Intravitreal Triamcinolone Acetonide Research Articles

Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma.

This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA). An institutional review board-approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015. A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%). Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.

Intravitreal steroids for macular edema in diabetes.

Intravitreal steroids for macular edema in diabetes.

Managing solitary choroidal tuberculoma in an immunocompetent patient

Aim: We describe a case of young immunocompetent 18-year-old female patient who presented with sudden painless diminution of vision in left eye with vision of 20/100 on Snellen’s chart. Retinal evaluation showed a massive solitary choroidal granuloma. A positive Mantoux test (20X20 mm) was noted. The patient was started on anti-tubercular therapy and oral steroids and showed resolution of the granuloma with subretinal fluid at macula. After 3 months of oral therapy, the persistent subretinal fluid was managed with intravitreal injection of triamcinolone acetonide(2 mg). This case highlights favorable resolution of granuloma with oral therapy and a safer efficacy of triamcinolone acetonide in treating subretinal fluid due to choroidal tuberculoma with good visual outcome. Introduction: Choroidal tuberculoma is a rare ocular form of tuberculosis (TB) and is a diagnostic and a therapeutic challenge, especially when occurring without other manifestations of the disease.1,2 Involvement of the choroid occurs by direct infection or indirect immune‐mediated hypersensitivity and is the commonest clinical manifestation of intraocular TB.3 The presentation varies from a solitary choroidal granuloma (tuberculoma) to multiple choroidal tubercles, a subretinal abscess or choroiditis. We present a case of an immunocompetent patient, who presents with massive choroidal granuloma and responded to oral antitubercular and steroid therapeutic regimen. Visual acuity improved with intravitreal triamcinolone acetonide injection which resulted in resolution of subretinal fluid after 3 months

Intravitreal bevacizumab versus bevacizumab and 1 mg triamcinolone acetonide in eyes with bilateral diabetic macular edema

AIM: To Compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema. METHODS: In this retrospective comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab (IVB group) was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide (IVTA-IVB group) was performed. Main outcomes were the central macular thickness (CMT) measured with optical coherence tomography (OCT), ETDRS visual acuity (VA) and intraocular pressure (IOP). RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 µm and 546.8±165.6 µm before injections; 430.4±133.2 µm and 363.7±105.3 µm at first month; 484.8±167.4 µm and 407.3±108.7 µm at 3rd month; 550.4±191.5 µm and 516.8±158 µm after 6mo respectively. Differences were significant at first and 3rd month (P?0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 at first month; 59±13.7 and 59.3±13.6 at 3rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant at first and 3rd and 6mo (P?0.05). There was no IOP difference. IVTA-IVB group gains best VA at 3rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo. CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.

Intravitreal triamcinolone acetonide could be a first line medication for patients with DME in a community setting

Study aims to establish the efficacy and safety of intravitreal triamcinolone injections in the denovo treatment of DME in a rural poor socio-economic set up.4 mg Intravitreal injections of 04 mg of triamcinolone acetonide (IVTA) was given to 50 DME patients as an initial treatment. Best corrected visual acuity (BCVA), central retinal thickness (CMT) and intraocular pressure (IOP) were analysed before and after the treatment at intervals of 1 week, 1 month, 3 months and 6 months.Statistically significant improvements were observed in BCVA, as well as a decrease in CMT after all time-intervals following IVTA. IOP increases were observed 1 week, 1 and 3 months after IVTA, but not at 6 months after IVTA. No sight-threatening side effects of IVTA were observed.IVTA is effective therapeutic measure in control of DME; it could be a therapeutic option of choice in patients with poor socioeconomic status.

Centrifuged-Concentrated Intravitreal Slurry Triamcinolone Acetonide: An Inexpensive, Easy, and Viable Alternative to Long-Term Steroid Delivery.

