Kenalog
Intravitreal triamcinolone acetonide for the treatment of cystoid macular edema secondary to Behcet disease.

Karacorlu M, Mudun B, Ozdemir H, Karacorlu SA, Burumcek E.

Istanbul Retina Institute, Istanbul, Turkey. retina pobox.com

PURPOSE: To evaluate the safety and effectiveness of intravitreal triamcinolone acetonide in patients with cystoid macular edema (CME) associated with Behcet disease. DESIGN: Interventional case series. METHODS: Ten eyes of 10 patients with CME from Behcet disease made up the study population. All eyes had persistent CME despite medical treatment for at least 2 months. Intravitreal injection of 4 mg (0.1 ml) of triamcinolone acetonide was offered to treat macular edema. The visual and anatomic responses were observed. RESULTS: At 1-month follow-up, a reduction in mean foveal thickness of 37.4%, from 416 microm to 260.5 microm, was attained. At 3-month follow-up, mean foveal thickness was 286.2 microm and at 6 months, 263.7 microm. No eyes had lost vision at 1 month, and eight eyes (80%) showed improvement in visual acuity. At 3-month and 6-month follow-up, three eyes (30%) remained stable and the other eyes had maintained the improved acuity. CONCLUSION: Intravitreal triamcinolone acetonide is a promising therapeutic method for CME from Behcet disease.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15289142&dopt=Abstract triamcinolone Kenalog



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Intravitreal triamcinolone for the treatment of macular edema associated with central retinal vein occlusion.

Ip MS, Gottlieb JL, Kahana A, Scott IU, Altaweel MM, Blodi BA, Gangnon RE, Puliafito CA.

Department of Ophthalmology and Visual Science, University of Wisconsin, Madison 53711-1068, USA. msip wisc.edu

OBJECTIVE: To investigate the safety and efficacy of intravitreal triamcinolone acetonide as treatment for macular edema associated with central retinal vein occlusion (CRVO). METHODS: We reviewed the medical records of 13 consecutive patients (13 eyes) with macular edema associated with CRVO who were treated with an injection of intravitreal triamcinolone acetonide (4 mg) at the University of Wisconsin and the Bascom Palmer Eye Institute. Each intravitreal injection was delivered through the pars plana using a 27- or 30-gauge needle. MAIN OUTCOME MEASURES: Change in Snellen visual acuity, clinical appearance of macular edema, measurement of foveal thickening with optical coherence tomography (OCT), and frequency of complications. RESULTS: The median age of the 13 patients was 67 years (interquartile range, 57-77 years), and the median duration of symptoms before injection was 8 months (interquartile range, 4-9 months). Mean baseline visual acuity was 20/500 in the affected eye. Mean visual acuity at the 6-month follow-up examination was 20/180 in the affected eye. All 13 patients completed the 6-month examination. Eyes with nonischemic CRVO (n = 5) demonstrated a significant improvement in visual acuity, whereas eyes with ischemic CRVO (n = 8) demonstrated a nonsignificant visual acuity improvement. No patient had a decrease in visual acuity. Mean baseline foveal thickness as measured by OCT was 590 micro m (retinal thickening = 416 micro m). Mean foveal thickness as measured by OCT at the 1-month follow-up examination in 12 patients was 212 micro m (retinal thickening = 38 micro m). At the 3-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 193 micro m (retinal thickening = 19 micro m). Between the 3- and 6-month follow-up examinations, 4 patients developed a recurrence of macular edema. Three of the 4 patients were retreated with a second injection of triamcinolone. Two of these 3 patients experienced an improvement in visual acuity following retreatment. At the 6-month follow-up examination, mean foveal thickness as measured by OCT for 13 patients was 281 micro m (retinal thickening = 107 micro m). No adverse effects such as retinal detachment or endophthalmitis occurred. One patient experienced an increase in intraocular pressure that was controlled with 2 aqueous suppressants. CONCLUSIONS: Intravitreal injection of triamcinolone appears to be a possibly effective treatment in some patients with macular edema associated with CRVO. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO, and retreatment may be necessary in some patients. In this case series, severe complications were not noted.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15302652&dopt=Abstract triamcinolone Kenalog



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Intravitreal triamcinolone for the management of macular edema due to nonischemic central retinal vein occlusion.

Bashshur ZF, Ma'luf RN, Allam S, Jurdi FA, Haddad RS, Noureddin BN.

Department of Ophthalmology, American University of Beirut - Medical Center, Lebanon. zb00 aub.edu.lb

OBJECTIVE: To evaluate the efficacy of intravitreal triamcinolone acetonide in the management of persistent macular edema secondary to nonischemic central retinal vein occlusion (CRVO). METHODS: Twenty consecutive patients were selected with a 3- to 4-month history of nonischemic CRVO and persistent macular edema. These patients received a single intravitreal injection of 4 mg of triamcinolone acetonide (40 mg/mL). The follow-up period ranged from 10 to 12 months. The amount of macular edema was assessed by the amount of retinal thickening on clinical examination using the Goldmann contact lens and by the area and intensity of staining on fluorescein angiography. Treated patients were compared with a retrospectively matched group of patients who were managed with observation only. MAIN OUTCOME MEASURES: Changes in visual acuity and amount of macular edema were assessed in the treated patients and compared with the observation group. RESULTS: The mean baseline visual acuity in the treatment group was 20/132 vs 20/123 for the observation group (P =.57). After 1 week, the treated group had a mean visual acuity of 20/51. At final follow-up, the treated group had a mean visual acuity of 20/37 while the observation group had a mean visual acuity of 20/110 (P =.001). Sixty percent of treated patients had a final visual acuity of 20/40 or better vs only 20% in the observation group (P =.01). Forty percent of the untreated patients had a final visual acuity worse than 20/200 while none of the treated patients did (P<.001). At final follow-up, 75% of treated patients had complete resolution of macular edema on clinical examination vs only 20% of the untreated patients (P<.001). Two of the treated patients had recurrence of macular edema at 6 months, and 3 had elevated intraocular pressure. CONCLUSION: This study shows a treatment benefit from intravitreal triamcinolone in terms of visual acuity and macular edema for nonischemic CRVO.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15302653&dopt=Abstract triamcinolone Kenalog



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A simple and rapid method for purification of triamcinolone acetonide suspension for intravitreal injection.

