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Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases.

Abstract

Intravitreal triamcinolone acetonide (IVTA) has increasingly been applied as treatment for various intraocular neovascular and oedematous diseases. Comparing the various diseases with respect to effect and side-effects of the treatment, the best response in terms of gain in visual acuity (VA) has been achieved for intraretinal oedematous diseases such as diffuse diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion and pseudophakic cystoid macular oedema. In eyes with various types of non-infectious uveitis, including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, VA increased and the degree of intraocular inflammation decreased. Some studies have suggested that intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischaemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration (AMD), particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure (IOP) and may stabilize the eye. The complications of intravitreal triamcinolone therapy include: secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high IOP leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% of elderly patients within 1 year of injection; postoperative infectious endophthalmitis occurring at a rate of about one per 1000; non-infectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudo-endophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other intraocular surgeries, including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated if the resultant benefits decrease after the initial IVTA injection. In non-vitrectomized eyes, the duration of the effect and side-effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. So far, it has remained unclear whether the solvent agent should be removed, and if so, how.

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  • Authors+Show Affiliations

    Department of Ophthalmology, Faculty of Clinical Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Germany. Jost.Jonas@augen.ma.uni-heidelberg.de

    Source

    Acta ophthalmologica Scandinavica 83:6 2005 Dec pg 645-63

    MeSH

    Choroidal Neovascularization
    Diabetic Retinopathy
    Glucocorticoids
    Humans
    Injections
    Intraocular Pressure
    Macular Degeneration
    Macular Edema
    Ocular Hypertension
    Triamcinolone Acetonide
    Vitreous Body

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    16396641

    Citation

    Jonas, Jost B.. "Intravitreal Triamcinolone Acetonide for Treatment of Intraocular Oedematous and Neovascular Diseases." Acta Ophthalmologica Scandinavica, vol. 83, no. 6, 2005, pp. 645-63.
    Jonas JB. Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmol Scand. 2005;83(6):645-63.
    Jonas, J. B. (2005). Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. Acta Ophthalmologica Scandinavica, 83(6), pp. 645-63.
    Jonas JB. Intravitreal Triamcinolone Acetonide for Treatment of Intraocular Oedematous and Neovascular Diseases. Acta Ophthalmol Scand. 2005;83(6):645-63. PubMed PMID: 16396641.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Intravitreal triamcinolone acetonide for treatment of intraocular oedematous and neovascular diseases. A1 - Jonas,Jost B, PY - 2006/1/7/pubmed PY - 2006/2/8/medline PY - 2006/1/7/entrez SP - 645 EP - 63 JF - Acta ophthalmologica Scandinavica JO - Acta Ophthalmol Scand VL - 83 IS - 6 N2 - Intravitreal triamcinolone acetonide (IVTA) has increasingly been applied as treatment for various intraocular neovascular and oedematous diseases. Comparing the various diseases with respect to effect and side-effects of the treatment, the best response in terms of gain in visual acuity (VA) has been achieved for intraretinal oedematous diseases such as diffuse diabetic macular oedema, branch retinal vein occlusion, central retinal vein occlusion and pseudophakic cystoid macular oedema. In eyes with various types of non-infectious uveitis, including acute or chronic sympathetic ophthalmia and Adamantiadis-Behcet's disease, VA increased and the degree of intraocular inflammation decreased. Some studies have suggested that intravitreal triamcinolone may be useful as angiostatic therapy in eyes with iris neovascularization and proliferative ischaemic retinopathies. Intravitreal triamcinolone may possibly be helpful as adjunct therapy for exudative age-related macular degeneration (AMD), particularly in combination with photodynamic therapy. In eyes with chronic, therapy-resistant ocular hypotony, intravitreal triamcinolone can induce an increase in intraocular pressure (IOP) and may stabilize the eye. The complications of intravitreal triamcinolone therapy include: secondary ocular hypertension in about 40% of the eyes injected; medically uncontrollable high IOP leading to antiglaucomatous surgery in about 1-2% of the eyes; posterior subcapsular cataract and nuclear cataract leading to cataract surgery in about 15-20% of elderly patients within 1 year of injection; postoperative infectious endophthalmitis occurring at a rate of about one per 1000; non-infectious endophthalmitis, perhaps due to a reaction to the solvent agent, and pseudo-endophthalmitis with triamcinolone acetonide crystals appearing in the anterior chamber. Intravitreal triamcinolone injection can be combined with other intraocular surgeries, including cataract surgery, particularly in eyes with iris neovascularization. Cataract surgery performed some months after the injection does not show a markedly elevated complication rate. The injection may be repeated if the resultant benefits decrease after the initial IVTA injection. In non-vitrectomized eyes, the duration of the effect and side-effects of a single intravitreal injection of triamcinolone is about 6-9 months for a dosage of about 20 mg, and about 2-4 months for a dosage of 4 mg. So far, it has remained unclear whether the solvent agent should be removed, and if so, how. SN - 1395-3907 UR - https://www.unboundmedicine.com/medline/citation/16396641/Intravitreal_triamcinolone_acetonide_for_treatment_of_intraocular_oedematous_and_neovascular_diseases_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1395-3907&date=2005&volume=83&issue=6&spage=645 DB - PRIME DP - Unbound Medicine ER -