Intravitreal Injection Of Triamcinolone Acetonide Research Articles

Treatment of Noninfectious Uveitic Macular Edema with Periocular and Intraocular Corticosteroid Therapies: A Report by the American Academy of Ophthalmology

To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Evaluation of clinical outcomes of raised intraocular pressure following intravitreal triamcinolone acetonide injection.

Aim: To assess the incidence, risk factors, and treatment outcomes in intravitreal triamcinolone acetonide injection (IVTA) induced intraocular pressure rise and to compare IOP rise in 1-mg and 2-mg IVTA. Materials and methods: Prospective observational study conducted in all eyes receiving IVTA. Any pre-existing glaucoma and patients who received IVTA or dexamethasone implant in the last 6 months were excluded. Results: 9 between 61-70 years of age developed an IOP spike. The mean and standard deviation of age in years was 61.95 ± 8.70. Maximum eyes had ME due to Diabetic Retinopathy (53.3%). All cases of uveitic ME were reported to have an IOP spike. 2 out of 3 high myopic eyes and 1 eye with thyroid abnormality had an IOP spike. High IOP was found in 13 eyes, with more than 25 mm Hg rise in 4 eyes and more than 5 mm Hg rise from baseline IOP in 9 eyes. The mean and standard deviation of time taken for IOP raise (in days) was 46.39 ± 37.68. A total of 38 eyes received 1 mg of IVTA and the rest 22 received 2 mg of IVTA. 23.7% of 1 mg eyes experienced an IOP rise while it was 18.2% in eyes with 2 mg IVTA. The injection was repeated in 12 eyes and 41.7% developed an IOP spike among them. The independent "t" test results showed that there was a significant difference in the mean of IOP (Pre-injection) concerning the IOP rise (P=0.007*). 1 eye had IVTA crystals in the anterior chamber with raised IOP of 30 mm Hg. 1 out of 13 eyes with raised IOP needed 2 AGMs, the other 12 eyes responded well to 1 AGM. Discussion: IVTA is widely used in refractory cases of ME and steroid-induced glaucoma is the most common side effect of IVTA. To the best of our knowledge, there is a lack of literature on prospective studies on IVTA-associated risk factors, patterns of IOP elevation, and treatment outcomes. The pre-injection mean ± SD baseline IOP for uneventful eyes was 12.87±2.65 and the pre-injection mean IOP for eyes with IOP event was 15.23±2.89 (P=0.007*). Conclusion: We proposed that TA is an independent risk factor for post-intravitreal injection IOP spike. IVTA causes a maximum IOP spike at 1 to 2 months and has a protracted course that responds to anti-glaucoma medications. High baseline IOP, a repeated dose of IVTA, the presence of TA crystals in the anterior chamber, and high myopia were associated with significant IOP elevation. Abbreviations: ACD = Anterior chamber depth, AS = Anterior segment, AGM = Anti-glaucoma medications, ARMD = Age-related macular degeneration, BCVA = Best-corrected visual acuity, BRVO = Branch retinal vein occlusion, CCT = Central corneal thickness, CRVO = Central retinal vein occlusion, CME = Cystoid macular edema, CNVM = Choroidal neovascularization membrane, CSME = Clinically significant macular edema, DR = Diabetic retinopathy, ERM = Epiretinal membrane, IOP = Intraocular pressure, IGS = Irvine-Grass syndrome, GAGs = Glycosaminoglycans, IVTA = Intravitreal triamcinolone acetonide injection, ME = Macular edema, NVG = Neovascular glaucoma, OHT = Ocular hypertension, PDS = Pigment dispersion syndrome, PACG = Primary closed angle glaucoma, POAG = Primary open-angle glaucoma, PXF = Pseudoexfoliation, VA = Visual acuity, VEGF = Vascular endothelial growth factors, VH = Vonherick's grading, SD = Standard deviation, TA = Triamcinolone acetonide, TIGR = Trabecular meshwork inducible glucocorticoid response.

Sterile endophthalmitis after intravitreal injection of triamcinolone acetonide: case report and literature review.

