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Intravitreal triamcinolone for diabetic macular oedema in Chinese patients: six-month prospective longitudinal pilot study.

Lam DS, Chan CK, Tang EW, Li KK, Fan DS, Chan WM.

Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong. dennislam cuhk.edu.hk

AIM: To evaluate the safety and efficacy of intravitreal triamcinolone (IVTA) in Chinese patients with diabetic clinical significant macular oedema (CSMO). METHODS: Eighteen eyes of 17 consecutive patients with CSMO were prospectively recruited and treated with a 4 mg injection of IVTA. Best-corrected visual acuity (BCVA) on the ETDRS chart and central macular thickness (CMT) on optical coherence tomography were measured at baseline weeks 1, 2, 3, and months 1, 2, 3, 4, 5 and 6. Side-effects were monitored. RESULTS: All patients completed 6 months of follow up. The mean baseline BCVA and CMT were 1.20 +/- 0.31 logMAR units and 552 +/- 179 microm, respectively. Improvements in CMT and BCVA were observed as early as at 1 and 2 weeks, respectively (P < 0.05). Mean BCVA peaked at 2 months (0.97 +/- 0.38 logMAR units) while mean CMT was maximally reduced at 3 months (326 +/- 145 microm). Improvements in BCVA and CMT were less afterwards but still statistically significant at 6 months; the final mean BCVA and CMT were 0.99 +/- 0.36 logMAR units and 427 +/- 145 microm, respectively. A total of 5/18 (28%) eyes developed a transient increase in intraocular pressure. Cataract progression was noted in 2/12 (17%) of the phakic eyes. CONCLUSIONS: Intravitreal triamcinolone appeared generally safe and effective in Chinese patients with CSMO. Although the improvements in BCVA and CMT were transient, there were residual benefits at 6 months. Due to the transient nature of IVTA, re-treatment seems necessary but the optimal timing and dosage will require further investigations.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15575825&dopt=Abstract triamcinolone Kenalog



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Improved visual acuity and macular thickness 1 week after intravitreal triamcinolone for diabetic macular oedema.

Islam MS, Negi A, Vernon SA.

1Ophthalmology, Queen's Medical Centre, Nottingham, UK.

PURPOSE: To evaluate the clinical and volumetric improvement 1 week after an injection of intravitreal triamcinolone acetonide in eyes with diabetic macular oedema. METHODS: Seven phakic eyes of seven diabetic patients diagnosed with clinically significant macular oedema were treated with a single 4-mg intravitreal injection of triamcinolone acetonide (0.1 ml). LogMAR best corrected visual acuity (logMAR BCVA), best corrected reading ability (RA), and central macular thickness (CMT) with optical coherence tomography (OCT) were assessed prior and 1 week subsequent to treatment. RESULTS: Mean improvement in logMAR BCVA was 0.146 (P=0.03). Mean reduction in CMT was 150.9 mum (P=0.02, Wilcoxon signed-rank test). Mean improvement in RA was 3 lines. CONCLUSION: Reduction in macular oedema was demonstrated on OCT at 1 week, in most cases associated with improvement in central visual function, in particular, reading ability. Total resolution of diabetic macular oedema may occur at 1 week following intravitreal steroid injection.Eye advance online publication, 3 December 2004; doi:10.1038/sj.eye.6701766.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15578081&dopt=Abstract triamcinolone Kenalog



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Intravitreal concentration and clearance of triamcinolone acetonide in nonvitrectomized human eyes.

Mason JO 3rd, Somaiya MD, Singh RJ.

Retina Consultants of Alabama, P.C., Department of Ophthalmology, Callahan Eye Foundation Hospital, University of Alabama at Birmingham, USA.

PURPOSE: To determine the intravitreal concentration and clearance of triamcinolone acetonide at various intervals after intravitreal injection into nonvitrectomized eyes. METHODS: Six participants were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. All six eyes underwent therapeutic pars plana vitrectomy with membranectomy at various post injection intervals ranging from 1.25 to 5 months from the intravitreal injection. Undiluted specimens of vitreous overlying the macula and of aqueous humor were submitted for analysis. Vitreous and aqueous humor concentrations of triamcinolone were measured by high performance liquid chromatography. RESULTS: Four eyes demonstrated detectable intravitreal concentrations of triamcinolone acetonide between 1.25 and 2.75 months after a single injection. Two eyes had an undetectable level of triamcinolone in both the vitreous and aqueous at 3 and 5 months post single injection. CONCLUSIONS: The intravitreal concentration of triamcinolone acetonide is detectable up to 2.75 months post a single 4 mg injection in nonvitrectomized eyes. A reinjection interval of 3 months may be needed to achieve sustained measurable levels of triamcinolone in nonvitrectomized patients.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15579987&dopt=Abstract triamcinolone Kenalog



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The effect of intravitreal triamcinolone on diabetic macular oedema.

Krepler K, Wagner J, Sacu S, Wedrich A.

Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria, katharina.krepler meduniwien.ac.at.