This work reports the duration, safety, and viability of intravitreal slurry triamcinolone acetonide (TA; 1.0 mL of 40-mg/mL TA centrifuge concentrated into a 0.1-mL pellet) to treat cystoid macular edema (CME). A retrospective, consecutive review was conducted of patients undergoing intravitreal slurry TA injections, July 2009 to December 2018. In 143 eyes of 120 patients, slurry TA resolved CME for a mean of 327.15 (SD=213.11) days, or 10.76 (SD=7.00) months, per intravitreal injection (n=466). In 100 eyes requiring multiple injections (n=423), mean duration was 270.95 (SD=177.14) days, or 8.91 (SD=5.82) months, between injections. In 43 single-injection eyes, duration was 749.30 (SD=483.17) days, or 24.63 (SD=15.88) months. Mean duration decreased from 337.89 (SD=210.46) days, or 11.11 (SD=6.92) months, in nonvitrectomized eyes to 279.74 (SD 179.63) days, or 9.20 (SD=5.91) months, in vitrectomized eyes (n=74 injections, t=2.24, P=.014, 1-tailed). Central foveal thickness as shown on optical coherence tomography decreased by 173.89μ (SD=147.56μ), from 459.16μ (SD=47.14μ) to 285.27μ (SD=77.27μ; t=-25.31, P<.001), within 43.41 days (SD=36.86). Visual acuity improved from 20/100 (logMAR 0.70, SD=0.33) to 20/74 (logMAR 0.57, SD=0.31; SD=0.21; t=-11.01, P<.001), within 33.98 (SD 24.98) days. Fifteen of 31 phakic eyes (48.39%) underwent cataract extraction. Fifty-seven eyes (39.86%) developed a steroid response (>10 mm Hg increase from baseline) 94.79 days (SD=85.52 days), or 3.11 (SD=2.81) months, following injection. A single injection of slurry TA lasted on average 10.76 months with significant improvement of CME and visual acuity. Adverse ocular effects were comparable to currently available, long-term, implantable steroids. Slurry TA appears to be an easily reproducible, safe, and cost-effective alternative to long-term intraocular steroid delivery.

CHARACTERISTIC AND TREATMENT OF CENTRAL RETINAL VEIN OCCLUSION IN CIPTO MANGUNKUSUMO HOSPITAL, INDONESIA

Background: To evaluate the characteristics and treatment of central retinal vein occlusion (CRVO) in Vitreoretinal Division in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.&#x0D; Methods: A retrospective descriptive study was conducted in 79 subjects (80 eyes) with CRVO. Study groups were divided into 4 groups; laser photocoagulation, intravitreal bevacizumab (IVB), combination of IVB and laser photocoagulation (IVB/laser), also intravitreal triamcinolone acetonide (IVTA) group. Visual acuity evaluation and central macular thickness (CMT) measurement were performed for 6 months therapy.&#x0D; Results: This study found 43 eyes with ischemic CRVO (53.25%) and 37 eyes observed with non-ischemic type (46.25%). The common risk factors of CRVO in this study were hypertension (65.8%), diabetes mellitus (30.4%) and dyslipidemia (22.8%), while the most frequent complication was macular edema (87.5%). The improvement in central macular thickness was found in most of the patients with both CRVO types in all treatment groups. Meanwhile, the improvement of visual acuity was mostly found in patients with ischemic CRVO in IVB with/without laser group.&#x0D; Conclusion: Hypertension, diabetes mellitus and dyslipidemia patients should be aware of CRVO incidence. IVB with/without laser may be suggested as the treatment of choice for ischemic and non-ischemic CRVO patients in our hospital.&#x0D; Keyword: anti-vascular endothelial growth factor, bevacizumab, central retinal vein occlusion, intravitreal injection of triamcinolone acetonide, laser photocoagulation

Phacoemulsification Combined with Intravitreal Triamcinolone Acetonide Injection in Cataract Patients with Diabetic Macular Edema

Phacoemulsification Combined with Intravitreal Triamcinolone Acetonide Injection in Cataract Patients with Diabetic Macular Edema

Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO. Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up. Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

Diabetic retinopathy progression 6 months post-cataract surgery with intravitreous bevacizumab vs triamcinolone: A secondary analysis of the DiMECAT trial.

