Intravitreal triamcinolone

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Comparison of Combination Posterior Sub Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

Comparison of Combination Posterior Sub Tenon Triamcinolone and Modified Grid Laser Treatment with Intravitreal Triamcinolone Treatment in Patients with Diffuse Diabetic Macular Edema

Purpose: To compare the efficacy of posterior sub-Tenon’s capsule triamcinolone acetonide injection combined with modified grid macular photocoagulation (PSTI + MP) with intravitreal triamcinolone acetonide (IVTA) injection in the treatment of diffuse diabetic macular edema (DME). Materials and Methods: Forty eyes of 33 patients with diffuse DME were randomly allocated into either PSTI + MP (20 eyes) or IVTA (20 eyes). Best corrected visual acuity (VA) and foveal thickness were measured. Results: The ETDRS scores at baseline were 25.2 ± 13.6 (mean ± SD) letters in the PSTI + MP group, whereas 21.7 ± 16.3 letters in the IVTA group. The ETDRS scores improved by 33.2 ± 15.9, 34.7 ± 16.6 and 30.9 ± 19.0 letters in the PSTI + MP group whereas by 30.9 ± 15.4, 30.1 ± 17.9 and 31.5 ± 15.0 letters in the IVTA group at 1, 3, and 6 months after the treatments, respectively. The VA improved significantly at 1 month and 3 months after both treatments (all p < 0.02, paired t-test). The VA improvements were no longer significant at 6 months in either group. There were no statistically significant differences at any time points between the 2 groups (all p > 0.05, Student’s t-test). The foveal thicknesses at baseline and 1, 3, and 6 months after the treatments were 382.8 ± 148.3, 309.1 ± 131.3, 319.3 ± 93.3, 340.4 ± 123.5 m μ (mean ± SD) in the PSTI + MP group vs. 369.1 ± 123.1, 241.4 ± 52.3, 277.5 ± 137.4, 290.2 ± 127.9 m μ in the IVTA group, respectively. Pairwise comparisons revealed significant decrease in foveal thickness at 1 month (p = 0.01, paired t-test) for the
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The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabeticfoveal oedema and cataract

The combination of intravitreal triamcinolone and phacoemulsification surgery in patients with diabeticfoveal oedema and cataract

which were watertight at the close of surgery. These are important factors in avoiding infective complications. We had no cases of posterior capsule rupture in this series. Triamcinolone has been used to help visualise vitreous during posterior capsule rupture and anterior vitrectomy [40] and anecdotally in cases of phacoemulsification sur- gery with posterior capsule rupture to reduce the inci- dence of post operative cystoid macular oedema and postoperative inflammation [41]. Potentially therefore intravitreal triamcinolone administration could be con- sidered even if posterior capsule rupture was to occur although we have no experience of this.
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Comparison of the Efficacy and Safety of Single Dose of 4mg Vs 2mg Intravitreal Triamcinolone Acetonide Injection for Diabetic Cystoid Macular Edema

Comparison of the Efficacy and Safety of Single Dose of 4mg Vs 2mg Intravitreal Triamcinolone Acetonide Injection for Diabetic Cystoid Macular Edema

This is to certify that this dissertation entitled “COMPARISON OF THE EFFICACY AND SAFETY OF SINGLE DOSE OF 4mg Vs 2mg INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION FOR DIABETIC CYSTOID MACULAR EDEMA” is a bonafide record of the research work done by Dr.M.SIVASUBRAMANIYAM, post graduate in Regional Institute of Ophthalmology, Government Ophthalmic Hospital, Madras Medical College and Research Institute, Chennai-03 in partial fulfillment of the regulations laid down by the The Tamilnadu Dr.M.G.R. Medical University for the award of M.S.Ophthalmology Branch III, under my guidance and supervision during the academic years 2013-2016.
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Is There a Role for Intravitreal Triamcinolone Acetonide Injection in the Treatment of Purtscher Like Retinopathy? Report of Two Cases

Is There a Role for Intravitreal Triamcinolone Acetonide Injection in the Treatment of Purtscher Like Retinopathy? Report of Two Cases

To our knowledge, no report exists about the place of intravitreal triamcinolone injection in Purtscher-like re- tinopathy. We decided to treat the study patients as both had poor initial visual acuity and unilateral involvement. However, in order to avoid systemic steroid side-effects we preferred to administer intravitreal triamcinolone acetonide. Instead of 4 mg dose, we chose 1 mg dose as the volume of injection was smaller and the possible intraocular pressure hike sometimes seen after any injection was less likely. Though both patients were satisfied with the visual outcome, we were not convinced enough that there was any treatment benefit over the natural disease course. Still intravitreal triamcinolone acetonide or even dexamethasone implant administration may find a niche in the treatment armamentarium of some cases with Purtscher-like retinopathy.
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Clinical study on the safety and efficacy of intravitreal triamcinolone for recalcitrant acular edema in south Indian population.