Objectives: The first purpose is to present the diagnosis and therapeutic approach in a patient with sterile endophthalmitis associated with triamcinolone acetonide injection. The secondary objective is to assess the incidence of this complication and to summarize the risk factors described in the literature. Case presentation: A 76-year-old male patient presented for painless, unilateral, decreased visual acuity, four days after cataract surgery and simultaneously intravitreal triamcinolone acetonide injection for diabetic macular edema in the right eye. The diagnosis of sterile endophthalmitis was made. Eight days after the presentation, the symptoms subsided, the maximum corrected visual acuity reaching that before the procedures. Discussions: The incidence of sterile endophthalmitis varies in the literature between 0% and 23.8%. Visual prognosis is good, although the pathogenesis is not fully understood. Preservatives in injectable solutions have been suggested, however, there are studies in which inflammation was also present with preservative-free products. The particle size of triamcinolone was analyzed, demonstrating an association between smaller particles and an increased frequency of adverse reactions of this type. History of uveitis, posterior capsule rupture following cataract surgery, and Irvine-Gass syndrome are other associations described. Conclusion: The physiopathological mechanism of sterile endophthalmitis is not fully understood. However, the visual prognosis is good, the final vision being dependent on the underlying pathology.

A RARE CASE OF STERILE ENDOPHTHALMITIS FOLLOWING INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN VITRECTOMIZED EYE

Introduction : Intravitreal Triamcinolone Acetonide (IVTA) has been widely used to treat Diabetic Macular Edema (DME). Sterile endophthalmitis is one of the major related complications after IVTA which occurs between 0.20% and 6.73% of the injections. We present a case of sterile endophthalmitis following IVTA injection in a patient with a vitrectomized eye and DME.
 Case Illustration : A 53?year?old female patient with a history of vitrectomy due to high-risk characteristic proliferative diabetic retinopathy on her right eye underwent IVTA for DME. One day after the injection, the visual acuity (VA) improved from 6/45 to 6/12 without any complication. Three days later, she complained of ocular discomfort and sudden diminution of vision. The VA had dropped to hand movement, with conjunctival injection, hypopyon, anterior chamber reaction, and an inaccessible fundus. The patient was treated with topical antibiotics, corticosteroids, and cycloplegic, followed by intravitreal antibiotics injection. Furthermore, vitrectomy and vitreous tap were performed. On one- week follow-up, the VA was improved to 6/60 with normal IOP. The anterior chamber and the vitreous cavity remained clear.
 Discussion : The etiology of sterile endophthalmitis following IVTA injection remains unclear. Compared to infectious endophthalmitis, the patient is usually in less pain, and the eye is less injected. Although it generally has a benign course, some studies have shown serious complications such as vitreous hemorrhage and retinal detachment. Therefore, caution should be taken to prevent such complications from developing.
 Conclusion : In presumed sterile endophthalmitis, a careful diagnosis and intervention must be reconsidered to avoid potential long-term visual loss due to its related complications.

Retracted: Clinical Comparative Study of Intravitreal Injection of Triamcinolone Acetonide and Aflibercept in the Treatment of Diabetic Retinopathy Cystoid Macular Edema.

[This retracts the article DOI: 10.1155/2022/1348855.].

Impact of intravitreal triamcinolone injection following epiretinal membrane peeling on ectopic inner foveal layer classification.

This study aimed to evaluate the impact of intravitreal triamcinolone acetonide (TA) administration after peeling of idiopathic epiretinal membranes (iERM) on both anatomical and visual outcomes, utilizing the ectopic inner foveal layer (EIFL) staging scheme. In this retrospective case-control study, we analyzed 43 eyes from 43 patients diagnosed with iERM between June 2019 and December 2021. All participants were categorized into the TA or control groups based on administering intravitreal TA injection following ERM peeling. We thoroughly reviewed the clinical data, including the preoperative and postoperative best-corrected visual acuity (BCVA), central foveal thickness (CFT), and macular cube volume (VOL), with ERM stages classified according to the EIFL staging scheme. The study enrolled 22 eyes in the TA and 21 in the control groups. Following a mean follow-up period of 11.07 ± 2.02 months, noteworthy improvements in EIFL stages were observed in both cohorts (p < 0.01), but without significant distinctions between groups. In the TA group, 63.64% of eyes demonstrated improvements in EIFL stages, while the control group exhibited 76.19% (p = 0.37). At the final visit, both groups experienced a noteworthy reduction in the postoperative CFT and VOL (p < 0.05), coupled with significant improvement in BCVA (p < 0.01). No substantial differences appeared between the two groups concerning BCVA, CFT, and VOL (all p > 0.05). Our study suggested that concurrent intravitreal TA injection following ERM removal did not provide additional benefits regarding anatomical and visual improvement in iERM cases classified as Stages 2 and 3.