Diabetic retinopathy (DR) may progress following cataract surgery due to surgery-induced inflammation. The effect of intravitreal bevacizumab (BVB) and triamcinolone acetonide (TCA), which have differing anti-inflammatory properties, on DR progression following cataract surgery has not been reported. To report the progression of DR in diabetic patients undergoing cataract extraction treated with intravitreal BVB or TCA during the surgery. Post hoc analysis of 6-month data from a prospective, randomized, double-masked clinical trial. Diabetic patients with clinically significant cataract and fovea involving diabetic macular oedema (DME), or a recent history of DME. Participants were randomly allocated 1:1 to receive intravitreal BVB 1.25 mg or TCA 4 mg during and post-cataract surgery as needed. The rate of DR progression between groups was compared. DR progression. There were 61 eyes included. Patients receiving BVB were older than those receiving TCA (70.2 vs 64.3 years; P < .05). Three participants (10.7%) in the BVB and three (9.09%) in the TCA group had a one-step progression, while none in BVB and only one (3%) in the TCA group demonstrated two-step DR progression. In the majority of these patients, DR progression was from mild to moderate non-proliferative diabetic retinopathy. In this study, BVB and TCA groups had a similar, and lower rate of DR progression compared to previous studies where no adjunctive treatment was administered, suggesting that patients with DME may benefit from either intraoperative intravitreous BVB or TCA injection to reduce the risk of DR progression following cataract surgery.

Dramatic Resolution of Recalcitrant Cystoid Macular Edema after Concurrent Intravitreal Injection of Bevacizumab and Triamcinolone

Background: Cystoid macular edema (CME), a common complication of branch retinal vein occlusion (BRVO), is associated with a significant vision loss. Anti-vascular endothelial growth factor (anti-VEGF) therapy is the gold standard of treatment, while grid macular photocoagulation has also been used as an adjuvant in patients with CME secondary to BRVO. More recent efforts were successful by the use of intravitreal triamcinolone acetonide. We proposed a concurrent use of intravitreal triamcinolone acetonide and intravitreal bevacizumab in the treatment of CME secondary to BRVO.&#x0D; Case presentation: We described an 82-year-old female with a BRVO in the right eye who developed associated CME. Repeated injections of intravitreal bevacizumab and modified grid macular laser treatment were ineffective. A concurrent treatment with intravitreal bevacizumab and triamcinolone acetonide resulted in complete and dramatic resolution of CME with a favorable visual outcome. Optical Coherence Tomography (OCT) demonstrated a significant decrease in central subfield thickness (CST) from 764μm to 253μm, without any post-procedure complications or recurrence of macular edema with complete recovery of visual acuity at 6-month follow-up.&#x0D; Conclusion: Early concurrent treatment with intravitreal anti-VEGF therapy (e.g. intravitreal bevacizumab) and intravitreal triamcinolone acetonide is likely to be more effective than intravitreal anti-VEGF agents alone or grid macular photocoagulation in the management of CME associated with BRVO.

Rebound Phenomenon after Intravitreal Injection of Triamcinolone Acetonide for Macular Edema

Introduction: The aim of this article was to report on a rebound phenomenon after intravitreal triamcinolone acetonide (IVTA) injection for macular edema secondary to diabetic retinopathy (DR) and central or branch retinal vein occlusion (CRVO/BRVO). Methods: The data were analyzed retrospectively. Complete ophthalmic examinations, including spectral domain optical coherence tomography, were performed before and 2 months after IVTA injection. The incidence of a rebound phenomenon was defined as an increase in central retinal thickness of >10% from baseline at 2 months after IVTA injection. Results: This retrospective study included 211 consecutive patients (268 eyes). One hundred ninety (71.2%), 39 (14.6%), and 39 (14.6%) eyes had macular edema (ME) due to DR, CRVO, and BRVO. In total, 9.7% of the eyes showed a rebound phenomenon (DR: 9.5%, CRVO: 5.2%, BRVO: 15.4%). The mean number of prior injections of vascular endothelial growth factor inhibitor or corticosteroid agent was statistically significantly higher in the rebound group (6.8 vs. 5.3) than in the nonrebound group (p = 0.01). Conclusion: Our study shows that 9.7% of the eyes with ME secondary to DR and RVO developed a rebound phenomenon following IVTA injection, limiting its therapeutic effect. We found an increased number of prior intravitreal pharmacotherapy to be a risk factor for a rebound phenomenon.