Clinical study on the safety and efficacy of intravitreal triamcinolone for recalcitrant acular edema in south Indian population.

The administration of intravitreal triamcinolone is appealing for a number of reasons. In a country like India with a significant number of diabetics, visual morbidity due to diabetic macular edema is high. As of current practice, laser treatment as advocated by the ETDRS xxviii remains the standard therapy of DME. However refractory DME can be considered for treatment with pharmacological agents like intravitreal Triamcinolone or anti VEGF agents. There have been RCTs which have demonstrated that intravitreal triamcinolone alone can provide visual and anatomical benefits for upto 2 years ( Gillies et al, Ophthalmology 2006). Anti VEGF agents though a promising mode of therapy , remains a costly affair in a developing economy like India. Anti VEGF agents for macular edema await phase III clinical trials. In this scenario , therapy with intravitreal corticosteroids can be considered for individual patients after a risk-benefit evaluation .
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The effects and safety of intravitreal triamcinolone injections in the treatment of diabetic macular edema

The effects and safety of intravitreal triamcinolone injections in the treatment of diabetic macular edema

Due to their anti-inflammatory effect, glucocorticoids have been used as a local pharmacological treatment in DME when the inflammation seems to have a pathologi- cal background. Intravitreal triamcinolone injections of different doses (1, 4, 8, 12, 16 and 20 mg) have been found effective in reducing macular edema and improving vi- sion in refractory DME following laser treatment, or even as an initial treatment. 5–8 The bigger the dose of triam-

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Intravitreal triamcinolone versus laser photocoagulation as a primary treatment for diabetic macular oedema - a comparative pilot study

Intravitreal triamcinolone versus laser photocoagulation as a primary treatment for diabetic macular oedema - a comparative pilot study

Patients were properly positioned on a stable chair with the chin rested on the slit lamp that was mounted with a laser wavelength, Carl Zeiss Visulas 532S laser system. Patients were given grid or focal laser depending on the type of the macular oedema. Topical anaesthetic, 5% pro- paracaine hydrochloride was instilled in the eye which needed to be lasered. The laser settings were 50 micron spot size, duration of 0.1 seconds and appropriate power started from 50 mW and stepped up till it burned the retina with light gray burn. The number of laser burn given was based on the severity of diabetic macular oedema (range: 20 - 200 laser burns and 500 μm away from the centre of the fovea). Only one session of laser (either focal or grid laser) was given to each patient in LASER group. The procedure was done by Investigator A (ophthalmologist). Patient was follow-up at 3 months post laser and no other treatment was given during that period. 2.2 Intravitreal triamcinolone acetonide
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Intraoperative intravitreal triamcinolone decreases macular edema after vitrectomy with phacoemulsification

Intraoperative intravitreal triamcinolone decreases macular edema after vitrectomy with phacoemulsification

The data from the current study suggest that in eyes with macular edema undergoing combined phacoemulsification and vitrectomy, intravitreal triamcinolone acetonide may play an important role in modulating inflammation. It may contribute to a decrease in retinal thickness and, in some eyes, rapid resolution of macular edema. The low rate of postop- erative macular edema (6.3%) when there was no edema preoperatively is slightly lower than previously published rates, and the extent to which this is attributable to intravitreal triamcinolone acetonide deserves further study. Significant secondary ocular hypertension due to intravitreal triam- cinolone acetonide was not seen in this series. Combined phacoemulsification with vitrectomy and intravitreal triam- cinolone acetonide was well tolerated with good visual and anatomic results in this complex patient population.
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Intravitreal triamcinolone and its effect on intraocular pressure

Intravitreal triamcinolone and its effect on intraocular pressure

Gillies in a study of intravitreal triamcinolone injected in a dose of 4mg to patients with classic neovascular age-related macular degeneration, noted a significant rise in IOP in twenty one of 75 eyes (28%), compared with one of 76 placebo-treated patients (1.31%). A severe rise of IOP occurred in only two patients. All patients achieved good control with topical medications. A single medication sufficed in eighteen of these eyes while the other three required two medications. He observed that adverse events were also noted in patients injected with triamcinolone acetonide injected into the posterior subtenon’s space which by far is considered to be the safest route of injection with IOP rise occurring in 30% of patients. 18
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Intravitreal triamcinolone with transpupillary therapy for subfoveal choroidal neovascularization in age related macular degeneration. A randomized controlled pilot study [ISRCTN74123635]

Intravitreal triamcinolone with transpupillary therapy for subfoveal choroidal neovascularization in age related macular degeneration. A randomized controlled pilot study [ISRCTN74123635]