Phacoemulsification in patients with diabetic macular edema - A real-world data of 75 eyes.

The purpose of this study was to evaluate the outcomes of phacoemulsification with intravitreal triamcinolone acetonide (IVTA) injection in patients with cataract and diabetic macular edema (DME) across the grades of diabetic retinopathy (DR). It was a retrospective observational study. The study included 70 patients (75 eyes) with cataract and clinically significant macular edema in diabetics with nonproliferative (61 eyes) or proliferative (14 eyes) DR who underwent phacoemulsification with IVTA. Visual outcome and progression of DME over 3 months were studied in terms of the best-corrected visual acuity (BCVA) and central macular thickness (CMT), respectively. The case records of 70 patients (75 eyes) were studied. The mean baseline BCVA (n = 75) in the logMAR scale ± SD was 0.92 ± 0.53. 3 weeks after the surgery, the mean BCVA improved to 0.39 ± 0.26 and the mean CMT (n = 40) was 382.57 ± 192.30 compared with the mean preoperative CMT of 480.57 ± 163.25 in the same set (P = 0.01). The mean CMT decreased at 3 weeks in 22 (55% of the eyes). An improvement of ≥2 lines was seen at 3 weeks in 52 (69.33%) eyes and in 49 (65.33%) eyes at 3 months. The mean CMT at 3 months was 445.51 ± 222.99 (n = 70) compared to the preoperative mean CMT of 470.72 ± 176.15 in the same set (P = 0.29). The mean CMT decreased at 3 months in 34 (48.5%) eyes. Phacoemulsification with IVTA injection improved the mean visual acuity at 3 weeks and 3 months in two-thirds of cases and decreased the mean CMT at 3 weeks in nearly half the numbers.

Early use of intravitreal triamcinolone to inhibit traumatic proliferative vitreoretinopathy: a randomised clinical trial

AimsTo evaluate the efficacy and safety of intravitreal triamcinolone acetonide (TA) injection at the end of emergency surgery for open globe injury (OGI) to suppress traumatic proliferative vitreoretinopathy (TPVR).MethodsA single-centre,...

Evaluation of a steroid delivery system to mitigate the severity of proliferative vitreoretinopathy in a minipig model

PurposeTo investigate the efficacy of liposomal prednisolone phosphate to mitigate the severity of proliferative vitreoretinopathy (PVR) in a minipig model of PVR.MethodsA total of 18 eyes of 9 minipigs underwent PVR induction surgically. Eyes were randomized equally into three groups: intravitreal injection of liposomal prednisolone phosphate (LPP), triamcinolone acetonide (TA), and controls. PVR severity was graded on fundoscopic examination using a modified version of the Silicon Study Classification System. Severe PVR was defined as grade 2-5 on this classification, and the proportion of eyes with retinal detachment from severe PVR, defined as retinal re-detachment, i.e., PVR grade 2-5, was compared between treatment and control groups.ResultsOn day 28, five eyes (83.3%) in the control group were observed to have severe PVR. Within the LPP group, one (16.7%) eye developed retinal detachment due to severe PVR. Grade 0 PVR was observed in four (66.7%) eyes, grade 1 in one (16.7%) eye, and grade 5 in one (16.7%) eye. Within the TA group, grade 0 PVR was observed in four eyes (66.7%), grade 1 in two eyes (16.6%), and grade 5 in one (16.7%) eye. The difference in the proportion of eyes with severe PVR was significantly lower in the LPP group compared to controls at day 28 (16.7% vs 83.3%, p=0.02). There was no significant difference in the rate of severe PVR or median PVR grade between the liposomal prednisolone phosphate and triamcinolone acetonide groups.ConclusionLiposomal prednisolone phosphate reduces the severity of PVR in a minipig model of PVR.