Surgical Outcomes of Retropupillary-Fixated Iris-Claw Intraocular Lens

Purpose:To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation.Methods:For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted.Results:One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis.Conclusions:Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.

Intracameral injection of triamcinolone acetonide to treat macular edema in pseudophakia

The study aimed to evaluate the effectiveness of intracameral injection of triamcinolone acetonide (TA) on macular edema before and after cataract surgery. Intracameral injection of TA was performed at the end of cataract surgery in patients with macular edema before cataract surgery. We also performed intracameral injection of TA to treat macular edema in other pseudophakic eyes. In the patient receiving intracameral injection of TA during cataract surgery, central macular thickness decreased from 351 to 272 μm at 1 month after cataract surgery. In 2 patients who had secondary intraocular lens (IOL) implantation using retropupillary fixation of the iris claw IOL, intracameral TA injection successfully reduced central macular thickness, although 1 patient was refractory to intravitreal TA injection. Intracameral injection of TA seems to be more familiar to cataract surgeons and is an effective treatment for macular edema in pseudophakic eyes.

Response of Retinal Sensitivity to Intravitreal Anti-angiogenic Bevacizumab and Triamcinolone Acetonide for Patients with Diabetic Macular Edema over One Year

ABSTRACT Aim The aim of this study was to evaluate and compare microperimetry changes in patients with clinically significant diabetic macular edema secondary to diabetes mellitus, following intravitreal injections of bevacizumab or triamcinolone during a follow-up of 1 year after treatment. Materials and Methods 30 patients with clinically significant macular edema were randomized into two groups of 15 patients each. One group initially received three intravitreal injections of 2.5 mg bevacizumab at monthly intervals. The other received a single injection of 8 mg of triamcinolone followed by two sham interventions at monthly intervals. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were measured. Macular function was documented by microperimetry at baseline, 3, 6, 9 months and at the last visit of each patient. Results In the bevacizumab group, the mean differential light threshold (±standard deviation) under therapy improved significantly from 8.40 (± 3.8) dB to 12.8 (±4.3) dB at the 12-month follow-up visit (p ≤ .05), whereas in the triamcinolone group it increased from 8.0 (± 2.4) dB at baseline to 9.3 (±3.6) dB at the last visit without reaching statistical significance (p > .05). The mean differential light thresholds between the two groups were not statistically significant at baseline or the last visit (p > .05). In the bevacizumab group, the improvement (slope) in mean differential light threshold was significantly superior to the Triamcinolone group (Estimate = 0.588, p ≤ .05). Conclusion Central macular function as measured by microperimetry in patients with acute DME improved in addition to anatomical restoration after intravitreal bevacizumab and triamcinolone injection. In our clinical study, the measures of the variables in patients receiving bevacizumab were superior to those receiving triamcinolone throughout the one-year observation period.

The effects of intravitreal triamcinolone acetonide in diabetic macular edema refractory to anti-VEGF treatment.

To investigate the efficacy and safety of primary intravitreal triamcinolone acetonide (IVTA) in eyes affected by diabetic macular edema (DME) refractory to anti-vascular endothelial growth factor (VEGF) therapy. Retrospective observational study METHODS: The medical records of patients who attended our clinic from March 2013 to September 2018 with refractory macular were reviewed. We included the patients who were injected at least one IVTA and completed 6 months of observation. Best-corrected Snellen visual acuity (VA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events (AEs) were examined at baseline and at 1 month, 2 months, 3 months, and 6 months. Sixty-four eyes of 54 subjects were included. The mean VA was improved significantly at all time points compared to pre-treatment (P < 0.0001), with the greatest mean improvement at 1 month (0.3 logMAR). The reduction in mean CMT was also significant at all follow-up examinations compared to baseline (P < 0.0001), with the greatest decrease at 1 month (113.68 ± 53.78 μm). A poorer VA before injection was a factor that influenced visual gain 1 month post treatment (0.247 logMAR units/unit increase in baseline VA, P = 0.006). The most common AE associated with IVTA treatment was elevated IOP (11 eyes), observed significantly more often after IVTA injections containing a preservative (25.8%) than after those that were preservative-free (9.1%) (P = 0.033). IVTA injection can be an alternative steroid treatment for DME refractory to anti-VEGF therapy.

