Single Intravitreal Injection Of Triamcinolone Acetonide Research Articles

Adjunctive Intravitreal Triamcinolone Acetonide for Exudative Retinal Detachment in Coats Disease.

This work aims to assess the value of intravitreal triamcinolone acetonide (IVTA) as an adjunctive therapy in advanced Coats disease with exudative retinal detachment (ERD). A retrospective review was conducted of patients with Coats disease stage 3 or higher who received IVTA to decrease subretinal fluid (SRF), facilitate retinal ablative therapy, and avoid surgical drainage. Primary outcomes were SRF resolution and avoidance of surgical SRF drainage. Seventeen eyes of 17 patients (mean, [SD] age, 3.9 [3.4] years) met the inclusion criteria. ERD configuration was bullous in 7 and shallow in 10 eyes. Following a single IVTA injection, ablative therapy was achieved after a mean (SD) of 2.1 (3.0) weeks. Complete SRF resolution was observed in 13 eyes (76.4%) after a mean of 1.3 IVTA injections and a mean of 2 (SD, 1.27) laser sessions, and none of these eyes required SRF drainage up to last follow-up (mean [SD], 50.5 [26.24] months). In 4 eyes with bullous ERD at presentation, SRF persisted (P = .015) despite additional measures including surgical drainage. Final visual acuity ranged from 20/100 to no light perception. Cataract developed in 12 of the 17 eyes (70.5%). None developed an increase in intraocular pressure at final follow-up. IVTA injection can be a helpful adjunctive modality to address SRF in advanced Coats disease. It may obviate the need to surgically drain SRF to effectively treat the condition, particularly when the ERD is not highly bullous.

Triamcinolone acetonide induces sterile endophthalmitis in patients with intermediate uveitis: A case report series.

Due to their anti-inflammatory, antiangiogenic and antiedematous properties, corticosteroids have been commonly used in the treatment of retinal diseases. Intravitreal administration of steroids offers the maximal drug efficacy and the lowest risk of systemic side effects. The authors report three cases of presumed sterile endophthalmitis induced by triamcinolone acetonide (TA) in three eyes with intermediate non-infectious uveitis. Each patient received a single intravitreal injection of TA of 4 mg. Because of the intense vitreous inflammatory reaction, retina examination and the optical coherence tomography could not be performed, although vitreous opacities were observed on the ocular ultrasound. The dense vitreous opacity is a defining factor, the anterior segment inflammation is mild to moderate and a hypopyon is present, which may be a sterile inflammatory reaction or the triamcinolone material itself. In cases of sterile endophthalmitis, the visual acuity increases progressively as the intraocular inflammation diminishes. Local treatment with topical antibiotics, prednisolone acetate and cycloplegic eyedrops is recommended to control the inflammatory reaction.

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

The management of nonarteritic anterior ischemic optic neuropathy centers around prevention of second eye involvement, without a uniformly accepted therapy for the involved eye. Several researchers have assessed the benefit of steroids with conflicting results. This experimental study was designed to evaluate the efficacy of a single intravitreal triamcinolone acetonide injection (IVTA) in preserving retinal ganglion cells (RGCs) in a rodent model of anterior ischemic optic neuropathy (rAION). The rAION was induced in female Wistar rats. Animals were randomized into 3 groups: 1) untreated, 2) treated with 56 μg IVTA, and 3) intravitreal saline (placebo). Procedures were performed in the left eye, with the right eye serving as control. After 30 days, animals were sacrificed and eyes were assessed histologically for RGC number. The average number of RGC was significantly lower in rAION subgroups when compared with the control group (P < 0.001). No significant difference was seen between rAION eyes treated with IVTA, placebo, and untreated eyes (P > 0.05%). In this rodent model for AION, no therapeutic benefit of intravitreal steroid injection was identified.

Comparison between Intravitreal Bevacizumab and Triamcinolone Acetonide in Management of Diabetic Macular Edema

Background: To critically evaluate the efficacy and safety profile of intravitreal bevacizumab (IVB)compared to intravitreal triamcinolone acetonide (IVTA) in patients with diabetic macular edema(DME).Methods: We searched publication related to diabetic macular edema managed by bevacizumab andtriamcinolone acteonide through systematic search of database in a period of January 2002 untilOctober 2013. Information needed from all articles were extracted into a data extraction sheet. Wereviewed the efficacy of both treatment in decreasing central macular thickness (CMT), improvementof visual acuity and the adverse effects following the injection.Results: Twelve articles were included after fulfilling inclusion and exclusion cirteria. Our analysisshowed single IVTA injection were more effective in decreasing CMT and improving visual acuity at1 week to 3 months. There were no significant improvement of CMT in multiple injection of IVTAcompared to multiple injection of IVB.Conclusion: A single intravitreal injection of IVTA appears to offer certain short-term advantagesover IVB for the management of patients with diabetic macular edema, particularly with regard toCMT. Keywords: intravitreal, triamcinolone acetonide, bevacizumab, diabetic macular edema

Intravitreal triamcinolone injections in non-arteritic anterior ischemic optic neuropathy

