The Evolution of Triamcinolone Acetonide Therapeutic Use in Retinal Diseases: From Off-Label Intravitreal Injection to Advanced Nano-Drug Delivery Systems

Abstract

Ophthalmic drug delivery to the posterior segment of the eye has been challenging due to the complex ocular anatomy. Intravitreal injection of drugs was introduced to deliver therapeutic doses in the posterior segment. Different posterior segment diseases including age-related macular degeneration, diabetic macular edema, retinal vein occlusions, uveitis, and cystoid macular edema, among others, have been historically treated with intravitreal corticosteroids injections, and more recently with intravitreal corticosteroids drug implants. Triamcinolone acetonide (TA) is the most frequently used intraocular synthetic corticosteroid. Using nanoparticle-based TA delivery systems has been proposed as an alternative to intravitreal injections in the treatment of posterior segment diseases. From these novel delivery systems, topical liposomes have been the most promising strategy. This review is oriented to exhibit triamcinolone acetonide drug evolution and its results in treating posterior segment diseases using diverse delivery platforms.

The Treatment of Diabetic Retinal Edema with Intravitreal Steroids: How and When

“…IVTA has been widely used off-label with different dosages and intervals between administrations, showing to be an effective and relatively inexpensive method for DME management [ 88 ].…”

“…TA intravitreal injection has shown a clear time-limited therapeutic effect, with clinical efficacy for approximately 3 months [ 87 , 88 , 89 , 90 ].…”

“…The cumulative incidence of OHT after IVTA injections ranges between 13% and 50% [ 46 , 59 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ]. The time required for the IOP elevation after a TA injection is 1–8 weeks, IOP reaches the peak value in 2–16 weeks, remains elevated for 1–9 months, and returns to pre-treatment values after 4–9 months [ 94 ].…”

“…The incidence of cataract extraction requirement after IVTA injections ranges between 10% and 83%, with a higher incidence in younger patients [ 46 , 59 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ].…”

“…As already underlined, IV steroids are associate with high risk of IOP rise (0–35%) and cataract development (0–80%) [ 40 , 42 , 46 , 59 , 87 , 88 , 89 , 92 ], whereas these complications affect ≤ 15% of anti-VEGF-treated eyes [ 66 ].…”