Bevacizumab versus triamcinolone for persistent diabetic macular edema: a randomized clinical trial.

To evaluate 24-week visual acuity and anatomic outcomes of two "pro re nata" (prn) treatment strategies (intravitreal bevacizumab [IVB] prn versus intravitreal triamcinolone acetonide [IVT] prn) in patients with persistent diabetic macular edema (pDME) after 24weeks of prn-IVB. One hundred eyes with center-involving DME were enrolled and treated with prn-IVB for 24weeks; at week 24, eyes with pDME (central subfield thickness [CST] on spectral domain optical coherence tomography > 300μm) were randomized to IVB monthly prn (group I; prn-IVB) or IVT every 3months prn (group II; prn-IVT) and eyes in which the CST was ≤ 300μm were assigned to continue prn-IVB (group III). Seventy-four eyes completed a 48-week study period. At week 24, 65 (79.3%) eyes still had DME with CST > 300μm and, therefore, were randomized to prn-IVB (group I, n = 33) or prn-IVT (group II, n = 32); the remaining 17 (20.7%) eyes had CST ≤ 300μm and were assigned to continued treatment with prn-IVB (group III). At baseline, mean CST (μm) ± standard error of the mean (SEM) was 447.2 ± 24.4, 478.0 ± 19.7, and 386.0 ± 21.0 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no significant difference in mean CST between groups I and II (369.9 ± 23.3 and 426.0 ± 26.1, respectively; p = 0.9995). A significant reduction in mean CST, compared with baseline, was noted at weeks 28 (p = 0.0002) and 44 (p = 0.0002) in group II. Group I did not show a significant reduction in mean CST compared with baseline at any study visit. There were no significant differences in mean CST between groups I and II at any study visit. At baseline, mean ± SEM best-corrected visual acuity (BCVA) (logMAR) was 0.50 ± 0.00, 0.60 ± 0.10, and 0.50 ± 0.10 in groups I, II, and III, respectively (p > 0.05). At week 48, there was no statistically significant difference in mean BCVA between groups I and II (0.50 ± 0.10 and 0.80 ± 0.10, respectively; p = 0.4473). There was no significant improvement in mean BCVA, as compared with baseline, at any study follow-up visit in any of the groups. Group II demonstrated significantly lower BCVA after 24weeks of IVT (at week 48) compared with baseline (p = 0.0435). There was no significant difference in mean BCVA between groups I and II at any time-point. In eyes with pDME after 24weeks of treatment with prn-IVB, there was no difference between continued treatment with prn-IVB versus a treatment switch to prn-IVT with respect to mean BCVA or mean CST at week 48. However, BCVA was stable in the prn-IVB group, while prn-IVT was associated with BCVA reduction from baseline and a higher risk of IOP elevation.

Intravitreal Triamcinolone Acetonide Injection in a Rodent Model of Anterior Ischemic Optic Neuropathy: Response.