In non-arteritic anterior ischemic optic neuropathy (NA-AION), no treatments have demonstrated to be effective in recovering visual loss in randomized clinical trials. Oral steroids have been evaluated, and small series of intravitreal triamcinolone acetonide (IVTA) injection in NA-AION have been reported. The purpose of our study was to report the visual outcome and morphological changes in response to a single IVTA injection as a treatment for patients with NA-AION. The charts of 36 patients with visual symptoms and optic disc swelling caused by NA-AION were evaluated. Twenty-one patients had received 4mg IVTA and were compared with 15 non-treated patients. Visual acuity (VA), retinal nerve fiber layer thickness and static visual field were evaluated after 6months. VA improvement at 6months is statistically better in the treated group than in the non-treated group (p = 0.0035). In the treated group, there was a significant inverse correlation between the delay of the injection and the visual acuity achieved at 6months (p < 0.0083**, r = -0.56). A significant improvement of the visual field was noted in the injected group when compared with the non-treated group at 6months (p < 0.0028). In this retrospective study, patients receiving IVTA in the acute phase of NA-AION have better improvement of VA and visual field during the follow-up period of 6months. However, only a large randomized controlled trial may enable to evaluate the benefits of IVTA Injections on visual outcome in NA-AION.

Evaluation of Contrast Sensitivity after Single Intravitreal Triamcinolone Injection for Macular Edema Secondary to Branch Retinal Vein Occlusion

Purpose. To evaluate visual acuity (VA), contrast sensitivity (CS), and central retinal thickness (CRT) after intravitreal triamcinolone acetonide (IVT) injection for macular edema secondary to branch retinal vein occlusion (BRVO). Methods. In this prospective study, a total of 21 eyes of 21 patients were included. VA, CS, and CRT were assessed at baseline and at 1, 3, and 6 months after a single IVT injection. Results. Mean age was 64.57 ± 8.34 years. The mean baseline VA (LogMAR) increased from 1.11 ± 0.63 to 0.55 ± 0.39 (P < 0.001), 0.60 ± 0.40 (P < 0.001), and 0.78 ± 0.39 (P = 0.07) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 1 meter improved from 0.66 ± 0.49 to 1.11 ± 0.32 (P < 0.001), 0.99 ± 0.38 (P < 0.001), and 0.72 ± 0.37 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CS (log CS) at 3 meters improved from 0.34 ± 0.41 to 0.74 ± 0.41 (P < 0.001), 0.64 ± 0.44 (P = 0.036), and 0.46 ± 0.49 (P = 0.8) at 1, 3, and 6 months, respectively. The mean baseline CRT decreased from 511 ± 146 μm to 242 ± 119 μm, 277 ± 131 μm, and 402 ± 166 μm at 1, 3, and 6 months after IVT (P < 0.001 for each). Conclusion. Single IVT injection improved VA and CS and reduced CRT at 1 and 3 months of treatment. VA and CS returned to baseline levels at 6 months.

Single injection of triamcinolone versus three repeated injections of bevacizumab for treatment of diabetic macular edema

To compare the effect of a single intravitreal injection of triamcinolone acetonide versus three consecutive monthly intravitreal injections of bevacizumab for the treatment of diabetic macular edema (DME). Forty patients treated with a single intravitreal injection of 4mg triamcinolone acetonide (triamcinolone group) were compared with 40 patients treated with three consecutive monthly intravitreal injections of 1.25mg bevacizumab (bevacizumab group). The triamcinolone group showed a significant decrease in mean central retinal thickness (CRT) from 472.5μm±120.35 to 374.0μm±152.31 after 3 months (p < 0.001). The bevacizumab group also showed a significant reduction in CRT from 464.5μm±115.3 to 370.0μm±142.31 (p<0.001). The triamcinolone group displayed an increase in best-corrected visual acuity (BCVA) following a single intravitreal triamcinolone acetonide injection from a mean of +0.70±0.17 logMAR to a mean of +0.54±0.38 logMAR after 3months (p<0.05). The bevacizumab group also showed an increase in BCVA following three injections of bevacizumab from a mean of +0.73±0.28 logMAR to a mean of +0.57±0.33 logMAR (p<0.05). Statistical analysis showed no significant difference between both groups at 3months. Our study showed that a single intravitreal injection of triamcinolone is as effective as three consecutive monthly intravitreal injections of bevacizumab for treatment of DME with regard to BCVA and CRT measured by optical coherence tomography. Despite the recent popularity of bevacizumab, three injections are no more effective than a single injection of triamcinolone for the treatment of DME.

