal injection (IVT) of Triamcinolone Acetonide (TA) on intraocular pressure (IOP) and optic nerve structural parameters in patients treated for Diabetic Macular Edema (DME). Methods: This retrospective study included patients with DME that were naïve to intraocular steroids and underwent one IVT of TA of 4 mg/0.1 mL and age-matched controls with DME without criteria for IVT. Patients records were reviewed for IOP (at baseline and a month after IVT) and optic nerve parameters measured by optical coherence tomography (up to 6 months before and 6 months after IVT). Exclusion criteria included glaucoma and treatment with hypotensive agents. Results: Twenty-six eyes were included in the Control Group and 29 in the IVT Group, with a mean age of 65.10 ± 10.08 and 67.30 ± 4.71 years, respectively ( p = 0.06). At baseline, IOP and optic nerve measurements were equivalent between groups ( p > 0.05). One month after IVT, mean IOP measurements in IVT Group were higher than those of controls (17.84 ± 4.50 vs 11.59 ± 3.09 mmHg, p < 0.001). Ocular hypertension (OHT) developed in 17.24% of cases and reversed with topical medication. After one IVT, vertical cup/disc ratio was higher (0.57 ± 0.25 vs 0.60 ± 0.14, p = 0.04) and retinal nerve fiber layer thickness was globally lower (mean: 91.03 ± 4.25 vs 81.33 ± 19.10 µm, p = 0.001) in the IVT Group. Conclusion: Our results confirmed that intravitreal TA results in IOP increase. This seems to negatively affect optic nerve morphology, even in patients without OHT or adequately treated with hypotensive agents.

Comparing the Efficacy of 4 Mg vs 2 Mg Intravitreal Triamcinolone Acetonide in the Treatment of Diffuse Diabetic Macular Edema

“…The increase in visual activity was in line with the findings of previous studies (Kusumowidagdo et al, 2019). However, unlike the results of the study conducted by Carreira et al, TA did not have any dose-dependent effect on VA (Carreira et al, 2022). In this study effects of 13, 5, and 2 mg TA injections were studied; 2 or 5 mg did not have any significant impact on DME, likely due to the small sample size.…”

Risk of intraocular pressure elevation associated with triamcinolone acetonide administration via different routes in macular edema: a systematic review and network meta-analysis of randomized controlled trials

“…Macular edema (ME) is secondary to many different ocular and systemic disease processes and is defined as the accumulation of intra and/or subretinal fluid in the macular region. [1][2] It can occur in several retinal conditions, such as diabetic retinopathy (DR), agerelated macular degeneration (AMD), retinal vascular disorders, and many other ocular and systemic diseases resulting in visual impairment. [3][4] At present, antivascular endothelial growth factor (anti-VEGF) drugs, glucocorticoids, and laser photocoagulation alone or in combination are mostly used to reconstruct the blood-retinal barrier in patients with macular edema in clinical practice.…”