We would like to thank Dr. Harvey for his interest in our study titled “Intravitreal triamcinolone acetonide injection in a rodent model of anterior ischemic optic neuropathy” (1). He points out the limitations of using a rodent model to investigate anterior ischemic optic neuropathy (AION). We are in agreement that animal models will always fall short of studying human disease. However, they are often the most appropriate first step. There is no question that rodents have different responses to tissue injury than do primates. We also agree that, unlike AION in humans, the current animal models of AION, both rodent and nonhuman primate, are potentially different from human AION. With all animal models, we know exactly when damage occurred; however, with humans, we do not know when damage began—only when symptoms were first detected. Positive studies are of most value. If drug studies in rodents and other lower animals (e.g., rodents, rabbits, and hamsters) work, then we have a basis on which to test drugs in nonhuman primates or, in some cases, directly in humans. However, if they do not work, we still do not know with certainty that they would not work in humans. Such negative studies do have value in that they serve as essential building blocks, providing direction for future studies and at times justification for funding. Dr. Harvey voices several specific concerns. He asserts that laser-induced optic AION should be viewed as “a homolog” to end-stage AION. This presumption may or may not be accurate. But, even if accurate, our findings would still suggest that steroids lack benefit at this stage of disease, which may be at or shortly after appreciation of visual symptoms. He further argues that edema may play a role in the pathophysiology of AION, at different phases of the disease, and in some cases, preceding infarction. This likely is correct, and it is possible that steroids could have benefit in a subset of patients, specifically those with progressive axonal ischemia related to secondary compartmental compression. As we stated in our discussion section, we agree that our findings do not negate the possibility that steroids may have benefit in all or possibly a subset of human patients. In closing, we agree with Dr. Harvey that findings in a rodent model of AION far from perfectly parallel human disease. However, it would be unwise to assume animal studies such as this are entirely without value. They are, in many cases, the most appropriate initial step. We maintain that our data are sufficient to exclude a significant impact of intravitreal triamcinolone, with a final intravitreal concentration of 1 mg/mL, on retinal ganglion cells number in rodent eyes with nonarteritic ischemic optic neuropathy (NAION). Our findings do not exclude the possibility that anti-inflammatory therapy may be beneficial in all or in subsets of human patients with NAION. A detailed account of our study's limitations and implications comprises the bulk of the discussion section of the article (1). We are hopeful that these data will benefit future the design of more focused studies.

Erosive Retinopathy and Retinal Detachment From Depot Intravitreal Triamcinolone Acetonide Injection at the End of Pars Plana Vitrectomy.

Intravitreal triamcinolone acetonide (IVTA) used as a surgical adjuvant for pars plana vitrectomy (PPV) can stain cortical vitreous, control postoperative inflammation, and reduce retinal edema. Sterile endophthalmitis uncommonly complicates office-based IVTA injection. The authors report a new complication of IVTA depot injection at the end of PPV. Retrospective records review of all patients treated at the Cincinnati Eye Institute with PPV between January 1, 2011, and December 31, 2017, who developed a triad of sterile endophthalmitis, atrophic retinal breaks under the depot IVTA in the inferior retina, and rhegmatogenous retinal detachment (RRD). Eyes with flap tears, solely superior breaks, or stretch holes from proliferative vitreoretinopathy causing RRD were excluded. Eight eyes of eight patients (four males and four females; mean age: 73.7 years) who received 4 mg or 8 mg IVTA depot at the end of PPV surgery presented at a mean of 23.5 days following PPV with RRD (one macula-involving, seven macula-sparing), requiring treatment with PPV in six eyes and laser retinopexy alone in two eyes. Seven eyes that underwent membrane peeling (MP) received IVT to prevent cystoid macular edema (CME) and one eye with prior MP was treated for CME. Mean vitreous inflammation was 2+ cell at 1 week postoperatively. Two patients had documented sterile endophthalmitis within the first week requiring vitreous cultures and antibiotics injections. Visual acuity (VA) for eyes requiring PPV for RD repair declined from 20/90 preoperatively to 20/212 at 6 months postoperatively. VA for eyes amenable to laser alone improved from 20/53 to 20/35. All eyes remained attached, with the exception of one patient who refused further treatment after developing recurrent detachment from PVR. Particle-induced sterile endophthalmitis from IVTA depot at the end of PPV surgery resulted in atrophic inferior retinal breaks and RRD as a newly described entity coined "erosive retinopathy." All retinal detachment surgeries required silicone oil tamponade. Poor visual outcome at 6 months was common for eyes requiring PPV for RD repair. The authors recommend avoiding IVTA depot injection at the end of PPV. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:613-619.].

Study of efficacy of intravitreal triamcinolone acetonide (IVTA) for the treatment of refractory diabetic macular edema (DME) in type 2 diabetes mellitus patients

Study of efficacy of intravitreal triamcinolone acetonide (IVTA) for the treatment of refractory diabetic macular edema (DME) in type 2 diabetes mellitus patients - IJCEO- Print ISSN No: - 2395-1443 Online ISSN No:- 2395-1451 Article DOI No:- 10.18231/j.ijceo.2019.097, Indian Journal of Clinical and Experimental Ophtha