Hypothalamic–pituitary–adrenal axis function following intravitreal triamcinolone acetonide injection

To evaluate the pituitary-adrenal axis function by means of the adrenocorticotropic hormone (ACTH) stimulation test following a single intravitreal injection of triamcinolone acetonide (IVTA). Prospective comparative clinical interventional study. Twenty-eight patients (28 eyes) received a single IVTA (4 mg in 0.1 ml) for macular edema. The basal cortisol level and the response to 1 μg adrenocorticotropic hormone stimulation were determined on the morning before IVTA injection and at 1 day and 1, 2, and 4 weeks after IVTA injection. Results were compared with those obtained from a control group of 50 healthy subjects. All patients in the study had normal basal cortisol and normal response to ACTH challenge before receiving IVTA. 1 day following IVTA, basal cortisol was suppressed in one patient in the study group. Fasting serum cortisol levels at 1, 2, and 4 weeks after IVTA injection were normal in all patients in the study group. 1 day following IVTA, the peak response to ACTH at 30 min was blunted in four patients (14.3 % of the study group, p = 0.05) and the cortisol response at 60 min was suppressed (p = 0.009). 1 week following IVTA, the response to ACTH challenge was blunted in only one patient. A single IVTA injection may be associated with impaired hypothalamic-pituitary-adrenal function in some patients during the first 24 h following IVTA.

Intravitreal triamcinolone acetonide injection in the acuite phase nonarteritic anterior ischemic optic neuropathy

Abstract Purpose In nonarteritic anterior ischaemic optic neuropathy (NA‐AION), no treatment has shown to be effective in recovering visual loss in a randomized controlled clinical trial. Oral steroids have been evaluated and small series of IVTA have been reported. The purpose of this study was to analyse the visual outcome in response to a single intravitreal triamcinolone acetonide injection (IVTA) as a treatment for patients with acute NA‐AION. Methods Consecutive patients with either significant visual loss (visual acuity &lt; 0.4) in the first eye or optic nerve head swelling in the second eye due to acute NAION were treated with 4 mg/0.1 mL IVTA. Patient's best‐corrected visual acuity, optical coherence tomography of the retinal nerve fiber layer (RNFL) and visual field were performed before injection, visual acuity was assessed at 1 week, and 2‐12 months after. Results Visual acuity was between 0.08 and 1.0 on inclusion, it improved in 2 eyes (more than 1 line) and remained stable (+/‐ 1 line) in 4 eyes after injection. In the group of eyes reaching (n=2) or maintaining (n=1) a final visual acuity of 1.0, the delay between onset and injection was 7 days or less. In the second group of patients, final visual acuity was between 0.08 and 0.4, the delay between onset was between 2 and 3 weeks. Conclusion The clinical course of these patients suggests that an IVTA may be effective in increasing or maintaining visual acuity following an acute NAION if the treatment is applied within one week. A large randomized controlled study is required to confirm these preliminary data.

Short-term Results of a Single Intravitreal Bevacizumab (Avastin) Injection versus a Single Intravitreal Triamcinolone Acetonide (Kenacort) Injection for the Management of Refractory Noninfectious Uveitic Cystoid Macular Edema

Purpose: To report the short-term results of a single intravitreal injection of bevacizumab (IVB) versus a single intravitreal injection of triamcinolone acetonide (IVT) to treat refractory noninfectious uveitic cystoid macular edema (CME).Methods: Twenty-eight consecutive patients (36 eyes) were retrospectively included. Patients received either 2.5 mg of IVB (16 eyes) or 4 mg of IVT (20 eyes).Results: In the IVT group, baseline best-corrected visual acuity (BCVA) was logMAR 1.1 ± 0.2, and improved to 0.7 ± 0.3 (p < .001) at 6 months. In the IVB group, baseline BCVA was logMAR of 1.2 ± 0.4 and improved to 0.8 ± 0.4 at 6 months (p = .031). At 6 months, central macular thickness (CMT) in the IVT group improved from 454.8 ± 238.9 μm to 296 ± 134.4 μm (p < .0001).Conclusion: A single IVT injection improves BCVA and reduces CMT more effectively than IVB in refractory noninfectious uveitic CME at 6 months.

Pars Plana Vitrectomy with Internal Limiting Membrane Peeling Compared with Intravitreal Triamcinolone Injection in the Treatment of Diabetic Macular Edema

Aim: To compare the efficacy of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) removal and intravitreal triamcinolone acetonide (IVTA) injection in patients with diabetic macular edema (DME). Methods: This study was a retrospective, comparative, interventional case study examining 14 patients (15 eyes in total) who underwent PPV and ILM removal (vitrectomy group), and 14 patients (14 eyes in total) who were treated with an IVTA injection (triamcinolone group). Main outcome measures were visual acuity and central macular thickness at 1, 3 and 6 months postoperatively. Results: Patients in the vitrectomy group had significantly decreased central macular thicknesses at 1, 3 and 6 months postoperatively (p = 0.001, p = 0.001 and p = 0.002, respectively). The improvement in visual acuity was not significant at 1 month, but it gradually became statistically significant at 3 and 6 months after surgery (p = 0.031 and p = 0.015, respectively). Compared with the triamcinolone group, the vitrectomy group showed a better visual acuity at 6 months after surgery (p = 0.025). Conclusions: PPV combined with ILM removal is a good therapeutic option for improving visual acuity and decreasing macular thickness in DME, and this treatment has a better long-term efficacy than a single IVTA injection.

Intravitreal steroids in the management of macular oedema

The use of intravitreal corticosteroids in the management of macular oedema has recently gained widespread acceptance. New long-acting steroid preparations and methods of delivery have facilitated the use of these new modalities. This review describes the various types of macular oedema for which this therapeutic option is used and the results.