Intraocular Pressure Elevation Following Intra-Vitreal Injection of Bevacizumab, Ranibizumab and Triamcinolone Acetonide

Purpose:  To record intraocular pressure (IOP) at different time intervals after intravitreal injection (IVI) and to correlate the rise in IOP with refractive error and post-injection reflux. Study Design:  Retrospective review of records. Place and Duration of Study:  Sri Aurobindo Medical College &amp; Postgraduate institute, Indore, Madhya Pradesh, India. September 2022 and December 2022. Method:  We included 126 untreated eyes of 120 patients. The indications of IVI were macular edema, and age-related macular degeneration.IOP and refractive status were determined. Bevacizumab, Ranibizumabor Triamcinolone Acetonidewas injected. Presence of vitreous reflux was noted at the injection site immediately after injection. IOP was measured at 10, 20, 30, and 45-minutes after injection. Descriptive statistics were calculated as mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. Repeated measure ANOVA was applied and p-value of &lt;0.05 was considered significant. Results:  Transient IOP rise was observed in 95.24% cases whereas 4.76% patients showed sustained rise beyond 30minutes, which returned to normal after use of topical beta-blocker.Hypermetropic eyesinjected withTriamcinolone injection showed significant sustained rise of IOP (p&lt;0.05). Vitreous reflux was seen in 47 (37.3%) eyes that showed significantlylowermean IOP of 20.89 ± 5.159 mm Hg (p&lt;0.05) when compared to eyes with no vitreous reflux (IOP=30.75± 7.384 mm Hg). Conclusion:  IVI results in transientrise of IOP which is lesser with vitreous reflux. Triamcinolonehasa propensity to cause sustained rise of IOP especially in hypermetropic eyes that requires intervention.

Retracted: Efficacy and Safety of Intravitreal Injection of Triamcinolone Acetonide and Conbercept for Intraocular Lens after Cataract Surgery.

[This retracts the article DOI: 10.1155/2022/5606343.].

Intravitreal triamcinolone acetonide and bevacizumab injection as prevention of proliferative vitreoretinopathy in open globe injury

Link of Video Abstract: https://youtu.be/VVibnyUdBx4 Background: Proliferative vitreoretinopathy (PVR) is common following an open globe injury (OGI) due to aberrant wound healing that can result in retinal detachment or vitreous hemorrhage. Despite the anatomical success, visual acuity improvement remains unsatisfactory. Triamcinolone acetonide (TCA) and Bevacizumab are among these therapies. This study aims to explore the effect of TCA and Bevacizumab intravitreal injection as potential preventive therapies for PVR in OGI. Methods: This literature review compiles and elaborates on previous studies from many authors to support future experimental studies, which will be conducted to evaluate the intravitreal triamcinolone acetonide and bevacizumab injection as prevention of proliferative vitreoretinopathy in open globe injury through several relevant articles. Results: The healing process requires inflammation that stimulates inflammatory cells and mediators, such as transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), interleukin-1 (IL-1), IL-2, IL-3, IL-6, IL-8, and IL-10. Plasminogen activator inhibitor-1 (PAI) is upregulated during inflammation, resulting in continued collagen deposition due to fibrosis. The injection of corticosteroids as immunosuppressants and anti-VEGFs as antiangiogenesis is thought to have a positive impact by reducing inflammation and the development of new blood vessels, thus suppressing fibrosis. Conclusion: TCA injection was associated with improved anatomical and visual acuity in humans, pre-operatively or during pars plana vitrectomy. Anti-VEGFs, such as Bevacizumab, ranibizumab, conbercept, and aflibercept, demonstrated protective effects on the eyes of animal models and showed their ability to reduce VEGF, TGF-β, and PAI-1, thereby inhibiting wound fibrosis.

Retinal Microvascular Changes after Intravitreal Triamcinolone Acetonide in Diabetic Macular Edema.

Intravitreal injection of triamcinolone acetonide (TA) is essential for clinical treatment in patients who insufficiently respond to vascular endothelial factor inhibitors for diabetic macular edema (DME). The aim of this study was to investigate microvascular changes treated with TA using optical coherence tomography angiography (OCTA). After TA in twelve eyes of eleven patients with central retinal thickness (CRT), there was a 20% or more reduction observed. Visual acuity, the number of microaneurysms, vessel density, and the foveal avascular zone (FAZ) area were compared before and at 2 months after TA. At baseline, the number of microaneurysms was 2.1 ± 1.1 in the superficial capillary plexuses (SCP) and 2.0 ± 1.1 in the deep capillary plexuses (DCP), with a significant decrease post-treatment to 1.0 ± 1.0 for SCP and 0.8 ± 0.8 for DCP (SCP; p = 0.018, DCP; p = 0.008). There was significant enlargement of the FAZ area from 0.28 ± 0.11 mm2 to 0.32 ± 0.14 mm2 (p = 0.041). There was no significant difference in the visual acuity and vessel density of SCP and DCP. Results indicated that OCTA was useful for the evaluation of qualitative and morphological retinal microcirculation and that intravitreal TA may decrease microaneurysms.