Transpupillary thermotherapy was delivered through a slit lamp using a modified infrared diode laser at 810 nm with an adjustable beam width of 1.2 mm, 2.0 mm, 3.0 mm and 4.3 mm (Iris Medical Instruments, Mountain View, CA). The treatment parameter was adjusted accord- ing to the CNV type and size. Topical 0.5% proparacaine was applied before placement of a three mirror Gold- mann lens coated for use with the diode laser. Continues observation through the slit lamp ensured fixation. Treat- ment was initiated with one spot for 60 seconds' duration at a power setting ranging between 360 and 880 mW such that no visible change or a barely detectable light-gray appearance to the lesion was present at the end of the treatment. Power settings was proportional to the spot size with larger spots requiring higher energy levels. In general, for a 2-mm spot size, the initial power level was between 360 mW and 700 mW. The spot size was adjusted to be 500 um larger than the membranes' greater diame- ter, if the CNV is larger than 4300 um, then overlapping spots were used. If any retinal whitening was observed or patient felt any pain, the power of the laser was decreased by 100 mW. Treatment was re-initiated and if retinal whit- ening continued to be observed, the power setting was again decreased by 100 mW. Care was taken to ensure that the entire lesion border was covered with treatment beam. Intravitreal triamcinolone injection
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Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks

Verteporfin photodynamic therapy combined with intravitreal triamcinolone for choroidal neovascularization due to angioid streaks

PDT alone can occlude CNV, but tends to cause a transient inflammatory response and increase in capillary permeability along with an enhanced expression of vascular endothelial growth factor (VEGF) activity shortly after treatment that may limit its efficacy. The addition of intravitreal triamcinolone acetonide (IVTA), which, by reducing inflammation and inhibiting VEGF, 6,7 seems to improve the

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Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

Comparison of the efficacy of intravitreal triamcinolone acetonide for cystoid macular edema with versus without serous retinal detachment in branch retinal vein occlusion: influence on macular sensitivity and morphology

Branch retinal vein occlusion (BRVO) is a common ret- inal vascular disease that often leads to macular edema, which is the chief reason for visual impairment in BRVO patients [1,2]. An increase of pressure and re- duction of blood flow in the macular capillaries can lead to dysfunction of the endothelial blood-retinal bar- rier and an increase of vascular permeability that results in macular edema [3]. Recent randomized, controlled clinical trials have evaluated several treatment modal- ities, including intravitreal triamcinolone acetonide [4] and anti-vascular endothelial growth factor (VEGF) therapy [5] for macular edema in patients with BRVO, and both treatments have been reported to improve vis- ual acuity after 12 months. We previously reported that VEGF and inflammatory factors may contribute to the pathogenesis of macular edema associated with BRVO [6-9], which provides a rationale supporting the efficacy of intravitreal triamcinolone (IVTA) and anti-VEGF ther- apy. However, previous clinical studies only employed measurement of visual acuity to evaluate visual func- tion, even though macular edema usually involves the larger macular area and not just the fovea. The Micro Perimeter 1 (MP-1) is an instrument that combines digital fundus imaging with automated perimetry [10,11]. Unlike measurement of visual acuity that only reflects foveal function, the MP-1 can evaluate both the fovea and the larger macular area. We have previ- ously found that retinal thickness and retinal volume are more closely related to retinal sensitivity than to visual acuity in BRVO patients who have macular edema [12].
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Intraocular pressure rise is predictive of vision improvement after intravitreal triamcinolone acetonide for diabetic macular oedema: a retrospective analysis of data from a randomised controlled trial

Intraocular pressure rise is predictive of vision improvement after intravitreal triamcinolone acetonide for diabetic macular oedema: a retrospective analysis of data from a randomised controlled trial

Background: Intravitreal triamcinolone acetonide (IVTA) is an effective treatment for recalcitrant diabetic macular oedema (DMO). It has been shown to improve vision with benefits persisting up to five years. The most common initial side effect of IVTA treatment is rise in intraocular pressure, occurring in approximately 50% of patients within the first 6 months of treatment. We evaluated whether there is a correlation between the development of intraocular pressure rise and improvement in vision.