Hernaez-Ortega MC, Soto-Pedre E.

European Innovative Biomedicine Institute, Castro- Urdiales, Cantabria, Spain.

Purification of triamcinolone acetonide suspension is important to avoid the potential toxic effects of the vehicle. The aim of this article is to describe a simple and rapid technique to remove the vehicle, instead of the long procedure described in the literature. Triamcinolone acetonide suspension was sedimented by density gradient centrifugation. In a few minutes, this new technique yielded a clear supernatant that was easily replaced by a nontoxic sterile solution. More prolonged procedures may not be convenient for unplanned treatments and may also contribute to a greater chance for contamination of the triamcinolone acetonide suspension.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15305565&dopt=Abstract triamcinolone Kenalog



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Intravitreal triamcinolone as a primary therapy in diabetic macular oedema.

Karacorlu M, Ozdemir H, Karacorlu S, Alacali N, Mudun B, Burumcek E.

1Istanbul Retina Institute, Istanbul, Turkey.

PURPOSE: To evaluate the effect of intravitreal triamcinolone in eyes with diabetic macular oedema that had no previous laser treatment. METHODS: In all, 12 eyes of 12 patients with diabetic retinopathy, aged 47-70 years (mean 59.2), made up the study. All the eyes had persistent diabetic macular oedema despite having received medical treatment for at least 3 months. In this consecutive case series, none of the eyes received previous laser photocoagulation. Intravitreal injection of 0.1 ml (4 mg) triamcinolone acetonide was offered to treat macular oedema. The visual and anatomic responses were observed as well as complications related to the injection procedure and corticosteroid medication. RESULTS: The follow-up period was between 6 and 10 months (mean 7.9 months) and all eyes completed 6 months of follow-up. Macular oedema was documented for an average of 3.5 months (ranged 3-5 months) before intravitreal corticosteroid injection. Baseline mean central macular thickness was 448.6 microm. At 1 month follow-up, a reduction in mean central macular thickness of 40.8% from 448.6 microm to 265.4 microm was obtained. At 3 and 6 months follow-up, mean central macular thicknesses, were 310 microm and 294.5 microm, respectively. No eyes lost vision at 1 month and 10 eyes (83.2%) showed improvement. At 3 months, no eyes lost vision from baseline and 8 eyes (66.6%) showed improvement. At 6 months, again no eyes lost vision from baseline and 10 eyes (83.2%) maintained improved visual acuity. CONCLUSIONS: Intravitreal triamcinolone is a promising therapeutic method in eyes with diabetic macular oedema without previous application of laser treatment. Further study with longer follow-up and large series is warranted to assess the long-term efficacy and safety and the need for retreatment.Eye advance online publication, 13 August 2004; doi:10.1038/sj.eye.6701512

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15309024&dopt=Abstract triamcinolone Kenalog



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Intravitreal triamcinolone acetonide: valuation of retinal thickness changes measured by optical coherence tomography in diffuse diabetic macular edema.

Micelli Ferrari T, Sborgia L, Furino C, Cardascia N, Ferreri P, Besozzi G, Sborgia C.

Departments of Ophthalmology and ORL, Division of Ophthalmology, University of Bari, Bari, Italy. tommasomicelliferrari tin.it

PURPOSE: The authors studied the efficacy of intravitreal triamcinolone acetonide in a case series of patients with diffuse diabetic macular edema without evidence of vitreous-macular traction refractory to laser photocoagulation. METHODS: Six eyes with clinically diffuse diabetic macular edema that failed to respond to at least two previous sessions of laser photocoagulation were included. The mean age of selected patients was 72.5+/-13.8 years, with a preoperative best-corrected visual acuity reduced to 1.48+/-0.18 logMar and a mean baseline intraocular pressure (IOP) of 15.17+/-2.64 mmHg. The authors also studied macular thickness measured by optical coherence tomography (OCT 2000 scanner, Humphrey Instruments, San Leandro, CA) - in the preoperative period it was 640.8+/-171.1 microm - and the fluorangiographic (Heidelberg Retina Angiograph, Heidelberg Engineering GmbH, Heidelberg, Germany) patterns, which showed pooling in tardy phases and leakage. Mean follow-up was 4 months. RESULTS: In each patient the authors observed a significant improvement, both functionally and anatomically. Mean best-corrected visual acuity increased in the postoperative period to 0.94+/-0.53 logMar. No patient showed decline of visual acuity at the end of follow-up. Base line macular thickness was reduced in the postoperative period to 312.2+/-157.65 microm measured by OCT and fluorangiographic patterns showed a reduction of pooling and of leakage. The most common complications described in the literature were not observed and the increase of mean IOP in the postoperative period to 18.76+/-5.72 mmHg was not significant. CONCLUSIONS: Intravitreal triamcinolone acetonide may decrease macular edema and improve visual acuity in eyes with diffuse diabetic macular edema.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15309977&dopt=Abstract triamcinolone Kenalog