Is There a Link Between Vitreous Cortex Remnants and Anatomic Outcome of Vitrectomy for Primary Rhegmatogenous Retinal Detachment?

To study the anatomic outcome of leaving vitreous cortex remnants (VCR) during pars plana vitrectomy (PPV) for primary rhegmatogenous retinal detachment (RRD). The study comprised patients with RRD who had PPV by a single surgeon between January 2019 and December 2020 and followed for 6 months. After intravitreal injection of triamcinolone acetonide, the topographic pattern of VCR at the periphery (p) and macula (m) was divided into 2 types by extent: complete or 4 quadrants (pVCR4Q), andbetween 2 and 4 quadrants ≥2 quadrants (pVCR>2Q), or by location >1 inferior retinal quadrant (pVCR>1InfQ), and at the macula (mVCR). Anatomical failure or retinal re-detachment within 6 months after surgery was the primary outcome measures. The occurrence of grade C proliferative vitreoretinopathy (PVR) and epiretinal membrane (ERM) were used as secondary outcome indicators. A 6-month prospective follow-up was performed on 103 patients. pVCR4Q was detected in 31 eyes, pVCR>2Q in 40 eyes, pVCR>1InfQ in 40 eyes and mVCR in 54 eyes. Recurrent RRD developed in 9 (8.7%) eyes, PVR grade C in 6 (5.8%) eyes and ERM in 11 (10.7%) eyes. According to multivariate regression analysis,the existence of any type of VCR did not correlate with anatomical failure, PVR or ERM. The initial success rate of PPV and the growth of PVR or ERM do not appear to be impacted by keeping VCR.

Intravitreal versus Oral Steroids for Inflammation Control in Uveitic Patients Undergoing Cataract Surgery

ABSTRACT Background This prospective experimental study was conducted on 40 eyes of 40 patients with complicated uveitic cataracts to compare a single intraoperative intravitreal injection of triamcinolone acetonide (IVTA) with oral steroids for inflammation control after cataract extraction. Methods The IVTA group (19 eyes) received an intravitreal injection of 4 mg/0.1 ml triamcinolone acetonide intraoperatively, and the oral steroid group (19 eyes) received oral steroids peri-operatively. Two patients had to be excluded from the study because they underwent extracapsular cataract extraction (ECCE), instead of phacoemulsification. Results A statistically significant difference was observed in the anterior chamber cell and flare response between both groups initially, but by the last follow-up, this became insignificant. None of the patients in each group experienced a recurrence of uveitis nor developed cystoid macular edema. Five patients in the oral steroid group had IOP >21 mmHg post-operatively. Conclusion A single injection of 4 mg IVTA has similar efficacy to peri-operative oral steroid administration.

Intravitreal triamcinolone acetonide in Berger space: A rare complication

We report the case of a 50-year-old male who presented with a diminution of vision in his right eye for the past 6 months and was subsequently found to have central retinal vein occlusion with macular edema. The patient was given intravitreal triamcinolone in view of non-resolving macular edema despite repeated injections of anti-vascular endothelial growth factor. We report this rare occurrence of accidental injection of intravitreal triamcinolone acetonide in Berger space. A careful slit lamp examination before to look for the presence of prominent Berger space in patients planned for intravitreal injections, along with proper counseling of patients to avoid unwanted eye movements during an injection, can be potential ways to prevent such complications. In our case, the triamcinolone resolved after 6 weeks and the intraocular pressure (IOP) spike was managed using glaucoma medications. It is imperative to measure IOP at each visit in these patients and if spikes are noted, they should be managed accordingly.

Commentary: Treatment of postoperative cystoid macular edema in vitrectomized eyes: An enigma.