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Resolution of vitreomacular traction following intravitreal triamcinolone acetonide injection in an eye with branch retinal vein occlusion

Resolution of vitreomacular traction following intravitreal triamcinolone acetonide injection in an eye with branch retinal vein occlusion

Abstract: A 60-year-old woman with a past medical history of branch retinal vein occlusion presented with decreased vision and metamorphopsia in her left eye. A fundus examination revealed a tortuous retinal vein with a few retinal hemorrhages in the inferotemporal quadrant. Optical coherence tomography revealed a partially separated posterior vitreous membrane pulling up the fovea. The patient refused surgical treatment so intravitreal triamcinolone acetonide (4 mg/0.1 mL) was administered. The patient reported resolution of symptoms in her left eye following this treatment, but her visual acuity did not show any improvement. Optical coherence tomography scanning revealed a complete detachment of the posterior hyaloid with release of the vitreomacular traction. In patients with vitreomacular traction and branch retinal vein occlusion, the combination of the possible vitreous liquefaction and mechanical increase of vitreous volume caused by an intravitreal injection with a degree of reduction in retinal thickness may play a role in the resolution of vitreomacular traction.
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Surgical results of Ahmed valve implantation combined with intravitreal triamcinolone acetonide injection for preventing choroidal detachment

Surgical results of Ahmed valve implantation combined with intravitreal triamcinolone acetonide injection for preventing choroidal detachment

Triamcinolone acetonide (TA), as a long-term gluco- corticoid, has been proved to be effective for treating macular edema associated with diabetic retinopathy (DR) and ischemic central retinal vein occlusion (CRVO) [7,8]. In addition to its effect on lowering inflammation and improving visual acuity in patients with DR and CRVO, intravitreal TA injection (IVTA) has been pro- posed as a potential adjuvant treatment for neovascular glaucoma (NVG) [9,10]. We previously reported that IVTA was an effective and safe method to treat retinal detachment with choroidal detachment [11].

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Baseline central macular thickness predicts the need for retreatment with intravitreal triamcinolone plus laser photocoagulation for diabetic macular edema

Baseline central macular thickness predicts the need for retreatment with intravitreal triamcinolone plus laser photocoagulation for diabetic macular edema

The major weakness of this retrospective analysis is the relatively small number of patients available for analysis. A weaker correlation than that found for base- line CMT may therefore have been missed. Conversely, the strength of the relationship between CMT and the number of IVTA plus laser treatments received should be viewed positively in light of the number of patients ana- lyzed. The need for retreatment was not a prospectively defined outcome and the reasons for a decision to retreat or not were not collected from the investigators. Future trials should assess these factors as the ability to predict the number of intravitreal therapies that will be required before embarking on a course of therapy would be highly beneficial to patient care. This would be equally applicable to vascular endothelial growth factor inhibitors, whose treatment regimen is more intense with less time between injections than that of IVTA.
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Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries

Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries

group comprising patients treated with anti-VEGF agents to compare the cost of the drug and the quality of life including ocular safety, treatment outcome, and follow-up dropouts. Another important limitation is the retrospective design of the study that allowed recruitment of patients with wide- range of pathologies and with different disease stages of the same pathology, and regardless of whether they were treatment naïve or were previously treated. This could be a source of bias at the time of statistical analysis. An impor- tant consideration related to IVTA dose used in the current study was that we employed a filter technique in preparing 20 mg TA for intravitreal injection. Although we concur that non-filter methods of preparing IVTA dose, 53,54 particularly
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Combined treatment of exudative age related macular degeneration with photodynamic therapy and intravitreal triamcinolone

Combined treatment of exudative age related macular degeneration with photodynamic therapy and intravitreal triamcinolone

The interval between PDT and TA injection is under discussion. We performed TA injection after PDT in order to avoid opacifi cation of the vitreous body by TA which might block laser irradiation, and the inhibition of free-radical for- mation (Dweik et al 1997) interfering with the mechanism of action of PDT (Weishaupt et al 1976). The fi ve day interval between PDT and intravitreal TA was chosen in order to avoid the photosensitizing effect of verteporfi n in the event that any problem such as retinal detachment or endophthal- mitis might appear after the injection, and before reperfusion or new vessel growth might take place.
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The comparison of intravitreal triamcinolone and bevacizumab in patients with macular edema secondary to branch retinal vein occlusion

The comparison of intravitreal triamcinolone and bevacizumab in patients with macular edema secondary to branch retinal vein occlusion

When patients with ischemic BRVO were compared (within groups) according to the change in BCVA levels from the pretreatment levels, a statistically significant increase [r]

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Intravitreal triamcinolone for intraocular inflammation and associated macular edema

Intravitreal triamcinolone for intraocular inflammation and associated macular edema

When steroids are injected into the eye, many studies have shown a low risk of retinal detachment, vitreous hemorrhage and endophthalmitis, both infectious and noninfectious. Cataract development and progression are well known com- plications of steroids, especially when injected intravitreally. Newly developed cataracts from intravitreal TA generally are posterior subcapsular in location. It is important to note that uveitis itself is a risk factor for the development of cata- racts. Several studies have been published showing the inci- dence of this to be anywhere from 29% to over 50% within 1 year of followup. 69,70,71 One hypothesis is that elevated
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