BACKGROUND: Diabetic macular oedema is a frequent cause of visual loss in patients with diabetic retinopathy. The purpose of this study was to assess the efficacy of intravitreal triamcinolone acetonide in reducing diabetic macular oedema and improving visual acuity. METHODS: In this prospective study 12 eyes of 12 patients with diabetic macular oedema unresponsive to prior laser treatment received an intravitreal injection of 4 mg triamcinolone acetonide. Examinations were performed 1 day preoperatively and at 1 week and 1, 3, 6, and 9 months after surgery and included slit-lamp examination, measurement of IOP, assessment of distance as well as reading visual acuity and assessment of macular thickness using optical coherence tomography (OCT). RESULTS: Mean age of the patients (mean+/-SD) was 66.6+/-8.6 years. Mean best-corrected visual acuity (BCVA) for distance (LogMAR using ETDRS charts) improved from 1.0+/-0.4 preoperatively to 0.9+/-0.4 (p=0.01) 1 week and to 0.9+/-0.4 (p=0.02) 1 month postoperatively. Mean BCVA for reading vision (LogRAD using Radner Reading Charts) improved from 1.1+/-0.4 preoperatively to 0.9+/-0.4 (p=0.002) 1 month postoperatively. Mean macular thickness decreased from 450+/-190 (mum) preoperatively to 305+/-153 (p=0.02) 1 month postoperatively. No significant improvement in VA and no significant reduction of macular thickness could be observed 3, 6, and 9 months postoperatively. Mean intraocular pressure significantly increased from 14.7+/-2.7 mmHg preoperatively to 16.9+/-3.0 mmHg at 1 month (p=0.02). CONCLUSION: A single intravitreal injection of triamcinolone acetonide led to a significant improvement in mean VA in patients with diabetic macular oedema. However, the significant effect was not permanent and persisted for only 1 month.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15586288&dopt=Abstract triamcinolone Kenalog



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Vitreous levels of vascular endothelial growth factor and stromal-derived factor 1 in patients with diabetic retinopathy and cystoid macular edema before and after intraocular injection of triamcinolone.

Brooks HL Jr, Caballero S Jr, Newell CK, Steinmetz RL, Watson D, Segal MS, Harrison JK, Scott EW, Grant MB.

Southern Vitreoretinal Association, Tallahassee, Fla, USA.

BACKGROUND: Diffuse macular edema (DME) and/or aberrant neovascularization (NV) can cause vision loss in diabetic retinopathy (DR) and may be modulated by growth factors and chemokines. The chemokine stromal-derived factor 1 (SDF-1) is a potent stimulator of vascular endothelial growth factor (VEGF) expression, the main effector of NV, and the key inducer of vascular permeability associated with DME. Circulating endothelial cell precursors migrating in response to SDF-1 participate in NV. OBJECTIVE: To investigate the relationship between SDF-1 and (VEGF) in vitreous of patients with varying degrees of DR and DME before and after intraocular injection of triamcinolone acetonide, used to treat refractory DME. METHODS: In this prospective study, 36 patients were included and observed for 6 months. Vitreous VEGF and SDF-1 levels were measured by enzyme-linked immunosorbent assay in samples obtained immediately before and 1 month after injection of triamcinolone. RESULTS: Both VEGF and SDF-1 were significantly higher (P<.01) in patients with proliferative DR than in patients with nonproliferative DR. Levels of SDF-1 were markedly increased in patients with DME compared with those without DME. Vascular endothelial growth factor correlated with SDF-1 levels and disease severity (r(2) = 0.88). CONCLUSIONS: Triamcinolone administration resulted in dramatic reductions of VEGF and SDF-1 to nearly undetectable levels, eliminated DME, and caused regression of active NV. Our results support a role for SDF-1 and VEGF in the pathogenesis of the adverse visual consequences of DR and suggest that the elimination of DME with regression and/or initiation of fibrosis of NV after triamcinolone injection may be due to the suppression of VEGF and SDF-1.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15596583&dopt=Abstract triamcinolone Kenalog



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Safety of intravitreal high-dose reinjections of triamcinolone acetonide.

Jonas JB, Degenring R, Kreissig I, Akkoyun I.

Department of Ophthalmology and Eye Hospital, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Germany. Jost.Jonas ma.augen.uni-heidelberg.de

PURPOSE: To report side effects after intravitreal high-dose reinjections of triamcinolone acetonide. DESIGN: Clinical interventional case series. METHODS: Forty-six patients (47 eyes) received at least two intravitreal injections of approximately 20 to 25 mg triamcinolone acetonide for treatment of diabetic macular edema (n = 6 eyes), exudative age-related macular degeneration (n = 23), and other diseases. Intervals between injections were 6.7 +/- 3.4 months, 8.0 +/- 4.6 months, and 10.2 months, respectively, before the second (n = 47 eyes), third (n = 9), and fourth (n = 2) injection. Mean follow-up was 20.7 +/- 8.9 months. RESULTS: After no reinjection were complications detected, other than those known to occur after a single intravitreal injection. After the first, second, and third injection, respectively, intraocular pressure remained normal in 24 (51%), 25 (53%), and 5 (56%) eyes. CONCLUSIONS: Intravitreal high-dosage reinjections of triamcinolone acetonide may be tolerated within a mean follow-up of approximately 21 months.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15629306&dopt=Abstract triamcinolone Kenalog