Post-operative cystoid macular edema (PCME) is a sight-threatening complication that could affect visual recovery following a successful ocular surgery. Irvine–Gass syndrome, that is, PCME following cataract surgery has extensively been studied. The incidence of clinical CME following phacoemulsification ranges from 0.2% to 2.35%.[1] The incidence of PCME following vitrectomy for vitreous floaters, rhegmatogenous retinal detachment (RRD), and the epiretinal membrane (ERM) has been found to be around 5%, 10–25%, and 13–47%, respectively.[1-4] Although the exact pathophysiology of PCME remains debatable, the most probable cause seems to be subclinical low-grade inflammation. Studies have shown that the levels of cytokines and prostaglandins are elevated in such eyes, leading to blood–aqueous barrier breakdown and consequent fluid accumulation.[1-4] Pole et al.[2] described the optical coherence tomography (OCT) characteristics of PCME after RRD surgery. These included fovea-involving diffuse CME, which involved all four macular quadrants and cysts in the inner nuclear and outer plexiform layers. In untreated eyes, the cysts may coalesce into larger irregular, polygonal-shaped cavities. CME may resolve spontaneously but cause disorganization and atrophy of the retinal layers. Several risk factors for the development of PCME following vitrectomy have been identified. Risk factors following RRD surgery include old age, cataract surgery, macula-off RRD, longer duration, pre-existing proliferative vitreoretinopathy changes (C or higher), intra-operative retinectomy, and multiple surgeries.[12] Risk factors following ERM removal surgery include old age, cataract surgery, stage 4 ERM, and the presence of pre-existing intraretinal cysts.[34] The post-operative tamponading agent did not influence the development of PCME in either pathology.[1-4] To date, there has been no consensus on the treatment for PCME. Its management is often complex due to its recurring nature. The various available treatment options include topical steroid and non-steroidal anti-inflammatory drug (NSAID) drops; intravitreal anti-vascular endothelial growth factor (VEGF) and triamcinolone acetonide (TA) injections; intravitreal dexamethasone and fluocinolone implants; suprachoroidal triamcinolone injection; and posterior subtenon and trans-tenon retrobulbar triamcinolone injection. The efficacy of topical treatment in previously vitrectomized eyes is usually limited.[12] Similarly, anti-VEGF injections also tend to be less effective in vitrectomized eyes due to faster clearance and reduced half-life.[12] Intravitreal triamcinolone acetonide (IVTA) injection has been found to be better than anti-VEGF injections in improving macular thickness and visual acuity.[2] However, the mean elimination half-life in vitrectomized eyes is merely 3.2 days compared to 18.6 days in non-vitrectomized eyes.[5] On the contrary, the vitreoretinal pharmacokinetic profiles of dexamethasone and fluocinolone implants in vitrectomized eyes are similar to that in non-vitrectomized eyes. Intravitreal dexamethasone implant has been found to be an effective treatment option for eyes with PCME following vitrectomy for RRD and even endophthalmitis.[67] Eyes that underwent vitrectomy for ERM compared to RRD, presence of subretinal fluid, intact outer retinal layers, and worse baseline best-corrected visual acuity (BCVA) have higher chances of visual improvement. Owing to the recurrent nature of the disease, multiple injections are often needed.[6] Intravitreal fluocinolone acetonide implant has been shown to achieve persistent functional and anatomical improvement with long recurrence-free periods. Miguel–Escuder et al.[8] suggested that it could be considered as a therapeutical option in eyes with refractory PCME following vitrectomy. Suprachoroidal TA injection with the help of custom-made needles is another treatment option. Due to its unique position, the suprachoroidal space serves as a drug reservoir with slow drug washout and better absorption. Animal model-based pharmacokinetic studies have shown that a 12-fold higher drug concentration can be achieved in the retina along with reduced entry drug in the anterior chamber, thus reducing the risk of intraocular pressure rise and cataract formation.[9] Trans-Tenon’s retrobulbar TA infusion has also been used successfully for the management of refractory diabetic macular edema (DME) in vitrectomized eyes. The described technique included making an incision in the conjunctiva and the Tenon’s capsule in the inferotemporal quadrant followed by infusion of 40 mg triamcinolone acetonide with a 25-gauge curved blunt cannula into sub-Tenon’s space under topical anesthesia.[10] Posterior subtenon triamcinolone (PST) injections have classically been used for the management of intermediate uveitis. It has been shown to provide a sustained high level of TA in the vitreous cavity level along with low systemic TA levels that cannot alter the systemic cortisol levels.[11] We congratulate the authors for their manuscript evaluating the efficacy and safety of PST for the treatment of chronic PCME in vitrectomized eyes.[12] However, prospective randomized studies with a larger sample size are required to compare the efficacy with other treatment modalities. Because simultaneous complicated cataract surgery is itself a risk factor for the development of PCME, eyes with nucleus drop should be excluded. Additionally, the management of a raised intraocular pressure in the steroid responder eyes may be challenging, because the depot of TA in the posterior subtenon location is difficult to remove completely.

Comparison between intravitreal ranibizumab injection and posterior subtenon triamcinolone acetonide injection at time of cataract surgery for prevention of progression of diabetic macular edema

BackgroundThe goal of this work is to assess progression of diabetic macular edema (DME) following intravitreal ranibizumab injection compared to subtenon triamcinolone acetonide injection at cataract operation.MethodsRetrospective analysis of 73 eyes of 65 participant with DME, with central macular thickness (CMT) ≥ 300 μm. The included eyes were separated into three groups; phacoemulsification with intravitreal Ranibizumab injection group, phacoemulsification with subtenon Triamcinolone acetonide injection group and phacoemulsification only group. Main measures involved best corrected visual acuity (BCVA) one week, one month and three months post-operative. The CMT was compared preoperative and postoperative (one and three months).ResultsAfter 1 month of operation, there was a statistical substantial distinction in the median of CMT between ranibizumab & control group (p < 0.001), between subtenon TA & control group (p < 0.001) and in ranibizumab and subtenon TA group (p = 0.023). After 3 months, the variance between ranibizumab & control group was considerable (p < 0.0001) and the variance between subtenon TA & control group was considerable (p = 0.030).ConclusionsCombined phacoemulsification with intravitreal injections of ranibizumab or subtenon triamcinolone acetonide may prevent further progression in CMT in individuals with DME following cataract operation.

THERAPEUTIC EFFECTS AND ADVERSE EVENTS OF SINGLE DOSE OF INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION IN MACULAR EDEMA

Objective: The objective of the study was to study the therapeutic effects and adverse events of single dose of intravitreal triamcinolone acetonide (TA) in macular edema (ME). Methods: This prospective observational study was conducted for a period of 18 months in a tertiary care hospital. A total of 100 patients who received intravitreal injection of TA 4 mg were followed up within 1 month of injection and thereafter monthly for 3 months. Therapeutic effect was noted by improvement in visual acuity and reduction in macular thickness. Safety was assessed based on adverse events reported during the study period. The quantitative variables were analyzed by paired t-test and the qualitative variables by Wilcoxon signed-rank test and Chi-square test. Results: The mean age was 58.66±11.21 years with majority of patients (46%) in 46–60 age group. Diabetic retinopathy was the most common etiology. Fifteen patients experienced improvement in vision within 1 month, 51, 84, and 91 patients had better visual acuity after 1, 2, and 3 months, respectively, which were statistically significant (p=0.001). The mean macular thickness of 497.79±115.08 at baseline reduced to 448.62±112.48 within 1 month which further reduced to 383.72±105.79, 327.33±86.49, and 263.83±68.68 at the end of the 1st, 2nd, and 3rd months, respectively (p=0.001). The adverse events of rise in intraocular pressure, cataract, redness, pain, floaters, and subconjunctival hemorrhage were not found to be statistically significant (p&gt;0.05). Conclusion: Intravitreal TA injection may be an effective and safe treatment option for ME due to various etiologies.

COMPARISON OF FOCAL LASER WITH INTRAVITREAL TRIAMCINOLONE INJECTION AS TREATMENT FOR MACULAR OEDEMA FOLLOWING BRANCH RETINAL VEIN OCCLUSION

Background: Branch Retinal Vein Occlusion is a sight threatening disease in which Macular edema is the most important cause of central visual loss. Grid laser photocoagulation was the only treatment for macular oedema. Nowadays, intravitreal injection of vascular endothelial growth factors inhibitors and triamcinolone acetonide can play a role in management of BRVO. To study the visual acuity after focal laser and Objective: intravitreal triamcinolone injection and to compare the visual outcome of focal laser with intravitreal triamcinolone injection. 30 eyes Methods: were taken up for study. Based on the FFA ndings, the area with capillary non perfusion were excluded from the treatment. Only 24 cases were included in the treatment with focal laser and IVTA. The study groups were di Result: vided into Group 1 (underwent focal laser) and Group 2 (underwent Triamcinolone injection). The p-value was &gt;0.5 and there was no signicant difference in the visual outcome among the 2 groups. Conclusion: The therapeutics effects of Triamcinolone showed no signicant difference compared with focal laser with regard to visual outcomes but seemed to cause more adverse events. Therefore, further large randomized trials with longer follow up are needed to compare the long term safety and efcacy of these treatments provide sustainable concrete.